fhir/plugins/org.eclipse.mdht.fhir.xsd/model/schemas/eligibilityresponse.xsd

<?xml version="1.0" encoding="UTF-8"?>
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  Generated on Wed, Dec 20, 2017 15:52+1100 for FHIR v3.2.0 

  Note: the schemas &amp; schematrons do not contain all of the rules about what makes resources
  valid. Implementers will still need to be familiar with the content of the specification and with
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<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" targetNamespace="http://hl7.org/fhir" elementFormDefault="qualified" version="1.0">
  <xs:include schemaLocation="fhir-base.xsd"/>
  <xs:element name="EligibilityResponse" type="EligibilityResponse">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="EligibilityResponse">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="DomainResource">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">The Response business identifier.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="status" minOccurs="0" maxOccurs="1" type="FinancialResourceStatusCodes">
            <xs:annotation>
              <xs:documentation xml:lang="en">The status of the resource instance.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="created" minOccurs="0" maxOccurs="1" type="dateTime">
            <xs:annotation>
              <xs:documentation xml:lang="en">The date when the enclosed suite of services were performed or completed.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="requestProvider" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The practitioner who is responsible for the services rendered to the patient.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="requestOrganization" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The organization which is responsible for the services rendered to the patient.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="request" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Original request resource reference.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="outcome" minOccurs="0" maxOccurs="1" type="RemittanceOutcome">
            <xs:annotation>
              <xs:documentation xml:lang="en">Transaction status: error, complete.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="disposition" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A description of the status of the adjudication.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="insurer" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The Insurer who produced this adjudicated response.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="inforce" minOccurs="0" maxOccurs="1" type="boolean">
            <xs:annotation>
              <xs:documentation xml:lang="en">Flag indicating if the coverage provided is inforce currently  if no service date(s) specified or for the whole duration of the service dates.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="insurance" type="EligibilityResponse.Insurance" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="preAuthRef" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A reference from the Insurer to which these services pertain.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="authorization" type="EligibilityResponse.Authorization" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A list of billable services for which an authorization prior to service delivery may be required by the payor.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="form" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The form to be used for printing the content.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="error" type="EligibilityResponse.Error" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Mutually exclusive with Services Provided (Item).</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="EligibilityResponse.Insurance">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="coverage" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of updated or additional Coverages from the Insurer.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="contract" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The contract resource which may provide more detailed information.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="benefitBalance" type="EligibilityResponse.BenefitBalance" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Benefits and optionally current balances by Category.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="EligibilityResponse.BenefitBalance">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="category" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Dental, Vision, Medical, Pharmacy, Rehab etc.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subCategory" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="excluded" minOccurs="0" maxOccurs="1" type="boolean">
            <xs:annotation>
              <xs:documentation xml:lang="en">True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="name" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A short name or tag for the benefit, for example MED01, or DENT2.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="description" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Network designation.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="unit" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Unit designation: individual or family.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="term" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="financial" type="EligibilityResponse.Financial" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Benefits Used to date.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="EligibilityResponse.Financial">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Deductable, visits, benefit amount.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:choice minOccurs="0" maxOccurs="1" >
            <xs:annotation>
              <xs:documentation xml:lang="en">Benefits allowed.</xs:documentation>
            </xs:annotation>
            <xs:element name="allowedUnsignedInt" type="unsignedInt"/>
            <xs:element name="allowedString" type="string"/>
            <xs:element name="allowedMoney" type="Money"/>
          </xs:choice>
          <xs:choice minOccurs="0" maxOccurs="1" >
            <xs:annotation>
              <xs:documentation xml:lang="en">Benefits used.</xs:documentation>
            </xs:annotation>
            <xs:element name="usedUnsignedInt" type="unsignedInt"/>
            <xs:element name="usedMoney" type="Money"/>
          </xs:choice>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="EligibilityResponse.Authorization">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="authorizationSequence" minOccurs="1" maxOccurs="1" type="positiveInt">
            <xs:annotation>
              <xs:documentation xml:lang="en">Sequence of procedures which serves to order and provide a link.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="required" minOccurs="1" maxOccurs="1" type="boolean">
            <xs:annotation>
              <xs:documentation xml:lang="en">A boolean flag indicating whether a prior authorization or pre-authorization is required prior to actual service delivery.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="note" minOccurs="0" maxOccurs="unbounded" type="Annotation">
            <xs:annotation>
              <xs:documentation xml:lang="en">Any comments regarding information or actions assciated with the pre-authorization.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="EligibilityResponse.Error">
    <xs:annotation>
      <xs:documentation xml:lang="en">This resource provides eligibility and plan details from the processing of an Eligibility resource.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="code" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">An error code,from a specified code system, which details why the eligibility check could not be performed.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
</xs:schema>