Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient		1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
Slices for serviced[x]		1..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created		1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies 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	S	0..*	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		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
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	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

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityRequest.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Summary

Mandatory: 7 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• DP_canonical (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical)
• DP_Identifier_A (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_code (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Patient (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient)
• DP_date (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-date)
• DP_Period_2 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2)
• DP_dateTime (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime)
• Nphies Provider Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Location (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/location)
• Nphies Coverage (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient		1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
Slices for serviced[x]		1..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created		1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource Constraints: ksa-purpose-unique-code, BV-00437, BV-00538
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies 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	S	0..*	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		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
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	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

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityRequest.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose From the FHIR Standard
CoverageEligibilityRequest.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
CoverageEligibilityRequest.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Summary

Mandatory: 7 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• DP_canonical (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical)
• DP_Identifier_A (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_code (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Patient (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient)
• DP_date (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-date)
• DP_Period_2 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2)
• DP_dateTime (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime)
• Nphies Provider Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Location (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/location)
• Nphies Coverage (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]