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

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Hồ sơ tài nguyên: Kết quả tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Response Profile

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.

Mức hưởng là ẢNH CHỤP CÓ THỜI ĐIỂM, không phải thuộc tính của thẻ (kiểm toán 07/08/2026, mục 1.12): CV 2036/BHXH-CSYT hướng dẫn cơ sở KCB dùng kết quả tra cứu có thời điểm và áp dụng quyền lợi cao nhất khi người tham gia thuộc nhiều đối tượng — mức hưởng, trần và số luỹ kế thay đổi theo thời gian và theo tổ hợp đối tượng nên phải nằm trong phản hồi tra cứu (created + serviced[x] + insurance.item.benefit), không được ghi tĩnh trên Coverage. Tổng cùng chi trả luỹ kế trong năm (NĐ 188/2025/NĐ-CP Điều 18 khoản 2) biểu diễn bằng insurance.item.benefit với type = vn-benefit-type-cs#annual-copay-accumulator (0.10.0 — thay cách dùng sai benefit-type#copay-maximum của HL7, vốn nghĩa là mức cùng chi trả tối đa cho MỘT dịch vụ — T-02 review 97b): allowedMoney = trần miễn cùng chi trả (6 tháng lương cơ sở), usedMoney = số đã cùng chi trả luỹ kế tính đến thời điểm tra cứu; kỳ tính (năm tài chính) ghi ở serviced[x]. Extension vn-ext-coverage-cumulative-copay trên Coverage đã ngừng authoring từ 0.10.0. 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; Điều 18 khoản 2 — điều kiện hưởng không cùng chi trả trong năm tài chính
• 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
• CV 2036/BHXH-CSYT — kết quả tra cứu có thời điểm; áp quyền lợi cao nhất khi thuộc nhiều đối tượng. PHẠM VI, làm rõ 07/09/2026: đây là công văn của BHXH Việt Nam gửi BHXH các tỉnh, thành phố, ràng buộc cơ sở KCB gián tiếp qua BHXH tỉnh và hợp đồng KCB BHYT — không phải văn bản quy phạm áp thẳng lên cơ sở. Thiết kế serviced[x] vẫn đứng vững vì nó phản ánh bản chất ảnh-chụp-có-thời-điểm của kết quả tra cứu.

Usages:

• Examples for this Profile: CoverageEligibilityResponse/ExampleCoverageEligibilityResponse, CoverageEligibilityResponse/ExampleCoverageEligibilityResponseBenefits and CoverageEligibilityResponse/ExampleCoverageEligibilityResponseInactive
• CapabilityStatements using this Profile: VN Core BHYT Gateway Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

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• Tất cả

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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 phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	?!SOΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SOΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1		Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
servicedDate			date
servicedPeriod			Period
created	SOΣ	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
request	SOΣ	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SOΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ClaimProcessingCodes (required): The outcome of the processing. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurer	SOΣ	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)
item	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item) Constraints: ces-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
benefit	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both.	category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
identifier	SO	0..*	Identifier	Mã giao dịch phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	SO	1..1	code	active | cancelled | draft | entered-in-error Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SO	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SO	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1	date, Period	Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
created	SO	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
request	SO	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SO	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurer	SO	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
coverage	S	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)
item	S	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item)
benefit	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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. Additional Bindings Purpose AllLanguages 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
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 phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	?!SOΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SOΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1		Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
servicedDate			date
servicedPeriod			Period
created	SOΣ	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	SOΣ	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SOΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ClaimProcessingCodes (required): The outcome of the processing. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
disposition		0..1	string	Disposition Message
insurer	SOΣ	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
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
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	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
item	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item) Constraints: ces-1
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
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)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
benefit	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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
authorizationRequired		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
error		0..*	BackboneElement	Processing errors
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
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing.
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG
CoverageEligibilityResponse.​insurance.item.authorizationSupporting	Base	example	CoverageEligibilityResponse Auth Support Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​form	Base	example	Forms	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​error.code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both.	category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Summary

Must-Support: 14 elements

Structures

This structure refers to these other structures:

• Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
• Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request)
• Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

Dạng xem phần tử chính

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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 phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	?!SOΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SOΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1		Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
servicedDate			date
servicedPeriod			Period
created	SOΣ	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
request	SOΣ	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SOΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ClaimProcessingCodes (required): The outcome of the processing. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurer	SOΣ	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)
item	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item) Constraints: ces-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
benefit	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both.	category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
identifier	SO	0..*	Identifier	Mã giao dịch phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	SO	1..1	code	active | cancelled | draft | entered-in-error Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SO	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SO	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1	date, Period	Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
created	SO	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
request	SO	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SO	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurer	SO	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
coverage	S	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	S	0..1	boolean	Thẻ BHYT còn hiệu lực tại thời điểm tra cứu (true/false)
item	S	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item)
benefit	S	0..*	BackboneElement	Mức hưởng theo loại quyền lợi (vd tỷ lệ %, trần thanh toán)
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG

Dạng xem SnapshotView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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. Additional Bindings Purpose AllLanguages 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
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 phản hồi — đối soát với request của cơ sở KCB Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
status	?!SOΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
purpose	SOΣ	1..*	code	Mục đích tra cứu (khớp request): validation | benefits | ... Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Intended recipient of products and services Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
serviced[x]	SO	0..1		Kỳ áp dụng của kết quả tra cứu — vd năm tài chính khi trả luỹ kế cùng chi trả Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
servicedDate			date
servicedPeriod			Period
created	SOΣ	1..1	dateTime	Thời điểm tạo phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	SOΣ	1..1	Reference(Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile)	Yêu cầu tra cứu tương ứng Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
outcome	SOΣ	1..1	code	queued | complete | error | partial — kết quả xử lý của Cổng BHYT Binding: ClaimProcessingCodes (required): The outcome of the processing. Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
disposition		0..1	string	Disposition Message
insurer	SOΣ	1..1	Reference(Organization)	Cơ quan BHXH phản hồi Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
insurance	SO	0..*	BackboneElement	Patient insurance information Obligations Actor SHALL:populate-if-known Bên giám định BHYT (Adjudicator) SHALL:no-error & SHALL:handle Bên gửi hồ sơ BHYT (Submitter)
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
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Insurance information
inforce	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
item	SC	0..*	BackboneElement	Chi tiết quyền lợi/mức hưởng BHYT khi purpose=benefits (mỗi nhóm quyền lợi 1 item) Constraints: ces-1
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
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)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
benefit	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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: Loại quyền lợi — VN Benefit Type ValueSet (extensible)
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
authorizationRequired		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
error		0..*	BackboneElement	Processing errors
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
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing.
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	extensible	Loại quyền lợi — VN Benefit Type ValueSet	📦0.10.0	This IG
CoverageEligibilityResponse.​insurance.item.authorizationSupporting	Base	example	CoverageEligibilityResponse Auth Support Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​form	Base	example	Forms	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​error.code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both.	category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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)
CoverageEligibilityResponse
identifier	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
status	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
purpose	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
patient	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
serviced[x]	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
created	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
request	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
outcome	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurer	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
insurance	SHALL:populate-if-known	SHALL:no-error & SHALL:handle
Documentation for this format

Summary

Must-Support: 14 elements

Structures

This structure refers to these other structures:

• Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
• Yêu cầu tra cứu quyền lợi BHYT VN Core — VN Core Coverage Eligibility Request Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage-eligibility-request)
• Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

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