Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource BV-00539: CoverageEligibilityResponse.status SHALL use the fixed value 'active'. ksa-purpose-unique-code: Purpose code values must be unique. BV-00310: CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. BV-00315: CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. BV-00503: CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. BV-00535: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. BV-00536: The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. BV-00559: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. BV-00561: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'.
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:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
type		0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (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	Response creation date
request		1..1	DP_Reference_1or3a(Nphies CoverageEligibilityRequest)	Eligibility request reference
outcome		1..1	DP_code	queued | complete | error | partial
disposition	S	0..1	string	Disposition Message Max Length:250
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
insurance	S	0..*	BackboneElement	Patient insurance information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
coverage		1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
inforce		1..1	boolean	Coverage inforce indicator
benefitPeriod	S	0..1	DP_Period_2	When the benefits are applicable
item	SC	0..*	BackboneElement	Benefits and authorization details BV-00311: CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. BV-00312: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters.
category	S	0..1	DP_CodeableConcept	Benefit classification Binding: Benefit Category (required)
excluded	S	0..1	boolean	Excluded from the plan
name	S	0..1	string	Short name for the benefit Max Length:100
description	S	0..1	string	Description of the benefit or services covered Max Length:250
network		1..1	DP_CodeableConcept	In or out of network Binding: NetworkTypeCodes (required)
unit		1..1	DP_CodeableConcept	Individual or family Binding: UnitTypeCodes (required)
term		1..1	DP_CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (required)
benefit	SC	0..*	BackboneElement	Benefit Summary BV-00313: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. BV-00314: CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters.
type		1..1	DP_CodeableConcept	Benefit classification Binding: Benefit Type (required)
Slices for allowed[x]		1..1	unsignedInt, string, Money	Benefits allowed Slice: Unordered, Open by type:$this
allowed[x]:allowedUnsignedInt	S	0..1	DP_unsignedInt	Benefits allowed
allowed[x]:allowedString	S	0..1	string	Benefits allowed Max Length:60
allowed[x]:allowedMoney	SC	0..1	DP_Money_SAR	Benefits allowed BV-00084: CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR
Slices for used[x]	S	0..1	unsignedInt, string, Money	Benefits used Slice: Unordered, Open by type:$this
used[x]:usedUnsignedInt	S	0..1	DP_unsignedInt	Benefits used
used[x]:usedString	S	0..1	string	Benefits used Max Length:60
used[x]:usedMoney	SC	0..1	DP_Money_SAR	Benefits used BV-00085: CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR
error	S	0..*	BackboneElement	Processing errors
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:expression	S	0..1	string	Error Expression URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression
code		1..1	DP_CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityResponse.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityResponse.insurer.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type from this IG
CoverageEligibilityResponse.insurance.coverage.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	required	BenefitCategory (a valid code from Benefit Category) http://nphies.sa/terminology/ValueSet/benefit-category from this IG
CoverageEligibilityResponse.insurance.item.network	required	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	required	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	required	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	required	BenefitType (a valid code from Benefit Type) http://nphies.sa/terminology/ValueSet/benefit-type from this IG
CoverageEligibilityResponse.error.code	required	AdjudicationError (a valid code from Adjudication Error) http://nphies.sa/terminology/ValueSet/adjudication-error from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00084	error	CoverageEligibilityResponse.insurance.item.benefit.allowed[x]:allowedMoney	CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00085	error	CoverageEligibilityResponse.insurance.item.benefit.used[x]:usedMoney	CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00310	error	CoverageEligibilityResponse	CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. : disposition.exists() implies disposition.length() <= 250
BV-00311	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. : name.exists() implies name.length() <= 100
BV-00312	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : name.exists() implies name.length() <= 60
BV-00313	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : allowed.ofType(string).exists() implies allowed.ofType(string).length() <= 60
BV-00314	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters. : used.ofType(string).exists() implies used.ofType(string).length() <= 60
BV-00315	error	CoverageEligibilityResponse	CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. : preAuthRef.exists() implies preAuthRef.length() <= 40
