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

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
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 CoverageEligibilityResponse — phản hồi từ Cổng giám định BHYT cho yêu cầu tra cứu thẻ: hiệu lực thẻ tại thời điểm tra cứu (`insurance.inforce`), quyền lợi và mức hưởng. Cặp với VNCoreCoverageEligibilityRequest. 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 — quyền lợi và mức hưởng BHYT - **NĐ 164/2025/NĐ-CP** — 29/6/2025 — giao dịch điện tử trong lĩnh vực BHXH - **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	VNCoreCoverageEligibilityResponse
publisher	Omi HealthTech / VN Core FHIR Community Initiative
purpose
status	draft
title	Kết quả tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Response Profile
type	CoverageEligibilityResponse
url	http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-response
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
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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 phản hồi — đối soát với request của cơ sở KCB	S	0..*	Identifier	Mã giao dịch phản hồi — đối soát với request của cơ sở KCB
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.
purpose	SΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Binding: ?? (required): A code specifying the types of information being requested.	SΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... 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)	Intended recipient of products and services	SΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services	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]		0..1	date, Period	Estimated date or dates of service		0..1	date, Period	Estimated date or dates of service
created	SΣ	1..1	dateTime	Thời điểm tạo phản hồi	SΣ	1..1	dateTime	Thời điểm tạo phản hồi
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	SΣ	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request)	Yêu cầu tra cứu tương ứng	SΣ	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng	Type Mismatch: Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request]]) vs Reference([CanonicalType[http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request]])
outcome	SΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ?? (required): The outcome of the processing.	SΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ?? (required): The outcome of the processing.
disposition		0..1	string	Disposition Message		0..1	string	Disposition Message
insurer	SΣ	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)	Cơ quan BHXH phản hồi	SΣ	1..1	Reference(Organization)	Cơ quan BHXH phản hồi	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]])
insurance	S	0..*	BackboneElement	Patient insurance information	S	0..*	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
coverage	SΣ	1..1	Reference(http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)	Insurance information	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information	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]])
inforce	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)
benefitPeriod		0..1	Period	When the benefits are applicable		0..1	Period	When the benefits are applicable
item	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item)	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item)
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
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)	Performing practitioner		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family.		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime.		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime.
benefit	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)
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
type		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc.		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1	unsignedInt, string, Money	Benefits allowed		0..1	unsignedInt, string, Money	Benefits allowed
used[x]		0..1	unsignedInt, string, Money	Benefits used		0..1	unsignedInt, string, Money	Benefits used
authorizationRequired		0..1	boolean	Authorization required flag		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization.		0..*	CodeableConcept	Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.
error		0..*	BackboneElement	Processing errors		0..*	BackboneElement	Processing errors
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
code		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing.		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing.
Documentation for this format