Data Model Libraries
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    Class CoverageEligibilityResponseInsuranceItemComponent

    CoverageEligibilityResponseInsuranceItemComponent Class

    FHIR Specification

    • Short: Benefits and authorization details
    • Definition: Benefits and optionally current balances, and authorization details by category or service.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    Methods

    parse getCategory setCategory hasCategory getProductOrService setProductOrService hasProductOrService getModifier setModifier addModifier hasModifier getProvider setProvider hasProvider getExcludedElement setExcludedElement hasExcludedElement getExcluded setExcluded hasExcluded getNameElement setNameElement hasNameElement getName setName hasName getDescriptionElement setDescriptionElement hasDescriptionElement getDescription setDescription hasDescription getNetwork setNetwork hasNetwork getUnit setUnit hasUnit getTerm setTerm hasTerm getBenefit setBenefit addBenefit hasBenefit getAuthorizationRequiredElement setAuthorizationRequiredElement hasAuthorizationRequiredElement getAuthorizationRequired setAuthorizationRequired hasAuthorizationRequired getAuthorizationSupporting setAuthorizationSupporting addAuthorizationSupporting hasAuthorizationSupporting getAuthorizationUrlElement setAuthorizationUrlElement hasAuthorizationUrlElement getAuthorizationUrl setAuthorizationUrl hasAuthorizationUrl fhirType isEmpty copy toJSON getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension getId setId hasId getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension isRequiredFieldsEmpty isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initModifier initBenefit initAuthorizationSupporting

    Constructors

    Properties

    category?: CodeableConcept

    CoverageEligibilityResponse.insurance.item.category Element

    FHIR Specification

    • Short: Benefit classification
    • Definition: Code to identify the general type of benefits under which products and services are provided.
    • Comment: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
    • Requirements: Needed to convey the category of service or product for which eligibility is sought.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    productOrService?: CodeableConcept

    CoverageEligibilityResponse.insurance.item.productOrService Element

    FHIR Specification

    • Short: Billing, service, product, or drug code
    • Definition: This contains the product, service, drug or other billing code for the item.
    • Comment: Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).
    • Requirements: Needed to convey the actual service or product for which eligibility is sought.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    modifier?: CodeableConcept[]

    CoverageEligibilityResponse.insurance.item.modifier Element

    FHIR Specification

    • Short: Product or service billing modifiers
    • Definition: Item typification or modifiers codes to convey additional context for the product or service.
    • Comment: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
    • Requirements: To support provision of the item or to charge an elevated fee.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    provider?: Reference

    CoverageEligibilityResponse.insurance.item.provider Element

    FHIR Specification

    excluded?: BooleanType

    CoverageEligibilityResponse.insurance.item.excluded Element

    FHIR Specification

    • Short: Excluded from the plan
    • Definition: True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
    • Requirements: Needed to identify items that are specifically excluded from the coverage.
    • FHIR Type: boolean
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    name?: StringType

    FHIR Specification

    • Short: Short name for the benefit
    • Definition: A short name or tag for the benefit.
    • Comment: For example: MED01, or DENT2.
    • Requirements: Required to align with other plan names.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    description?: StringType

    CoverageEligibilityResponse.insurance.item.description Element

    FHIR Specification

    • Short: Description of the benefit or services covered
    • Definition: A richer description of the benefit or services covered.
    • Comment: For example 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.
    • Requirements: Needed for human readable reference.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    network?: CodeableConcept

    CoverageEligibilityResponse.insurance.item.network Element

    FHIR Specification

    • Short: In or out of network
    • Definition: Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
    • Requirements: Needed as in or out of network providers are treated differently under the coverage.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    CoverageEligibilityResponse.insurance.item.unit Element

    FHIR Specification

    • Short: Individual or family
    • Definition: Indicates if the benefits apply to an individual or to the family.
    • Requirements: Needed for the understanding of the benefits.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    CoverageEligibilityResponse.insurance.item.term Element

    FHIR Specification

    • Short: Annual or lifetime
    • Definition: The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
    • Requirements: Needed for the understanding of the benefits.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    CoverageEligibilityResponse.insurance.item.benefit Element

    FHIR Specification

    • Short: Benefit Summary
    • Definition: Benefits used to date.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    authorizationRequired?: BooleanType

    CoverageEligibilityResponse.insurance.item.authorizationRequired Element

    FHIR Specification

    • Short: Authorization required flag
    • Definition: A boolean flag indicating whether a preauthorization is required prior to actual service delivery.
    • Requirements: Needed to convey that preauthorization is required.
    • FHIR Type: boolean
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    authorizationSupporting?: CodeableConcept[]

    CoverageEligibilityResponse.insurance.item.authorizationSupporting Element

    FHIR Specification

    • Short: Type of required supporting materials
    • Definition: Codes or comments regarding information or actions associated with the preauthorization.
    • Requirements: Needed to inform the provider of collateral materials or actions needed for preauthorization.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    authorizationUrl?: UriType

    CoverageEligibilityResponse.insurance.item.authorizationUrl Element

    FHIR Specification

    • Short: Preauthorization requirements endpoint
    • Definition: A web location for obtaining requirements or descriptive information regarding the preauthorization.
    • Requirements: Needed to enable insurers to advise providers of informative information.
    • FHIR Type: uri
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    Methods

    • Parse the provided CoverageEligibilityResponseInsuranceItemComponent JSON to instantiate the CoverageEligibilityResponseInsuranceItemComponent data model.

      Parameters

      • sourceJson: Value

        JSON representing FHIR CoverageEligibilityResponseInsuranceItemComponent

      • OptionaloptSourceField: string

        Optional data source field (e.g. <complexTypeName>.<complexTypeFieldName>); defaults to CoverageEligibilityResponseInsuranceItemComponent

      Returns undefined | CoverageEligibilityResponseInsuranceItemComponent

      CoverageEligibilityResponseInsuranceItemComponent data model or undefined for CoverageEligibilityResponseInsuranceItemComponent

      JsonError if the provided JSON is not a valid JSON object

    • Determines if the modifierExtension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Returns undefined | string

      the id property value

    • Assigns the provided value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid value

    • Returns boolean

      true if id exists and has a value; false otherwise

    • Determines if the extension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Determines if the extension property exists.

      Parameters

      • url: string

        the url that identifies a specific Extension

      Returns undefined | IExtension

      an Extension having the provided url

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Adds the provided Extension to the extension property array.

      Parameters

      • extension: undefined | IExtension

        the Extension value to add to the extension property array

      Returns this

      this

    • Removes the Extension having the provided url from the extension property array.

      Parameters

      • url: string

        the url that identifies a specific Extension to remove

      Returns void

      AssertionError for invalid url

    • Returns boolean

      true if and only if the data model has required fields (min cardinality > 0) and at least one of those required fields in the instance is empty; false otherwise

    • Returns boolean

      true if the instance is a FHIR complex or primitive datatype; false otherwise