This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). 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: R3 R2
Detailed Descriptions for the elements in the EligibilityRequest resource.
EligibilityRequest | |
Definition | This resource provides the insurance eligibility details from the insurer regarding a specified coverage and optionally some class of service. |
Control | 1..1 |
EligibilityRequest.identifier | |
Definition | The Response business identifier. |
Note | This is a business identifer, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
EligibilityRequest.status | |
Definition | The status of the resource instance. |
Control | 1..1 |
Binding | EligibilityRequestStatus: A code specifying the state of the resource instance. (Required) |
Type | code |
Is Modifier | true |
Summary | true |
EligibilityRequest.ruleset | |
Definition | The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
EligibilityRequest.originalRuleset | |
Definition | The style (standard) and version of the original material which was converted into this resource. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Requirements | Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. |
EligibilityRequest.created | |
Definition | The date when this resource was created. |
Control | 0..1 |
Type | dateTime |
EligibilityRequest.insurer[x] | |
Definition | The Insurer who is target of the request. |
Control | 0..1 |
Type | Identifier|Reference(Organization) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.provider[x] | |
Definition | The practitioner who is responsible for the services rendered to the patient. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.organization[x] | |
Definition | The organization which is responsible for the services rendered to the patient. |
Control | 0..1 |
Type | Identifier|Reference(Organization) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.priority | |
Definition | Immediate (STAT), best effort (NORMAL), deferred (DEFER). |
Control | 0..1 |
Binding | Priority Codes: The timeliness with which processing is required: STAT, normal, Deferred (Example) |
Type | Coding |
EligibilityRequest.enterer[x] | |
Definition | Person who created the invoice/claim/pre-determination or pre-authorization. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.facility[x] | |
Definition | Facility where the services were provided. |
Control | 0..1 |
Type | Identifier|Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.patient[x] | |
Definition | Patient Resource. |
Control | 0..1 |
Type | Identifier|Reference(Patient) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Comments | 1..1. |
EligibilityRequest.coverage[x] | |
Definition | Financial instrument by which payment information for health care. |
Control | 0..1 |
Type | Identifier|Reference(Coverage) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. |
Comments | 1..1. |
EligibilityRequest.businessArrangement | |
Definition | The contract number of a business agreement which describes the terms and conditions. |
Control | 0..1 |
Type | string |
EligibilityRequest.serviced[x] | |
Definition | The date or dates when the enclosed suite of services were performed or completed. |
Control | 0..1 |
Type | date|Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
EligibilityRequest.benefitCategory | |
Definition | Dental, Vision, Medical, Pharmacy, Rehab etc. |
Control | 0..1 |
Binding | Benefit Category Codes: Benefit categories such as: oral, medical, vision etc. (Example) |
Type | Coding |
EligibilityRequest.benefitSubCategory | |
Definition | Dental: basic, major, ortho; Vision exam, glasses, contacts; etc. |
Control | 0..1 |
Binding | Benefit SubCategory Codes: Benefit subcategories such as: oral-basic, major, glasses (Example) |
Type | Coding |