PREFIX fhir: PREFIX fhirvs: PREFIX xsd: PREFIX rdf: IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT IMPORT start=@ AND {fhir:nodeRole [fhir:treeRoot]} # CoverageEligibilityResponse resource EXTENDS @ CLOSED { a [fhir:CoverageEligibilityResponse]?; fhir:nodeRole [fhir:treeRoot]?; fhir:identifier @?; # Business Identifier for coverage # eligiblity request fhir:status @ AND {fhir:v @fhirvs:fm-status}; # active | cancelled | draft | # entered-in-error fhir:purpose @ AND {fhir:v @fhirvs:eligibilityresponse-purpose}; # auth-requirements | benefits | # discovery | validation fhir:patient @ AND {fhir:link @ ? }; # Intended recipient of products and # services fhir:event @?; # Event information fhir:serviced @ OR @ ?; # Estimated date or dates of service fhir:created @; # Response creation date fhir:requestor @ AND {fhir:link @ OR @ OR @ ? }?; # Party responsible for the request fhir:request @ AND {fhir:link @ ? }; # Eligibility request reference fhir:outcome @ AND {fhir:v @fhirvs:eligibility-outcome}; # queued | complete | error | partial fhir:disposition @?; # Disposition Message fhir:insurer @ AND {fhir:link @ ? }; # Coverage issuer fhir:insurance @?; # Patient insurance information fhir:preAuthRef @?; # Preauthorization reference fhir:form @?; # Printed form identifier fhir:error @?; # Processing errors } # Patient insurance information EXTENDS @ CLOSED { fhir:coverage @ AND {fhir:link @ ? }; # Insurance information fhir:inforce @?; # Coverage inforce indicator fhir:benefitPeriod @?; # When the benefits are applicable fhir:item @?; # Benefits and authorization details } # Benefits and authorization details EXTENDS @ CLOSED { fhir:category @?; # Benefit classification fhir:productOrService @?; # Billing, service, product, or drug # code fhir:modifier @?; # Product or service billing # modifiers fhir:provider @ AND {fhir:link @ OR @ ? }?; # Performing practitioner fhir:excluded @?; # Excluded from the plan fhir:name @?; # Short name for the benefit fhir:description @?; # Description of the benefit or # services covered fhir:network @?; # In or out of network fhir:unit @?; # Individual or family fhir:term @?; # Annual or lifetime fhir:benefit @?; # Benefit Summary fhir:authorizationRequired @?; # Authorization required flag fhir:authorizationSupporting @?; # Type of required supporting # materials fhir:authorizationUrl @?; # Preauthorization requirements # endpoint } # Processing errors EXTENDS @ CLOSED { fhir:code @; # Error code detailing processing # issues fhir:expression @?; # FHIRPath of element(s) related to # issue } # Event information EXTENDS @ CLOSED { fhir:type @; # Specific event fhir:when @ OR @ ; # Occurance date or period } # Benefit Summary EXTENDS @ CLOSED { fhir:type @; # Benefit classification fhir:allowed @ OR @ OR @ ?; # Benefits allowed fhir:used @ OR @ OR @ ?; # Benefits used } #---------------------- Cardinality Types (OneOrMore) ------------------- CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } CLOSED { rdf:first @ ; rdf:rest [rdf:nil] OR @ } #---------------------- Value Sets ------------------------ # The outcome of the processing. fhirvs:eligibility-outcome ["queued" "complete" "error" "partial"] # A code specifying the types of information being requested. fhirvs:eligibilityresponse-purpose ["auth-requirements" "benefits" "discovery" "validation"] # This value set includes Status codes. fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]

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