FHIR IG analytics| Package | hl7.fhir.uv.xver-r4b.r3 |
| Resource Type | StructureDefinition |
| Id | StructureDefinition-ext-R4B-CoverageEligibilityRequest.insurance.json |
| FHIR Version | R3 |
| Source | http://hl7.org/fhir/uv/xver-r4b.r3/0.1.0/StructureDefinition-ext-R4B-CoverageEligibilityRequest.insurance.html |
| URL | http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T21:02:03.8104715+00:00 |
| Name | ExtensionCoverageEligibilityRequest_Insurance |
| Title | R4B: Patient insurance information (new) |
| Realm | uv |
| Authority | hl7 |
| Description | R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement) |
| Purpose | This extension is part of the cross-version definitions generated to enable use of the element `CoverageEligibilityRequest.insurance` as defined in FHIR R4B in FHIR STU3. The source element is defined as: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` Across FHIR versions, the element set has been mapped as: * R4B: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` * R4: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` Following are the generation technical comments: Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). |
| Type | Extension |
| Kind | complex-type |
| ConceptMap | ||
| hl7.fhir.uv.xver-r4b.r3#0.1.0 | R4B-CoverageEligibilityRequest-element-map-to-R3 | Cross-version mapping for FHIR R4B CoverageEligibilityRequest to FHIR STU3 EligibilityRequest |
| StructureDefinition | ||
| hl7.fhir.uv.xver-r4b.r3#0.1.0 | profile-CoverageEligibilityRequest-for-EligibilityRequest | Cross-version Profile for R4B.CoverageEligibilityRequest for use in FHIR STU3 |
No resources found
No extension usage examples found
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition ext-R4B-CoverageEligibilityRequest.insurance
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Extension | 0..* | Extension | R4B: Patient insurance information (new) | |
  Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
   extension:focal | 0..1 | Extension | R4B: Applicable coverage (new) | |
  url | 1..1 | uri | "focal" | |
  value[x] | 0..1 | boolean | Applicable coverage | |
| extension:coverage | 1..1 | Extension | R4B: Insurance information additional types | |
| url | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/alternate-reference" | |
 extension:businessArrangement | 0..1 | Extension | R4B: Additional provider contract number | |
 url | 1..1 | uri | "businessArrangement" | |
| value[x] | 0..1 | string | Additional provider contract number | |
| url | 1..1 | uri | "http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance" | |
 value[x] | 0..0 | Value of extension | ||
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "StructureDefinition",
"id": "ext-R4B-CoverageEligibilityRequest.insurance",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r4b.r3"
},
{
"url": "version",
"valueString": "0.1.0"
},
{
"url": "uri",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
]
}
}
],
"url": "http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance",
"version": "0.1.0",
"name": "ExtensionCoverageEligibilityRequest_Insurance",
"title": "R4B: Patient insurance information (new)",
"status": "active",
"experimental": false,
"date": "2026-03-17T21:02:03.8104715+00:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"purpose": "This extension is part of the cross-version definitions generated to enable use of the\r\nelement `CoverageEligibilityRequest.insurance` as defined in FHIR R4B\r\nin FHIR STU3.\r\n\r\nThe source element is defined as:\r\n`CoverageEligibilityRequest.insurance` 0..* `BackboneElement`\r\n\r\nAcross FHIR versions, the element set has been mapped as:\r\n* R4B: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement`\n* R4: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement`\r\n\r\nFollowing are the generation technical comments:\r\nElement `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
}
],
"kind": "complex-type",
"abstract": false,
"contextType": "resource",
"context": [
"EligibilityRequest"
],
"type": "Extension",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "Extension",
"path": "Extension",
"short": "R4B: Patient insurance information (new)",
"definition": "R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)",
"comment": "Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nAll insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
"min": 0,
"max": "*",
"base": {
"path": "Extension",
"min": 0,
"max": "*"
},
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false
},
{
"id": "Extension.id",
"path": "Extension.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension",
"path": "Extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:focal",
"path": "Extension.extension",
"sliceName": "focal",
"short": "R4B: Applicable coverage (new)",
"definition": "R4B: `CoverageEligibilityRequest.insurance.focal` (new:boolean)",
"comment": "Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nA patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.",
"requirements": "To identify which coverage in the list is being used to evaluate this request. Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:focal.id",
"path": "Extension.extension.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:focal.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:focal.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "focal",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:focal.value[x]",
"path": "Extension.extension.value[x]",
"short": "Applicable coverage",
"definition": "A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.",
"comment": "A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:coverage",
"path": "Extension.extension",
"sliceName": "coverage",
"short": "R4B: Insurance information additional types",
"definition": "R4B: `CoverageEligibilityRequest.insurance.coverage` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.",
"requirements": "Required to allow the adjudicator to locate the correct policy and history within their information system. Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:coverage.id",
"path": "Extension.extension.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:coverage.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:coverage.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "http://hl7.org/fhir/StructureDefinition/alternate-reference",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:coverage.value[x]",
