Coverageeligibilityresponse.shex

ShEx statement for coverageeligibilityresponse

PREFIX fhir: <http://hl7.org/fhir/> 
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> 
PREFIX rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> 
IMPORT <uri.shex>
IMPORT <code.shex>
IMPORT <date.shex>
IMPORT <Money.shex>
IMPORT <Period.shex>
IMPORT <string.shex>
IMPORT <Patient.shex>
IMPORT <boolean.shex>
IMPORT <dateTime.shex>
IMPORT <Coverage.shex>
IMPORT <Reference.shex>
IMPORT <Identifier.shex>
IMPORT <unsignedInt.shex>
IMPORT <Organization.shex>
IMPORT <Practitioner.shex>
IMPORT <DomainResource.shex>
IMPORT <CodeableConcept.shex>
IMPORT <BackboneElement.shex>
IMPORT <PractitionerRole.shex>
IMPORT <CoverageEligibilityRequest.shex>
start=@<CoverageEligibilityResponse> AND {fhir:nodeRole [fhir:treeRoot]}
# CoverageEligibilityResponse resource
<CoverageEligibilityResponse> EXTENDS @<DomainResource> CLOSED { 
 a [fhir:CoverageEligibilityResponse]?;
 fhir:nodeRole [fhir:treeRoot]?;
 fhir:identifier @<OneOrMore_Identifier>?; # Business Identifier for coverage 
 # eligiblity request 
 fhir:status @<code> AND
 	{fhir:v @fhirvs:fm-status}; # active | cancelled | draft | 
 # entered-in-error 
 fhir:purpose @<OneOrMore_code> AND
 	{fhir:v @fhirvs:eligibilityresponse-purpose}; # auth-requirements | benefits | 
 # discovery | validation 
 fhir:patient @<Reference> AND {fhir:link 
 			@<Patient> ? }; # Intended recipient of products and 
 # services 
 fhir:event @<OneOrMore_CoverageEligibilityResponse.event>?; # Event information
 fhir:serviced @<date> OR 
 			@<Period> ?; # Estimated date or dates of service
 fhir:created @<dateTime>; # Response creation date
 fhir:requestor @<Reference> AND {fhir:link 
 			@<Organization> OR 
 			@<Practitioner> OR 
 			@<PractitionerRole> ? }?; # Party responsible for the request
 fhir:request @<Reference> AND {fhir:link 
 			@<CoverageEligibilityRequest> ? }; # Eligibility request reference
 fhir:outcome @<code> AND
 	{fhir:v @fhirvs:eligibility-outcome}; # queued | complete | error | partial
 fhir:disposition @<string>?; # Disposition Message
 fhir:insurer @<Reference> AND {fhir:link 
 			@<Organization> ? }; # Coverage issuer
 fhir:insurance @<OneOrMore_CoverageEligibilityResponse.insurance>?; # Patient insurance information
 fhir:preAuthRef @<string>?; # Preauthorization reference
 fhir:form @<CodeableConcept>?; # Printed form identifier
 fhir:error @<OneOrMore_CoverageEligibilityResponse.error>?; # Processing errors
} 
# Patient insurance information
<CoverageEligibilityResponse.insurance> EXTENDS @<BackboneElement> CLOSED { 
 fhir:coverage @<Reference> AND {fhir:link 
 			@<Coverage> ? }; # Insurance information
 fhir:inforce @<boolean>?; # Coverage inforce indicator
 fhir:benefitPeriod @<Period>?; # When the benefits are applicable
 fhir:item @<OneOrMore_CoverageEligibilityResponse.insurance.item>?; # Benefits and authorization details
} 
# Benefits and authorization details
<CoverageEligibilityResponse.insurance.item> EXTENDS @<BackboneElement> CLOSED { 
 fhir:category @<CodeableConcept>?; # Benefit classification
 fhir:productOrService @<CodeableConcept>?; # Billing, service, product, or drug 
 # code 
 fhir:modifier @<OneOrMore_CodeableConcept>?; # Product or service billing 
 # modifiers 
 fhir:provider @<Reference> AND {fhir:link 
 			@<Practitioner> OR 
 			@<PractitionerRole> ? }?; # Performing practitioner
 fhir:excluded @<boolean>?; # Excluded from the plan
 fhir:name @<string>?; # Short name for the benefit
 fhir:description @<string>?; # Description of the benefit or 
 # services covered 
 fhir:network @<CodeableConcept>?; # In or out of network
 fhir:unit @<CodeableConcept>?; # Individual or family
 fhir:term @<CodeableConcept>?; # Annual or lifetime
 fhir:benefit @<OneOrMore_CoverageEligibilityResponse.insurance.item.benefit>?; # Benefit Summary
 fhir:authorizationRequired @<boolean>?; # Authorization required flag
 fhir:authorizationSupporting @<OneOrMore_CodeableConcept>?; # Type of required supporting 
 # materials 
 fhir:authorizationUrl @<uri>?; # Preauthorization requirements 
 # endpoint 
} 
# Processing errors
<CoverageEligibilityResponse.error> EXTENDS @<BackboneElement> CLOSED { 
 fhir:code @<CodeableConcept>; # Error code detailing processing 
 # issues 
 fhir:expression @<OneOrMore_string>?; # FHIRPath of element(s) related to 
 # issue 
} 
# Event information
<CoverageEligibilityResponse.event> EXTENDS @<BackboneElement> CLOSED { 
 fhir:type @<CodeableConcept>; # Specific event
 fhir:when @<dateTime> OR 
 			@<Period> ; # Occurance date or period
} 
# Benefit Summary
<CoverageEligibilityResponse.insurance.item.benefit> EXTENDS @<BackboneElement> CLOSED { 
 fhir:type @<CodeableConcept>; # Benefit classification
 fhir:allowed @<unsignedInt> OR 
 			@<string> OR 
 			@<Money> ?; # Benefits allowed
 fhir:used @<unsignedInt> OR 
 			@<string> OR 
 			@<Money> ?; # Benefits used
} 
#---------------------- Cardinality Types (OneOrMore) -------------------
<OneOrMore_Identifier> CLOSED {
 rdf:first @<Identifier> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_Identifier> 
}
<OneOrMore_code> CLOSED {
 rdf:first @<code> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_code> 
}
<OneOrMore_CoverageEligibilityResponse.event> CLOSED {
 rdf:first @<CoverageEligibilityResponse.event> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityResponse.event> 
}
<OneOrMore_CoverageEligibilityResponse.insurance> CLOSED {
 rdf:first @<CoverageEligibilityResponse.insurance> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityResponse.insurance> 
}
<OneOrMore_CoverageEligibilityResponse.error> CLOSED {
 rdf:first @<CoverageEligibilityResponse.error> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityResponse.error> 
}
<OneOrMore_CoverageEligibilityResponse.insurance.item> CLOSED {
 rdf:first @<CoverageEligibilityResponse.insurance.item> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityResponse.insurance.item> 
}
<OneOrMore_CodeableConcept> CLOSED {
 rdf:first @<CodeableConcept> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CodeableConcept> 
}
<OneOrMore_CoverageEligibilityResponse.insurance.item.benefit> CLOSED {
 rdf:first @<CoverageEligibilityResponse.insurance.item.benefit> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityResponse.insurance.item.benefit> 
}
<OneOrMore_string> CLOSED {
 rdf:first @<string> ;
 rdf:rest [rdf:nil] OR @<OneOrMore_string> 
}
#---------------------- 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"]