BV-00503	error	CoverageEligibilityResponse	CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. : outcome.exists() implies (outcome = 'complete' implies extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').exists())
BV-00535	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. : iif( (insurance.where(inforce = true).count() = 0) and (extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count()=1), iif((extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.first().code='eligible') ,false,true), true)
BV-00536	error	CoverageEligibilityResponse	The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. : outcome.exists() implies (outcome = 'error' implies error.exists())
BV-00539	error	CoverageEligibilityResponse	CoverageEligibilityResponse.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
BV-00559	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. : iif( insurance.extension.exists(), iif( (insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), iif( extension.exists(), (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), true), false), true)
BV-00561	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'. : iif( (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count() = 1), iif(extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').first().value.ofType(CodeableConcept).coding.first().code='eligible', iif(insurance.extension.exists(),insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').select(value.ofType(CodeableConcept).coding.select(code='eligible').count()>0),false),false), true)
ksa-purpose-unique-code	error	CoverageEligibilityResponse	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management BV-00539: CoverageEligibilityResponse.status SHALL use the fixed value 'active'. ksa-purpose-unique-code: Purpose code values must be unique. BV-00310: CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. BV-00315: CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. BV-00503: CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. BV-00535: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. BV-00536: The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. BV-00559: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. BV-00561: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required) ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	DP_dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	DP_Reference_1or3a(Nphies CoverageEligibilityRequest)	Eligibility request reference ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	DP_code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. ele-1: All FHIR elements must have a @value or children
disposition	S	0..1	string	Disposition Message ele-1: All FHIR elements must have a @value or children Max Length:250
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
insurance	S	0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
coverage	Σ	1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
inforce		1..1	boolean	Coverage inforce indicator ele-1: All FHIR elements must have a @value or children
benefitPeriod	S	0..1	DP_Period_2	When the benefits are applicable ele-1: All FHIR elements must have a @value or children
item	SC	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. ele-1: All FHIR elements must have a @value or children BV-00311: CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. BV-00312: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	0..1	DP_CodeableConcept	Benefit classification Binding: Benefit Category (required) ele-1: All FHIR elements must have a @value or children
excluded	S	0..1	boolean	Excluded from the plan ele-1: All FHIR elements must have a @value or children
name	S	0..1	string	Short name for the benefit ele-1: All FHIR elements must have a @value or children Max Length:100
description	S	0..1	string	Description of the benefit or services covered ele-1: All FHIR elements must have a @value or children Max Length:250
network		1..1	DP_CodeableConcept	In or out of network Binding: NetworkTypeCodes (required) ele-1: All FHIR elements must have a @value or children
unit		1..1	DP_CodeableConcept	Individual or family Binding: UnitTypeCodes (required) ele-1: All FHIR elements must have a @value or children
term		1..1	DP_CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (required) ele-1: All FHIR elements must have a @value or children
benefit	SC	0..*	BackboneElement	Benefit Summary ele-1: All FHIR elements must have a @value or children BV-00313: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. BV-00314: CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	DP_CodeableConcept	Benefit classification Binding: Benefit Type (required) ele-1: All FHIR elements must have a @value or children
Slices for allowed[x]		1..1		Benefits allowed Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
allowed[x]:allowedUnsignedInt	S	0..1	DP_unsignedInt	Benefits allowed ele-1: All FHIR elements must have a @value or children
allowed[x]:allowedString	S	0..1	string	Benefits allowed ele-1: All FHIR elements must have a @value or children Max Length:60
allowed[x]:allowedMoney	SC	0..1	DP_Money_SAR	Benefits allowed ele-1: All FHIR elements must have a @value or children BV-00084: CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR
Slices for used[x]	S	0..1		Benefits used Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
used[x]:usedUnsignedInt	S	0..1	DP_unsignedInt	Benefits used ele-1: All FHIR elements must have a @value or children
