Healthcare Financial Services IG Edition 1
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Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: NphiesCoverageEligibilityResponse - Mappings

Draft as of 2025-06-23

Mappings for the eligibility-response resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

NphiesCoverageEligibilityResponse
CoverageEligibilityResponseEvent
   identifierEvent.identifier
   statusEvent.status
   patientEvent.subject
   requestEvent.basedOn
   dispositionEvent.note

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

NphiesCoverageEligibilityResponse
CoverageEligibilityResponse
   identifierFiveWs.identifier
   statusFiveWs.status
   purposeFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   serviced[x]FiveWs.done[x]
   serviced[x] (servicedDate)FiveWs.done[x]
   serviced[x] (servicedPeriod)FiveWs.done[x]
   createdFiveWs.recorded
   requestorFiveWs.source
   requestFiveWs.why[x]
   insurance
      item
         providerFiveWs.source

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

NphiesCoverageEligibilityResponse
CoverageEligibilityResponse
   patientC06,C07,C08, C05, C04
   serviced[x]F09
   serviced[x] (servicedDate)F09
   serviced[x] (servicedPeriod)F09
   requestorB01
   requestA02|G01
   insurance
      item
         providerB01
   preAuthRefF03
   formG42

Mappings for RIM Mapping (http://hl7.org/v3)

NphiesCoverageEligibilityResponse
CoverageEligibilityResponseEntity. Role, or Act
   meta
      idn/a
      extensionn/a
   textAct.text?
   containedN/A
   modifierExtensionN/A
   identifier
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   patient
      idn/a
      extensionn/a
      referenceN/A
      typeN/A
      identifier.identifier
         idn/a
         extensionn/a
         useRole.code or implied by context
         typeRole.code or implied by context
         systemII.root or Role.id.root
         valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
         periodRole.effectiveTime or implied by context
         assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
      displayN/A
   insurer
      idn/a
      extensionn/a
      referenceN/A
      typeN/A
      identifier.identifier
         idn/a
         extensionn/a
         useRole.code or implied by context
         typeRole.code or implied by context
         systemII.root or Role.id.root
         valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
         periodRole.effectiveTime or implied by context
         assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
      displayN/A
   insurance
      idn/a
      modifierExtensionN/A
      coverage
         idn/a
         extensionn/a
         referenceN/A
         typeN/A
         identifier.identifier
            idn/a
            extensionn/a
            useRole.code or implied by context
            typeRole.code or implied by context
            systemII.root or Role.id.root
            valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
            periodRole.effectiveTime or implied by context
            assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
         displayN/A
      item
         idn/a
         extensionn/a
         modifierExtensionN/A
         benefit
            idn/a
            extensionn/a
            modifierExtensionN/A
   preAuthRef23
   error
      idn/a
      modifierExtensionN/A