"path": "Extension.extension.value[x]",
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "base64Binary"
},
{
"code": "boolean"
},
{
"code": "code"
},
{
"code": "date"
},
{
"code": "dateTime"
},
{
"code": "decimal"
},
{
"code": "id"
},
{
"code": "instant"
},
{
"code": "integer"
},
{
"code": "markdown"
},
{
"code": "oid"
},
{
"code": "positiveInt"
},
{
"code": "string"
},
{
"code": "time"
},
{
"code": "unsignedInt"
},
{
"code": "uri"
},
{
"code": "Address"
},
{
"code": "Age"
},
{
"code": "Annotation"
},
{
"code": "Attachment"
},
{
"code": "CodeableConcept"
},
{
"code": "Coding"
},
{
"code": "ContactPoint"
},
{
"code": "Count"
},
{
"code": "Distance"
},
{
"code": "Duration"
},
{
"code": "HumanName"
},
{
"code": "Identifier"
},
{
"code": "Money"
},
{
"code": "Period"
},
{
"code": "Quantity"
},
{
"code": "Range"
},
{
"code": "Ratio"
},
{
"code": "Reference"
},
{
"code": "SampledData"
},
{
"code": "Signature"
},
{
"code": "Timing"
},
{
"code": "Meta"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:businessArrangement",
"path": "Extension.extension",
"sliceName": "businessArrangement",
"short": "R4B: Additional provider contract number",
"definition": "R4B: `CoverageEligibilityRequest.insurance.businessArrangement`",
"comment": "Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.",
"requirements": "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:businessArrangement.id",
"path": "Extension.extension.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:businessArrangement.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Extension.extension:businessArrangement.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "businessArrangement",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:businessArrangement.value[x]",
"path": "Extension.extension.value[x]",
"short": "Additional provider contract number",
"definition": "A business agreement number established between the provider and the insurer for special business processing purposes.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.url",
"path": "Extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 0,
"max": "0",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "base64Binary"
},
{
"code": "boolean"
},
{
"code": "code"
},
{
"code": "date"
},
{
"code": "dateTime"
},
{
"code": "decimal"
},
{
"code": "id"
},
{
"code": "instant"
},
{
"code": "integer"
},
{
"code": "markdown"
},
{
"code": "oid"
},
{
"code": "positiveInt"
},
{
"code": "string"
},
{
"code": "time"
},
{
"code": "unsignedInt"
},
{
"code": "uri"
},
{
"code": "Address"
},
{
"code": "Age"
},
{
"code": "Annotation"
},
{
"code": "Attachment"
},
{
"code": "CodeableConcept"
},
{
"code": "Coding"
},
{
"code": "ContactPoint"
},
{
"code": "Count"
},
{
"code": "Distance"
},
{
"code": "Duration"
},
{
"code": "HumanName"
},
{
"code": "Identifier"
},
{
"code": "Money"
},
{
"code": "Period"
},
{
"code": "Quantity"
},
{
"code": "Range"
},
{
"code": "Ratio"
},
{
"code": "Reference"
},
{
"code": "SampledData"
},
{
"code": "Signature"
},
{
"code": "Timing"
},
{
"code": "Meta"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
}
]
},
"differential": {
"element": [
{
"id": "Extension",
"path": "Extension",
"short": "R4B: Patient insurance information (new)",
"definition": "R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)",
"comment": "Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nAll insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
"min": 0,
"max": "*",
"base": {
"path": "Extension",
"min": 0,
"max": "*"
},
"isModifier": false
},
{
"id": "Extension.extension",
"path": "Extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:focal",
"path": "Extension.extension",
"sliceName": "focal",
"short": "R4B: Applicable coverage (new)",
"definition": "R4B: `CoverageEligibilityRequest.insurance.focal` (new:boolean)",
"comment": "Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nA patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.",
"requirements": "To identify which coverage in the list is being used to evaluate this request. Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`.\nElement `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:focal.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "focal"
},
{
"id": "Extension.extension:focal.value[x]",
"path": "Extension.extension.value[x]",
"short": "Applicable coverage",
"definition": "A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.",
"comment": "A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
]
},
{
"id": "Extension.extension:coverage",
"path": "Extension.extension",
"sliceName": "coverage",
"short": "R4B: Insurance information additional types",
"definition": "R4B: `CoverageEligibilityRequest.insurance.coverage` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.",
"requirements": "Required to allow the adjudicator to locate the correct policy and history within their information system. Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:coverage.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
},
{
"id": "Extension.extension:businessArrangement",
"path": "Extension.extension",
"sliceName": "businessArrangement",
"short": "R4B: Additional provider contract number",
"definition": "R4B: `CoverageEligibilityRequest.insurance.businessArrangement`",
"comment": "Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.",
"requirements": "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension.\nElement `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:businessArrangement.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "businessArrangement"
},
{
"id": "Extension.extension:businessArrangement.value[x]",
"path": "Extension.extension.value[x]",
"short": "Additional provider contract number",
"definition": "A business agreement number established between the provider and the insurer for special business processing purposes.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "Extension.url",
"path": "Extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance"
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"min": 0,
"max": "0",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
}
}
]
}
}