used[x]:usedString	S	0..1	string	Benefits used ele-1: All FHIR elements must have a @value or children Max Length:60
used[x]:usedMoney	SC	0..1	DP_Money_SAR	Benefits used ele-1: All FHIR elements must have a @value or children BV-00085: CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR
error	S	0..*	BackboneElement	Processing errors ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:expression	S	0..1	string	Error Expression URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code		1..1	DP_CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type from this IG
CoverageEligibilityResponse.insurance.coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurance.coverage.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	required	BenefitCategory (a valid code from Benefit Category) http://nphies.sa/terminology/ValueSet/benefit-category from this IG
CoverageEligibilityResponse.insurance.item.network	required	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	required	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	required	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	required	BenefitType (a valid code from Benefit Type) http://nphies.sa/terminology/ValueSet/benefit-type from this IG
CoverageEligibilityResponse.error.code	required	AdjudicationError (a valid code from Adjudication Error) http://nphies.sa/terminology/ValueSet/adjudication-error from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00084	error	CoverageEligibilityResponse.insurance.item.benefit.allowed[x]:allowedMoney	CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00085	error	CoverageEligibilityResponse.insurance.item.benefit.used[x]:usedMoney	CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00310	error	CoverageEligibilityResponse	CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. : disposition.exists() implies disposition.length() <= 250
BV-00311	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. : name.exists() implies name.length() <= 100
BV-00312	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : name.exists() implies name.length() <= 60
BV-00313	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : allowed.ofType(string).exists() implies allowed.ofType(string).length() <= 60
BV-00314	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters. : used.ofType(string).exists() implies used.ofType(string).length() <= 60
BV-00315	error	CoverageEligibilityResponse	CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. : preAuthRef.exists() implies preAuthRef.length() <= 40
BV-00503	error	CoverageEligibilityResponse	CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. : outcome.exists() implies (outcome = 'complete' implies extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').exists())
BV-00535	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. : iif( (insurance.where(inforce = true).count() = 0) and (extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count()=1), iif((extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.first().code='eligible') ,false,true), true)
BV-00536	error	CoverageEligibilityResponse	The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. : outcome.exists() implies (outcome = 'error' implies error.exists())
BV-00539	error	CoverageEligibilityResponse	CoverageEligibilityResponse.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
BV-00559	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. : iif( insurance.extension.exists(), iif( (insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), iif( extension.exists(), (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), true), false), true)
BV-00561	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'. : iif( (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count() = 1), iif(extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').first().value.ofType(CodeableConcept).coding.first().code='eligible', iif(insurance.extension.exists(),insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').select(value.ofType(CodeableConcept).coding.select(code='eligible').count()>0),false),false), true)
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ksa-purpose-unique-code	error	CoverageEligibilityResponse	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource BV-00539: CoverageEligibilityResponse.status SHALL use the fixed value 'active'. ksa-purpose-unique-code: Purpose code values must be unique. BV-00310: CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. BV-00315: CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. BV-00503: CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. BV-00535: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. BV-00536: The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. BV-00559: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. BV-00561: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'.
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
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity 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
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	0..1	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)
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
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (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	Response creation date
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	Σ	1..1	DP_Reference_1or3a(Nphies CoverageEligibilityRequest)	Eligibility request reference
outcome	Σ	1..1	DP_code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing.
