GAO Ballot Package

This page is part of the FHIR Specification (v1.1.0: STU 3 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

This is a frozen snapshot of the FHIR specification created for the purpose of balloting the GAO implementation Guide. It includes draft changes that may be part of the future DSTU 2.1 release but further change is expected. Readers should focus solely on the GAO implementation content, and FHIR DSTU 2 for other purposes.

7.7 Resource EnrollmentRequest - Content

This resource is marked as a draft.

Financial Management

Work Group

Maturity Level: 0

Compartments: Patient

This resource provides the insurance enrollment details to the insurer regarding a specified coverage.

7.7.1 Scope and Usage

This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft.

The EnrollmentRequest resource allows for the addition and removal of plan subscribers and their dependents to health insurance coverage.

Todo

This resource is referenced by enrollmentresponse

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest	Σ		DomainResource	Enrollment request
identifier	Σ	0..*	Identifier	Business Identifier
ruleset	Σ	0..1	Coding	Resource version Ruleset Codes (Example)
originalRuleset	Σ	0..1	Coding	Original version Ruleset Codes (Example)
created	Σ	0..1	dateTime	Creation date
target	Σ	0..1	Reference(Organization)	Insurer
provider	Σ	0..1	Reference(Practitioner)	Responsible practitioner
organization	Σ	0..1	Reference(Organization)	Responsible organization
subject	Σ	1..1	Reference(Patient)	The subject of the Products and Services
coverage	Σ	1..1	Reference(Coverage)	Insurance information
relationship	Σ	1..1	Coding	Patient relationship to subscriber Surface Codes (Example)
Documentation for this format

UML Diagram

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <target><!-- 0..1 Reference(Organization) Insurer --></target>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <subject><!-- 1..1 Reference(Patient) The subject of the Products and Services --></subject>
 <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
 <relationship><!-- 1..1 Coding Patient relationship to subscriber --></relationship>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Insurer
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "subject" : { Reference(Patient) }, // R!  The subject of the Products and Services
  "coverage" : { Reference(Coverage) }, // R!  Insurance information
  "relationship" : { Coding } // R!  Patient relationship to subscriber
}

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest	Σ		DomainResource	Enrollment request
identifier	Σ	0..*	Identifier	Business Identifier
ruleset	Σ	0..1	Coding	Resource version Ruleset Codes (Example)
originalRuleset	Σ	0..1	Coding	Original version Ruleset Codes (Example)
created	Σ	0..1	dateTime	Creation date
target	Σ	0..1	Reference(Organization)	Insurer
provider	Σ	0..1	Reference(Practitioner)	Responsible practitioner
organization	Σ	0..1	Reference(Organization)	Responsible organization
subject	Σ	1..1	Reference(Patient)	The subject of the Products and Services
coverage	Σ	1..1	Reference(Coverage)	Insurance information
relationship	Σ	1..1	Coding	Patient relationship to subscriber Surface Codes (Example)
Documentation for this format

UML Diagram

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <target><!-- 0..1 Reference(Organization) Insurer --></target>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <subject><!-- 1..1 Reference(Patient) The subject of the Products and Services --></subject>
 <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
 <relationship><!-- 1..1 Coding Patient relationship to subscriber --></relationship>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Insurer
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "subject" : { Reference(Patient) }, // R!  The subject of the Products and Services
  "coverage" : { Reference(Coverage) }, // R!  Insurance information
  "relationship" : { Coding } // R!  Patient relationship to subscriber
}

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

7.7.2.1 Terminology Bindings

Path	Definition	Type	Reference
EnrollmentRequest.ruleset EnrollmentRequest.originalRuleset	The static and dynamic model to which contents conform, which may be business version or standard/version.	Example	Ruleset Codes
EnrollmentRequest.relationship	The code for the relationship of the patient to the subscriber.	Example	Surface Codes

Path

Definition

Type

Reference

EnrollmentRequest.ruleset
EnrollmentRequest.originalRuleset

The static and dynamic model to which contents conform, which may be business version or standard/version.

Example

Ruleset Codes

EnrollmentRequest.relationship

The code for the relationship of the patient to the subscriber.

Example

Surface Codes

7.7.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Paths
identifier	token	The business identifier of the Enrollment	EnrollmentRequest.identifier
patient	reference	The party to be enrolled	EnrollmentRequest.subject (Patient)
subject	reference	The party to be enrolled	EnrollmentRequest.subject (Patient)