HL7 Vietnam VN Core FHIR Implementation Guide

Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam
0.6.0 - Draft for Community Review Viet Nam cờ

Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam - Draft for Community Review (v0.6.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Hồ sơ tài nguyên: Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile

URL chính thức: http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request Phiên bản: 0.6.0
Computable Name: VNCoreCoverageEligibilityRequest

Bản quyền/Pháp lý: Căn cứ pháp lý Việt Nam: Luật 51/2024/QH15 ngày 27/11/2024; NĐ 188/2025/NĐ-CP; NĐ 164/2025/NĐ-CP ngày 29/06/2025; QĐ 3176/QĐ-BYT ngày 29/10/2024.

Profile CoverageEligibilityRequest cho luồng tra cứu/kiểm tra hiệu lực và quyền lợi thẻ BHYT tại cơ sở KCB (khâu tiếp đón), gửi tới Cổng giám định BHYT của cơ quan BHXH. Đây là mắt xích ĐẦU của luồng BHYT (eligibility → Coverage → Claim → ClaimResponse → EOB → PaymentReconciliation). Căn cứ:

  • Luật 51/2024/QH15 — 27/11/2024 — sửa đổi Luật BHYT, hiệu lực 01/7/2025
  • NĐ 188/2025/NĐ-CP — ban hành 01/7/2025, hiệu lực 15/8/2025 — hướng dẫn Luật BHYT, quyền lợi và định danh thẻ BHYT
  • NĐ 164/2025/NĐ-CP — 29/6/2025 — giao dịch điện tử trong lĩnh vực BHXH (liên thông API Cổng BHXH, tra cứu thẻ BHYT)
  • QĐ 3176/QĐ-BYT — 29/10/2024 — chuẩn dữ liệu KCB phục vụ BHXH

Usages:

You can also check for usages in the FHIR IG Statistics

Các dạng xem hình thức của nội dung hồ sơ

Mô tả profile, differential, snapshot và các biểu diễn liên quan.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... purpose SΣ 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient SΣ 1..1 Reference(Bệnh nhân VN Core — VN Core Patient Profile) Người bệnh có thẻ BHYT cần tra cứu
... serviced[x] S 0..1 Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer SΣ 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... insurance S 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... status S 1..1 code active | cancelled | draft | entered-in-error
... purpose S 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
... serviced[x] S 0..1 date, Period Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
... created S 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer S 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... insurance S 1..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... priority 0..1 CodeableConcept Desired processing priority
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.
... purpose SΣ 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient SΣ 1..1 Reference(Bệnh nhân VN Core — VN Core Patient Profile) Người bệnh có thẻ BHYT cần tra cứu
... serviced[x] S 0..1 Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer SΣ 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... facility 0..1 Reference(Location) Servicing facility
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... information 1..1 Reference(Resource) Data to be provided
.... appliesToAll 0..1 boolean Applies to all items
... insurance S 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... focal 0..1 boolean Applicable coverage
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi
.... businessArrangement 0..1 string Additional provider contract number
... item 0..* BackboneElement Item to be evaluated for eligibiity
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... supportingInfoSequence 0..* positiveInt Applicable exception or supporting information
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... provider 0..1 Reference(Practitioner | PractitionerRole) Perfoming practitioner
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... facility 0..1 Reference(Location | Organization) Servicing facility
.... diagnosis 0..* BackboneElement Applicable diagnosis
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... detail 0..* Reference(Resource) Product or service details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Dạng xem phần tử chính

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... purpose SΣ 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient SΣ 1..1 Reference(Bệnh nhân VN Core — VN Core Patient Profile) Người bệnh có thẻ BHYT cần tra cứu
... serviced[x] S 0..1 Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer SΣ 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... insurance S 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Dạng xem Differential

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... status S 1..1 code active | cancelled | draft | entered-in-error
... purpose S 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
... serviced[x] S 0..1 date, Period Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
... created S 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer S 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... insurance S 1..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi

doco Documentation for this format

Dạng xem SnapshotView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest CoverageEligibilityRequest resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... priority 0..1 CodeableConcept Desired processing priority
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.
... purpose SΣ 1..* code Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient SΣ 1..1 Reference(Bệnh nhân VN Core — VN Core Patient Profile) Người bệnh có thẻ BHYT cần tra cứu
... serviced[x] S 0..1 Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Thời điểm tạo yêu cầu tra cứu
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author
... provider S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) Cơ sở KCB thực hiện tra cứu
... insurer SΣ 1..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH / đơn vị quản lý quỹ BHYT
... facility 0..1 Reference(Location) Servicing facility
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... information 1..1 Reference(Resource) Data to be provided
.... appliesToAll 0..1 boolean Applies to all items
... insurance S 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... focal 0..1 boolean Applicable coverage
.... coverage S 1..1 Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi
.... businessArrangement 0..1 string Additional provider contract number
... item 0..* BackboneElement Item to be evaluated for eligibiity
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... supportingInfoSequence 0..* positiveInt Applicable exception or supporting information
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... provider 0..1 Reference(Practitioner | PractitionerRole) Perfoming practitioner
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... facility 0..1 Reference(Location | Organization) Servicing facility
.... diagnosis 0..* BackboneElement Applicable diagnosis
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... detail 0..* Reference(Resource) Product or service details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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