disposition	S	0..1	string	Disposition Message Max Length:250
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: Organization Identifier (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
insurance	S	0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information
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
inforce		1..1	boolean	Coverage inforce indicator
benefitPeriod	S	0..1	DP_Period_2	When the benefits are applicable
item	SC	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. BV-00311: CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. BV-00312: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	0..1	DP_CodeableConcept	Benefit classification Binding: Benefit Category (required)
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
excluded	S	0..1	boolean	Excluded from the plan
name	S	0..1	string	Short name for the benefit Max Length:100
description	S	0..1	string	Description of the benefit or services covered Max Length:250
network		1..1	DP_CodeableConcept	In or out of network Binding: NetworkTypeCodes (required)
unit		1..1	DP_CodeableConcept	Individual or family Binding: UnitTypeCodes (required)
term		1..1	DP_CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (required)
benefit	SC	0..*	BackboneElement	Benefit Summary BV-00313: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. BV-00314: CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	DP_CodeableConcept	Benefit classification Binding: Benefit Type (required)
Slices for allowed[x]		1..1		Benefits allowed Slice: Unordered, Closed by type:$this
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
allowed[x]:allowedUnsignedInt	S	0..1	DP_unsignedInt	Benefits allowed
allowed[x]:allowedString	S	0..1	string	Benefits allowed Max Length:60
allowed[x]:allowedMoney	SC	0..1	DP_Money_SAR	Benefits allowed BV-00084: CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR
Slices for used[x]	S	0..1		Benefits used Slice: Unordered, Closed by type:$this
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
used[x]:usedUnsignedInt	S	0..1	DP_unsignedInt	Benefits used
used[x]:usedString	S	0..1	string	Benefits used Max Length:60
used[x]:usedMoney	SC	0..1	DP_Money_SAR	Benefits used BV-00085: CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR
authorizationRequired		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
error	S	0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:expression	S	0..1	string	Error Expression URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	DP_CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
CoverageEligibilityResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
CoverageEligibilityResponse.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose from the FHIR Standard
CoverageEligibilityResponse.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type from this IG
CoverageEligibilityResponse.insurance.coverage.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityResponse.insurance.coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurance.coverage.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	required	BenefitCategory (a valid code from Benefit Category) http://nphies.sa/terminology/ValueSet/benefit-category from this IG
CoverageEligibilityResponse.insurance.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityResponse.insurance.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityResponse.insurance.item.network	required	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	required	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	required	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	required	BenefitType (a valid code from Benefit Type) http://nphies.sa/terminology/ValueSet/benefit-type from this IG
CoverageEligibilityResponse.insurance.item.authorizationSupporting	example	CoverageEligibilityResponseAuthSupportCodes http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support from the FHIR Standard
CoverageEligibilityResponse.form	example	Form Codes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
CoverageEligibilityResponse.error.code	required	AdjudicationError (a valid code from Adjudication Error) http://nphies.sa/terminology/ValueSet/adjudication-error from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00084	error	CoverageEligibilityResponse.insurance.item.benefit.allowed[x]:allowedMoney	CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00085	error	CoverageEligibilityResponse.insurance.item.benefit.used[x]:usedMoney	CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00310	error	CoverageEligibilityResponse	CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. : disposition.exists() implies disposition.length() <= 250
BV-00311	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. : name.exists() implies name.length() <= 100
BV-00312	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : name.exists() implies name.length() <= 60
BV-00313	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : allowed.ofType(string).exists() implies allowed.ofType(string).length() <= 60
BV-00314	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters. : used.ofType(string).exists() implies used.ofType(string).length() <= 60
BV-00315	error	CoverageEligibilityResponse	CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. : preAuthRef.exists() implies preAuthRef.length() <= 40
BV-00503	error	CoverageEligibilityResponse	CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. : outcome.exists() implies (outcome = 'complete' implies extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').exists())
BV-00535	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. : iif( (insurance.where(inforce = true).count() = 0) and (extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count()=1), iif((extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.first().code='eligible') ,false,true), true)
BV-00536	error	CoverageEligibilityResponse	The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. : outcome.exists() implies (outcome = 'error' implies error.exists())
BV-00539	error	CoverageEligibilityResponse	CoverageEligibilityResponse.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
BV-00559	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. : iif( insurance.extension.exists(), iif( (insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), iif( extension.exists(), (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), true), false), true)
BV-00561	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'. : iif( (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count() = 1), iif(extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').first().value.ofType(CodeableConcept).coding.first().code='eligible', iif(insurance.extension.exists(),insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').select(value.ofType(CodeableConcept).coding.select(code='eligible').count()>0),false),false), true)
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ksa-purpose-unique-code	error	CoverageEligibilityResponse	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Summary

Mandatory: 5 elements(5 nested mandatory elements)
Must-Support: 22 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_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)
• DP_Reference_1or3a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or3a)
• Nphies CoverageEligibilityRequest (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/eligibility-request)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• Nphies Coverage (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_unsignedInt (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-unsignedInt)
• DP_Money_SAR (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityResponse.serviced[x]
• The element 1 is sliced based on the value of CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
• The element 1 is sliced based on the value of CoverageEligibilityResponse.insurance.item.benefit.used[x]

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource BV-00539: CoverageEligibilityResponse.status SHALL use the fixed value 'active'. ksa-purpose-unique-code: Purpose code values must be unique. BV-00310: CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. BV-00315: CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. BV-00503: CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. BV-00535: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. BV-00536: The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. BV-00559: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. BV-00561: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'.
