EnrollEligCOB UML Documentation

Element

EnrollEligCOB
Class ResponseItem

"Benefits and optionally current balances, and authorization details by category or service." - HL7 FHIR, CoverageEligibilityResponse.insurance.item

Attributes
«CS» Code	authorizationSupporting	"Codes or comments regarding information or actions associated with the preauthorization." Possible values include: Lab Order; Lab Report; Diagnostic Image Order; Diagnostic Image Report; Professional Report; Accident Report; Model; Picture. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationSupporting
String	authorizationUrl	"A web location for obtaining requirements or descriptive information regarding the preauthorization." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationUrl
Benefit	benefit	"Benefits used to date." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.benefit
«CS» Code	category	"Code to identify the general type of benefits under which products and services are provided." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.category
String	description	"A richer description of the benefit or services covered." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.description
Boolean	isAuthorizationRequired	"A boolean flag indicating whether a preauthorization is required prior to actual service delivery." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationRequired
Boolean	isExcluded	"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." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.excluded
«CS» Code	modifier	"Item typification or modifiers codes to convey additional context for the product or service." Possible values include: Repair of prior service or installation; Temporary service or installation; TMJ treatment; Implant or associated with an implant; Rush or Outside of office hours; None. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.modifier
String	name	"A short name or tag for the benefit." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.name
ProviderNetwork	network	"Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.network Note that FHIR uses a code, but FHIM uses a pointer to the Network class.
«CS» Code	productOrService	"This contains the product, service, drug or other billing code for the item." FHIR recommends the use of USCLS codes. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.productOrService
HealthcareProvider	provider	"The practitioner who is eligible for the provision of the product or service." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.provider
«CS» Code	term	"The term or period of the values such as Maximum lifetime benefit or Maximum annual visits." Possible values include: Annual; Day; Lifetime. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.term
«CS» Code	unit	"Indicates if the benefits apply to an individual or to the family." Possible values include: Individual; Family. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.unit

Properties:

Alias
Classifier Behavior
Is Abstract	false
Is Active	false
Is Leaf	false
Keywords
Name	ResponseItem
Name Expression
Namespace	EnrollEligCOB
Owned Template Signature
Owner	EnrollEligCOB
Owning Template Parameter
Package	EnrollEligCOB
Qualified Name	FHIM::EnrollEligCOB::ResponseItem
Representation
Stereotype
Template Parameter
Visibility	Public

Attribute Details

authorizationSupporting

Public «CS» Code authorizationSupporting

"Codes or comments regarding information or actions associated with the preauthorization." Possible values include: Lab Order; Lab Report; Diagnostic Image Order; Diagnostic Image Report; Professional Report; Accident Report; Model; Picture. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationSupporting

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	authorizationSupporting
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::authorizationSupporting
Stereotype
Template Parameter
Type	«CS» Code
Upper	*
Upper Value	(*)
Visibility	Public

authorizationUrl

Public String authorizationUrl

"A web location for obtaining requirements or descriptive information regarding the preauthorization." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationUrl

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	authorizationUrl
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::authorizationUrl
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

benefit

Public Benefit benefit

"Benefits used to date." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.benefit

Constraints:

Properties:

Aggregation	None
Alias
Association	benefitBalance_benefit
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	benefit
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::benefit
Stereotype
Template Parameter
Type	Benefit
Upper	*
Upper Value	(*)
Visibility	Public

category

Public «CS» Code category

"Code to identify the general type of benefits under which products and services are provided." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.category

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Terminologies	[ HL7_FHIR_R4 Benefit Category Codes http://hl7.org/fhir/ValueSet/ex-benefitcategory ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	category
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::category
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

description

Public String description

"A richer description of the benefit or services covered." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.description

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	description
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::description
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

isAuthorizationRequired

Public Boolean isAuthorizationRequired

"A boolean flag indicating whether a preauthorization is required prior to actual service delivery." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.authorizationRequired

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	isAuthorizationRequired
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::isAuthorizationRequired
Stereotype
Template Parameter
Type	Boolean
Upper	1
Upper Value	(1)
Visibility	Public

isExcluded

Public Boolean isExcluded

"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." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.excluded

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	isExcluded
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::isExcluded
Stereotype
Template Parameter
Type	Boolean
Upper	1
Upper Value	(1)
Visibility	Public

modifier

Public «CS» Code modifier

"Item typification or modifiers codes to convey additional context for the product or service." Possible values include: Repair of prior service or installation; Temporary service or installation; TMJ treatment; Implant or associated with an implant; Rush or Outside of office hours; None. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.modifier

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	modifier
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::modifier
Stereotype
Template Parameter
Type	«CS» Code
Upper	*
Upper Value	(*)
Visibility	Public

name

Public String name

"A short name or tag for the benefit." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.name

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	name
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::name
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

network

Public ProviderNetwork network

"Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.network
Note that FHIR uses a code, but FHIM uses a pointer to the Network class.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	network
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::network
Stereotype
Template Parameter
Type	ProviderNetwork
Upper	1
Upper Value	(1)
Visibility	Public

productOrService

Public «CS» Code productOrService

"This contains the product, service, drug or other billing code for the item." FHIR recommends the use of USCLS codes. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.productOrService

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	productOrService
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::productOrService
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

provider

Public HealthcareProvider provider

"The practitioner who is eligible for the provision of the product or service." - HL7 FHIR, CoverageEligibilityResponse.insurance.item.provider

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	provider
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::provider
Stereotype
Template Parameter
Type	HealthcareProvider
Upper	1
Upper Value	(1)
Visibility	Public

term

Public «CS» Code term

"The term or period of the values such as Maximum lifetime benefit or Maximum annual visits." Possible values include: Annual; Day; Lifetime. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.term

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Terminologies	[ HL7_FHIR_R4 Benefit Term Codes http://hl7.org/fhir/ValueSet/benefit-term ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	term
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::term
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

unit

Public «CS» Code unit

"Indicates if the benefits apply to an individual or to the family." Possible values include: Individual; Family. - HL7 FHIR, CoverageEligibilityResponse.insurance.item.unit

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	ResponseItem
Terminologies	[ HL7_FHIR_R4 Unit Type Codes http://hl7.org/fhir/ValueSet/benefit-unit ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	unit
Name Expression
Namespace	ResponseItem
Opposite
Owner	ResponseItem
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::ResponseItem::unit
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

Overview

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Element

EnrollEligCOB UML Documentation

Summary:AttributesProperties

Detail:Attributes