Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource Constraints: BV-00539, ksa-purpose-unique-code, BV-00310, BV-00315, BV-00503, BV-00535, BV-00536, BV-00559, BV-00561
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension: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
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
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
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Response creation date
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
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: 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
display	Σ	0..1	string	Text alternative for the resource Max Length:200
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)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
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 Constraints: ces-1, BV-00311, BV-00312
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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 Constraints: BV-00313, BV-00314
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 Constraints: BV-00084
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 Constraints: BV-00085
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
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	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​identifier.type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.type	Base	required	Patient Identifier Type	📦0.4.0	This IG
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.type	Base	required	Organization Identifier	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.coverage.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.identifier.​type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	required	Benefit Category	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.item.network	Base	required	Network Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	required	Unit Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	required	Benefit Term Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	required	Benefit Type	📦0.4.0	This IG
CoverageEligibilityResponse.​error.code	Base	required	Adjudication Error Codes	📦0.4.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
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    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource Constraints: BV-00539, ksa-purpose-unique-code, BV-00310, BV-00315, BV-00503, BV-00535, BV-00536, BV-00559, BV-00561
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 Constraints: BV-00311, BV-00312
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 Constraints: BV-00313, BV-00314
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 Constraints: BV-00084
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 Constraints: BV-00085
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	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​identifier.type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.type	Base	required	Patient Identifier Type	📦0.4.0	This IG
CoverageEligibilityResponse.​insurer.identifier.type	Base	required	Organization Identifier	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.coverage.identifier.​type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	required	Benefit Category	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.item.network	Base	required	Network Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	required	Unit Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	required	Benefit Term Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	required	Benefit Type	📦0.4.0	This IG
CoverageEligibilityResponse.​error.code	Base	required	Adjudication Error Codes	📦0.4.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
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    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource Constraints: BV-00539, ksa-purpose-unique-code, BV-00310, BV-00315, BV-00503, BV-00535, BV-00536, BV-00559, BV-00561
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension: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 Constraints: ces-1, BV-00311, BV-00312
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 Constraints: BV-00313, BV-00314
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 Constraints: BV-00084
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 Constraints: BV-00085
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	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​identifier.type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.type	Base	required	Patient Identifier Type	📦0.4.0	This IG
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.type	Base	required	Organization Identifier	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.coverage.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.identifier.​type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	required	Benefit Category	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.network	Base	required	Network Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	required	Unit Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	required	Benefit Term Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	required	Benefit Type	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.item.authorizationSupporting	Base	example	CoverageEligibilityResponse Auth Support Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​form	Base	example	Forms	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​error.code	Base	required	Adjudication Error Codes	📦0.4.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
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    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse	C	0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource Constraints: BV-00539, ksa-purpose-unique-code, BV-00310, BV-00315, BV-00503, BV-00535, BV-00536, BV-00559, BV-00561
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension: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
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
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
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Response creation date
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
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: 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
display	Σ	0..1	string	Text alternative for the resource Max Length:200
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)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	DP_Reference_1or2a(Nphies Coverage)	Insurance information
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
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 Constraints: ces-1, BV-00311, BV-00312
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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 Constraints: BV-00313, BV-00314
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 Constraints: BV-00084
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 Constraints: BV-00085
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
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	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​identifier.type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	EligibilityResponsePurpose	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​patient.identifier.type	Base	required	Patient Identifier Type	📦0.4.0	This IG
CoverageEligibilityResponse.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurer.identifier.type	Base	required	Organization Identifier	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.coverage.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.identifier.​type	Base	required	IdentifierType	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.category	Base	required	Benefit Category	📦0.4.0	This IG
CoverageEligibilityResponse.​insurance.item.network	Base	required	Network Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	required	Unit Type Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	required	Benefit Term Codes	📦4.0.1	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	required	Benefit Type	📦0.4.0	This IG
CoverageEligibilityResponse.​error.code	Base	required	Adjudication Error Codes	📦0.4.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
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()