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:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
type		0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (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	Response creation date
request		1..1	DP_Reference_1or3a(Nphies CoverageEligibilityRequest)	Eligibility request reference
outcome		1..1	DP_code	queued | complete | error | partial
disposition	S	0..1	string	Disposition Message Max Length:250
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
insurance	S	0..*	BackboneElement	Patient insurance information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required)
coverage		1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
inforce		1..1	boolean	Coverage inforce indicator
benefitPeriod	S	0..1	DP_Period_2	When the benefits are applicable
item	SC	0..*	BackboneElement	Benefits and authorization details BV-00311: CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. BV-00312: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters.
category	S	0..1	DP_CodeableConcept	Benefit classification Binding: Benefit Category (required)
excluded	S	0..1	boolean	Excluded from the plan
name	S	0..1	string	Short name for the benefit Max Length:100
description	S	0..1	string	Description of the benefit or services covered Max Length:250
network		1..1	DP_CodeableConcept	In or out of network Binding: NetworkTypeCodes (required)
unit		1..1	DP_CodeableConcept	Individual or family Binding: UnitTypeCodes (required)
term		1..1	DP_CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (required)
benefit	SC	0..*	BackboneElement	Benefit Summary BV-00313: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. BV-00314: CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters.
type		1..1	DP_CodeableConcept	Benefit classification Binding: Benefit Type (required)
Slices for allowed[x]		1..1	unsignedInt, string, Money	Benefits allowed Slice: Unordered, Open by type:$this
allowed[x]:allowedUnsignedInt	S	0..1	DP_unsignedInt	Benefits allowed
allowed[x]:allowedString	S	0..1	string	Benefits allowed Max Length:60
allowed[x]:allowedMoney	SC	0..1	DP_Money_SAR	Benefits allowed BV-00084: CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR
Slices for used[x]	S	0..1	unsignedInt, string, Money	Benefits used Slice: Unordered, Open by type:$this
used[x]:usedUnsignedInt	S	0..1	DP_unsignedInt	Benefits used
used[x]:usedString	S	0..1	string	Benefits used Max Length:60
used[x]:usedMoney	SC	0..1	DP_Money_SAR	Benefits used BV-00085: CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR
error	S	0..*	BackboneElement	Processing errors
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:expression	S	0..1	string	Error Expression URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression
code		1..1	DP_CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityResponse.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityResponse.insurer.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type from this IG
CoverageEligibilityResponse.insurance.coverage.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	required	BenefitCategory (a valid code from Benefit Category) http://nphies.sa/terminology/ValueSet/benefit-category from this IG
CoverageEligibilityResponse.insurance.item.network	required	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	required	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	required	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	required	BenefitType (a valid code from Benefit Type) http://nphies.sa/terminology/ValueSet/benefit-type from this IG
CoverageEligibilityResponse.error.code	required	AdjudicationError (a valid code from Adjudication Error) http://nphies.sa/terminology/ValueSet/adjudication-error from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00084	error	CoverageEligibilityResponse.insurance.item.benefit.allowed[x]:allowedMoney	CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00085	error	CoverageEligibilityResponse.insurance.item.benefit.used[x]:usedMoney	CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00310	error	CoverageEligibilityResponse	CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. : disposition.exists() implies disposition.length() <= 250
BV-00311	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. : name.exists() implies name.length() <= 100
BV-00312	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : name.exists() implies name.length() <= 60
BV-00313	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : allowed.ofType(string).exists() implies allowed.ofType(string).length() <= 60
BV-00314	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters. : used.ofType(string).exists() implies used.ofType(string).length() <= 60
BV-00315	error	CoverageEligibilityResponse	CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. : preAuthRef.exists() implies preAuthRef.length() <= 40
BV-00503	error	CoverageEligibilityResponse	CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. : outcome.exists() implies (outcome = 'complete' implies extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').exists())
BV-00535	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. : iif( (insurance.where(inforce = true).count() = 0) and (extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count()=1), iif((extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.first().code='eligible') ,false,true), true)
