Profile Comparison between http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request vs http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
copyright	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.
date	2026-06-21
description	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
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#VN
kind	resource
name	VNCoreCoverageEligibilityRequest
publisher	Omi HealthTech / VN Core FHIR Community Initiative
purpose
status	draft
title	Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile
type	CoverageEligibilityRequest
url	http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request
version	0.8.0	0.9.0	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id	Σ	0..1	id	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
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		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		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	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	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: ?? (required): A code specifying the state of the resource instance.	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
priority		0..1	CodeableConcept	Desired processing priority Binding: ?? (example): The timeliness with which processing is required: STAT, normal, Deferred.		0..1	CodeableConcept	Desired processing priority Binding: ?? (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: ?? (required): A code specifying the types of information being requested.	SΣ	1..*	code	Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng) Binding: ?? (required): A code specifying the types of information being requested.
patient	SΣ	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)	Người bệnh có thẻ BHYT cần tra cứu	SΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Người bệnh có thẻ BHYT cần tra cứu	Type Mismatch: Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient]]) vs Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient]])
serviced[x]	S	0..1	date, Period	Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request	S	0..1	date, Period	Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
created	SΣ	1..1	dateTime	Thời điểm tạo yêu cầu tra cứu	SΣ	1..1	dateTime	Thời điểm tạo yêu cầu tra cứu
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author		0..1	Reference(Practitioner | PractitionerRole)	Author
provider	S	0..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization | http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role)	Cơ sở KCB thực hiện tra cứu	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	Type Mismatch: Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization], CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role]]) vs Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization], CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role]])
insurer	SΣ	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)	Cơ quan BHXH / đơn vị quản lý quỹ BHYT	SΣ	1..1	Reference(Organization)	Cơ quan BHXH / đơn vị quản lý quỹ BHYT	Type Mismatch: Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/Organization|4.0.1]])
facility		0..1	Reference(Location)	Servicing facility		0..1	Reference(Location)	Servicing facility
supportingInfo		0..*	BackboneElement	Supporting information		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items		0..1	boolean	Applies to all items
insurance	S	1..*	BackboneElement	Patient insurance information	S	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal		0..1	boolean	Applicable coverage		0..1	boolean	Applicable coverage
coverage	S	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)	Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi	S	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT cần kiểm tra hiệu lực/quyền lợi	Type Mismatch: Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage]]) vs Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage]])
businessArrangement		0..1	string	Additional provider contract number		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity		0..*	BackboneElement	Item to be evaluated for eligibiity
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc.		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		0..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (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.		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (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		0..1	Reference(Practitioner | PractitionerRole)	Perfoming practitioner
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis		0..*	BackboneElement	Applicable diagnosis
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
diagnosis[x]		0..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes.		0..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes.
detail		0..*	Reference(Resource)	Product or service details		0..*	Reference(Resource)	Product or service details
Documentation for this format