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"]