BV-00536	error	CoverageEligibilityResponse	The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. : outcome.exists() implies (outcome = 'error' implies error.exists())
BV-00539	error	CoverageEligibilityResponse	CoverageEligibilityResponse.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
BV-00559	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. : iif( insurance.extension.exists(), iif( (insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), iif( extension.exists(), (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), true), false), true)
BV-00561	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'. : iif( (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count() = 1), iif(extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').first().value.ofType(CodeableConcept).coding.first().code='eligible', iif(insurance.extension.exists(),insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').select(value.ofType(CodeableConcept).coding.select(code='eligible').count()>0),false),false), true)
ksa-purpose-unique-code	error	CoverageEligibilityResponse	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management BV-00539: CoverageEligibilityResponse.status SHALL use the fixed value 'active'. ksa-purpose-unique-code: Purpose code values must be unique. BV-00310: CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. BV-00315: CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. BV-00503: CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. BV-00535: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. BV-00536: The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. BV-00559: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. BV-00561: The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required) ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	DP_dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	DP_Reference_1or3a(Nphies CoverageEligibilityRequest)	Eligibility request reference ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	DP_code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. ele-1: All FHIR elements must have a @value or children
disposition	S	0..1	string	Disposition Message ele-1: All FHIR elements must have a @value or children Max Length:250
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
insurance	S	0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:siteEligibility	S	0..1	DP_CodeableConcept	Site Eligibility URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility Binding: Site Eligibility (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
coverage	Σ	1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
inforce		1..1	boolean	Coverage inforce indicator ele-1: All FHIR elements must have a @value or children
benefitPeriod	S	0..1	DP_Period_2	When the benefits are applicable ele-1: All FHIR elements must have a @value or children
item	SC	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. ele-1: All FHIR elements must have a @value or children BV-00311: CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. BV-00312: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	0..1	DP_CodeableConcept	Benefit classification Binding: Benefit Category (required) ele-1: All FHIR elements must have a @value or children
excluded	S	0..1	boolean	Excluded from the plan ele-1: All FHIR elements must have a @value or children
name	S	0..1	string	Short name for the benefit ele-1: All FHIR elements must have a @value or children Max Length:100
description	S	0..1	string	Description of the benefit or services covered ele-1: All FHIR elements must have a @value or children Max Length:250
network		1..1	DP_CodeableConcept	In or out of network Binding: NetworkTypeCodes (required) ele-1: All FHIR elements must have a @value or children
unit		1..1	DP_CodeableConcept	Individual or family Binding: UnitTypeCodes (required) ele-1: All FHIR elements must have a @value or children
term		1..1	DP_CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (required) ele-1: All FHIR elements must have a @value or children
benefit	SC	0..*	BackboneElement	Benefit Summary ele-1: All FHIR elements must have a @value or children BV-00313: CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. BV-00314: CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	DP_CodeableConcept	Benefit classification Binding: Benefit Type (required) ele-1: All FHIR elements must have a @value or children
Slices for allowed[x]		1..1		Benefits allowed Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
allowed[x]:allowedUnsignedInt	S	0..1	DP_unsignedInt	Benefits allowed ele-1: All FHIR elements must have a @value or children
allowed[x]:allowedString	S	0..1	string	Benefits allowed ele-1: All FHIR elements must have a @value or children Max Length:60
allowed[x]:allowedMoney	SC	0..1	DP_Money_SAR	Benefits allowed ele-1: All FHIR elements must have a @value or children BV-00084: CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR
Slices for used[x]	S	0..1		Benefits used Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
used[x]:usedUnsignedInt	S	0..1	DP_unsignedInt	Benefits used ele-1: All FHIR elements must have a @value or children
used[x]:usedString	S	0..1	string	Benefits used ele-1: All FHIR elements must have a @value or children Max Length:60
