Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide
0.10.0 - Draft for Community Review
Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide - Draft for Community Review (v0.10.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| URL chính thức: http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request | Phiên bản: 0.10.0 | ||||
| Computable Name: VNCoreCoverageEligibilityRequest | |||||
| Định danh khác: OID:2.25.161089673617632664299011809196868855799.42.52 | |||||
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:
insurance là 1..* và mỗi mục trỏ tới một VNCoreCoverage đã tồn tại, nên hồ sơ chỉ dựng được khi đã biết mã thẻ. Tình huống thường gặp ở khâu tiếp đón — người bệnh chỉ xuất trình CCCD và cơ sở phải TRA RA mã thẻ — KHÔNG dùng profile này: đó là nghiệp vụ tra cứu của Cổng BHXH theo NĐ 164/2025/NĐ-CP, thực hiện qua API của cổng; kết quả trả về mới dùng để tạo VNCoreCoverage, rồi mới đến lượt profile này kiểm hiệu lực và mức hưởng. Ghi rõ ranh giới 16/08/2026 sau khi rà từ góc người triển khai: bản trước chỉ nói 'luồng tra cứu', khiến kỹ sư tưởng dựng được hồ sơ khám phá thẻ bằng CCCD rồi mắc kẹt ở cardinality bắt buộc.Usages:
You can also check for usages in the FHIR IG Statistics
Mô tả profile, differential, snapshot và các biểu diễn liên quan.
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
  CoverageEligibilityRequest |
||
  identifier |
| |
 status |
| |
| purpose |
| |
 patient |
| |
 serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
 insurance |
| |
| Documentation for this format | ||
| 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. |
| 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()
|
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| CoverageEligibilityRequest |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||||
 identifier |
SO | 0..* | Identifier | Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
| ||||||
| status |
SO | 1..1 | code | active | cancelled | draft | entered-in-error
| ||||||
| purpose |
SO | 1..* | code | Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
| ||||||
| patient |
SO | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Người bệnh có thẻ BHYT cần tra cứu
| ||||||
| serviced[x] |
SO | 0..1 | date, Period | Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
| ||||||
| created |
SO | 1..1 | dateTime | Thời điểm tạo yêu cầu tra cứu
| ||||||
| provider |
SO | 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 |
SO | 1..1 | Reference(Organization) | Cơ quan BHXH / đơn vị quản lý quỹ BHYT
| ||||||
 insurance |
SO | 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 | ||||||
| Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||||
| 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 |
SO | 0..* | Identifier | Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
| ||||||
| status |
?!SOΣ | 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 |
SOΣ | 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 |
SOΣ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Người bệnh có thẻ BHYT cần tra cứu
| ||||||
 serviced[x] |
SO | 0..1 | Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
| |||||||
 servicedDate |
date | |||||||||
| servicedPeriod |
Period | |||||||||
| created |
SOΣ | 1..1 | dateTime | Thời điểm tạo yêu cầu tra cứu
| ||||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||||
| provider |
SO | 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 |
SOΣ | 1..1 | Reference(Organization) | 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 |
SO | 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 | |||||||
| Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
| 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. |
| 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()
|
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
Summary
Mandatory: 1 element
Must-Support: 10 elements
Structures
This structure refers to these other structures:
Dạng xem phần tử chính
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
SO | 0..* | Identifier | Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
| ||||||
| status |
?!SOΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
| ||||||
| purpose |
SOΣ | 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 |
SOΣ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Người bệnh có thẻ BHYT cần tra cứu
| ||||||
| serviced[x] |
SO | 0..1 | Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
| |||||||
| servicedDate |
date | |||||||||
| servicedPeriod |
Period | |||||||||
| created |
SOΣ | 1..1 | dateTime | Thời điểm tạo yêu cầu tra cứu
| ||||||
| provider |
SO | 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 |
SOΣ | 1..1 | Reference(Organization) | Cơ quan BHXH / đơn vị quản lý quỹ BHYT
| ||||||
| insurance |
SO | 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 | ||||||
| Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
| 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. |
| 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
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| CoverageEligibilityRequest |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||||
| identifier |
SO | 0..* | Identifier | Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
| ||||||
| status |
SO | 1..1 | code | active | cancelled | draft | entered-in-error
| ||||||
| purpose |
SO | 1..* | code | Mục đích tra cứu — thường 'validation' (kiểm tra hiệu lực thẻ) hoặc 'benefits' (quyền lợi/mức hưởng)
| ||||||
| patient |
SO | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Người bệnh có thẻ BHYT cần tra cứu
| ||||||
| serviced[x] |
SO | 0..1 | date, Period | Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
| ||||||
| created |
SO | 1..1 | dateTime | Thời điểm tạo yêu cầu tra cứu
| ||||||
| provider |
SO | 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 |
SO | 1..1 | Reference(Organization) | Cơ quan BHXH / đơn vị quản lý quỹ BHYT
| ||||||
| insurance |
SO | 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 | ||||||
| Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
Dạng xem SnapshotView
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||||
| 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 |
SO | 0..* | Identifier | Mã giao dịch tra cứu của cơ sở KCB — để đối soát request/response
| ||||||
| status |
?!SOΣ | 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 |
SOΣ | 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 |
SOΣ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Người bệnh có thẻ BHYT cần tra cứu
| ||||||
| serviced[x] |
SO | 0..1 | Ngày/khoảng cần kiểm tra hiệu lực thẻ (vd ngày vào viện), khác thời điểm tạo request
| |||||||
| servicedDate |
date | |||||||||
| servicedPeriod |
Period | |||||||||
| created |
SOΣ | 1..1 | dateTime | Thời điểm tạo yêu cầu tra cứu
| ||||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||||
| provider |
SO | 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 |
SOΣ | 1..1 | Reference(Organization) | 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 |
SO | 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 | |||||||
| Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
| 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. |
| 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()
|
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter) |
|---|---|---|
| CoverageEligibilityRequest |
||
| identifier |
| |
| status |
| |
| purpose |
| |
| patient |
| |
| serviced[x] |
| |
| created |
| |
| provider |
| |
| insurer |
| |
| insurance |
| |
| Documentation for this format | ||
Summary
Mandatory: 1 element
Must-Support: 10 elements
Structures
This structure refers to these other structures:
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