used[x]:usedMoney	SC	0..1	DP_Money_SAR	Benefits used ele-1: All FHIR elements must have a @value or children BV-00085: CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR
error	S	0..*	BackboneElement	Processing errors ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:expression	S	0..1	string	Error Expression URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-error-expression ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code		1..1	DP_CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurer.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type from this IG
CoverageEligibilityResponse.insurance.coverage.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityResponse.insurance.coverage.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	required	BenefitCategory (a valid code from Benefit Category) http://nphies.sa/terminology/ValueSet/benefit-category from this IG
CoverageEligibilityResponse.insurance.item.network	required	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	required	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	required	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	required	BenefitType (a valid code from Benefit Type) http://nphies.sa/terminology/ValueSet/benefit-type from this IG
CoverageEligibilityResponse.error.code	required	AdjudicationError (a valid code from Adjudication Error) http://nphies.sa/terminology/ValueSet/adjudication-error from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00084	error	CoverageEligibilityResponse.insurance.item.benefit.allowed[x]:allowedMoney	CoverageEligibilityResponse.insurance.item.benefit.allowedMoney.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00085	error	CoverageEligibilityResponse.insurance.item.benefit.used[x]:usedMoney	CoverageEligibilityResponse.insurance.item.benefit.used.currency SHALL be SAR : currency.exists() implies currency ='SAR'
BV-00310	error	CoverageEligibilityResponse	CoverageEligibilityResponse.disposition SHALL have maximum length of 250 English characters and 125 Arabic characters. : disposition.exists() implies disposition.length() <= 250
BV-00311	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.name SHALL have maximum length of 100 English characters and 50 Arabic characters. : name.exists() implies name.length() <= 100
BV-00312	error	CoverageEligibilityResponse.insurance.item	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : name.exists() implies name.length() <= 60
BV-00313	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.allowedString SHALL have maximum length of 60 characters. : allowed.ofType(string).exists() implies allowed.ofType(string).length() <= 60
BV-00314	error	CoverageEligibilityResponse.insurance.item.benefit	CoverageEligibilityResponse.insurance.item.benefit.usedString SHALL have maximum length of 60 characters. : used.ofType(string).exists() implies used.ofType(string).length() <= 60
BV-00315	error	CoverageEligibilityResponse	CoverageEligibilityResponse.preAuthRef SHALL have maximum length of 40 characters. : preAuthRef.exists() implies preAuthRef.length() <= 40
BV-00503	error	CoverageEligibilityResponse	CoverageEligibiltyResponse.extension.siteEligibility SHALL be provided when CoverageEligibiltyResponse.outcome='complete'. : outcome.exists() implies (outcome = 'complete' implies extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').exists())
BV-00535	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.inforce value is 'false'. : iif( (insurance.where(inforce = true).count() = 0) and (extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count()=1), iif((extension.where(url = 'http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.first().code='eligible') ,false,true), true)
BV-00536	error	CoverageEligibilityResponse	The CoverageEligibilityResponse.error SHALL be provided when CoverageEligibilityResponse.outcome= 'error'. : outcome.exists() implies (outcome = 'error' implies error.exists())
BV-00539	error	CoverageEligibilityResponse	CoverageEligibilityResponse.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
BV-00559	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL be 'eligible' if at least in one array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is 'eligible'. : iif( insurance.extension.exists(), iif( (insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), iif( extension.exists(), (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').value.ofType(CodeableConcept).coding.where(code='eligible').count() > 0), true), false), true)
BV-00561	error	CoverageEligibilityResponse	The CoverageEligibiltyResponse.extension.siteEligibility value SHALL not be 'eligible' if for every array entry of CoverageEligibiltyResponse.insurance the related CoverageEligibilityResponse.insurance.siteEligibility is not 'eligible'. : iif( (extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').count() = 1), iif(extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').first().value.ofType(CodeableConcept).coding.first().code='eligible', iif(insurance.extension.exists(),insurance.extension.where(url='http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility').select(value.ofType(CodeableConcept).coding.select(code='eligible').count()>0),false),false), true)
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ksa-purpose-unique-code	error	CoverageEligibilityResponse	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()