STU 3 Ballot

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: R5 R4B R4 R3 R2

13.7 Resource EnrollmentRequest - Content

This resource is marked as a draft.

Financial Management Work GroupMaturity Level: 0Compartments: Patient

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

13.7.1 Scope and Usage

This resource has not yet undergone proper review by FM. At this time it is a 'stub', is known to be incomplete, and 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

13.7.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EnrollmentRequest DomainResourceEnrollment request
... identifier 0..*IdentifierBusiness Identifier
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
EnrollmentRequestStatus (Required)
... ruleset 0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset Codes (Example)
... created 0..1dateTimeCreation date
... insurer[x] 0..1Target
.... insurerIdentifierIdentifier
.... insurerReferenceReference(Organization)
... provider[x] 0..1Responsible practitioner
.... providerIdentifierIdentifier
.... providerReferenceReference(Practitioner)
... organization[x] 0..1Responsible organization
.... organizationIdentifierIdentifier
.... organizationReferenceReference(Organization)
... subject[x] 1..1The subject of the Products and Services
.... subjectIdentifierIdentifier
.... subjectReferenceReference(Patient)
... coverage 1..1Reference(Coverage)Insurance information

doco Documentation for this format

UML Diagram (Legend)

EnrollmentRequest (DomainResource)The Response business identifieridentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)EnrollmentRequestStatus! »The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when this resource was createdcreated : dateTime [0..1]The Insurer who is target of the requestinsurer[x] : Type [0..1] « Identifier|Reference(Organization) »The practitioner who is responsible for the services rendered to the patientprovider[x] : Type [0..1] « Identifier|Reference(Practitioner) »The organization which is responsible for the services rendered to the patientorganization[x] : Type [0..1] « Identifier|Reference(Organization) »Patient Resourcesubject[x] : Type [1..1] « Identifier|Reference(Patient) »Reference to the program or plan identification, underwriter or payorcoverage : Reference [1..1] « Coverage »

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer[x]><!-- 0..1 Identifier|Reference(Organization) Target --></insurer[x]>
 <provider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></provider[x]>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></organization[x]>
 <subject[x]><!-- 1..1 Identifier|Reference(Patient) The subject of the Products and Services --></subject[x]>
 <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{doco
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  // insurer[x]: Target. One of these 2:
  "insurerIdentifier" : { Identifier },
  "insurerReference" : { Reference(Organization) },
  // provider[x]: Responsible practitioner. One of these 2:
  "providerIdentifier" : { Identifier },
  "providerReference" : { Reference(Practitioner) },
  // organization[x]: Responsible organization. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // subject[x]: The subject of the Products and Services. One of these 2:
  "subjectIdentifier" : { Identifier },
  "subjectReference" : { Reference(Patient) },
  "coverage" : { Reference(Coverage) } // R!  Insurance information
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:EnrollmentRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EnrollmentRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentRequest.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.ruleset [ Coding ]; # 0..1 Resource version
  fhir:EnrollmentRequest.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  # EnrollmentRequest.insurer[x] : 0..1 Target. One of these 2
    fhir:EnrollmentRequest.insurerIdentifier [ Identifier ]
    fhir:EnrollmentRequest.insurerReference [ Reference(Organization) ]
  # EnrollmentRequest.provider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:EnrollmentRequest.providerIdentifier [ Identifier ]
    fhir:EnrollmentRequest.providerReference [ Reference(Practitioner) ]
  # EnrollmentRequest.organization[x] : 0..1 Responsible organization. One of these 2
    fhir:EnrollmentRequest.organizationIdentifier [ Identifier ]
    fhir:EnrollmentRequest.organizationReference [ Reference(Organization) ]
  # EnrollmentRequest.subject[x] : 1..1 The subject of the Products and Services. One of these 2
    fhir:EnrollmentRequest.subjectIdentifier [ Identifier ]
    fhir:EnrollmentRequest.subjectReference [ Reference(Patient) ]
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 1..1 Insurance information
]

Changes since DSTU2

EnrollmentRequest
EnrollmentRequest.status added
EnrollmentRequest.insurer[x] added
EnrollmentRequest.provider[x] Renamed from provider to provider[x]
Add Identifier
EnrollmentRequest.organization[x] Renamed from organization to organization[x]
Add Identifier
EnrollmentRequest.subject[x] Renamed from subject to subject[x]
Add Identifier
EnrollmentRequest.target deleted
EnrollmentRequest.relationship deleted

See the Full Difference for further information

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EnrollmentRequest DomainResourceEnrollment request
... identifier 0..*IdentifierBusiness Identifier
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
EnrollmentRequestStatus (Required)
... ruleset 0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset Codes (Example)
... created 0..1dateTimeCreation date
... insurer[x] 0..1Target
.... insurerIdentifierIdentifier
.... insurerReferenceReference(Organization)
... provider[x] 0..1Responsible practitioner
.... providerIdentifierIdentifier
.... providerReferenceReference(Practitioner)
... organization[x] 0..1Responsible organization
.... organizationIdentifierIdentifier
.... organizationReferenceReference(Organization)
... subject[x] 1..1The subject of the Products and Services
.... subjectIdentifierIdentifier
.... subjectReferenceReference(Patient)
... coverage 1..1Reference(Coverage)Insurance information

doco Documentation for this format

UML Diagram (Legend)

EnrollmentRequest (DomainResource)The Response business identifieridentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)EnrollmentRequestStatus! »The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when this resource was createdcreated : dateTime [0..1]The Insurer who is target of the requestinsurer[x] : Type [0..1] « Identifier|Reference(Organization) »The practitioner who is responsible for the services rendered to the patientprovider[x] : Type [0..1] « Identifier|Reference(Practitioner) »The organization which is responsible for the services rendered to the patientorganization[x] : Type [0..1] « Identifier|Reference(Organization) »Patient Resourcesubject[x] : Type [1..1] « Identifier|Reference(Patient) »Reference to the program or plan identification, underwriter or payorcoverage : Reference [1..1] « Coverage »

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer[x]><!-- 0..1 Identifier|Reference(Organization) Target --></insurer[x]>
 <provider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></provider[x]>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></organization[x]>
 <subject[x]><!-- 1..1 Identifier|Reference(Patient) The subject of the Products and Services --></subject[x]>
 <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{doco
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  // insurer[x]: Target. One of these 2:
  "insurerIdentifier" : { Identifier },
  "insurerReference" : { Reference(Organization) },
  // provider[x]: Responsible practitioner. One of these 2:
  "providerIdentifier" : { Identifier },
  "providerReference" : { Reference(Practitioner) },
  // organization[x]: Responsible organization. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // subject[x]: The subject of the Products and Services. One of these 2:
  "subjectIdentifier" : { Identifier },
  "subjectReference" : { Reference(Patient) },
  "coverage" : { Reference(Coverage) } // R!  Insurance information
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:EnrollmentRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EnrollmentRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentRequest.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.ruleset [ Coding ]; # 0..1 Resource version
  fhir:EnrollmentRequest.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  # EnrollmentRequest.insurer[x] : 0..1 Target. One of these 2
    fhir:EnrollmentRequest.insurerIdentifier [ Identifier ]
    fhir:EnrollmentRequest.insurerReference [ Reference(Organization) ]
  # EnrollmentRequest.provider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:EnrollmentRequest.providerIdentifier [ Identifier ]
    fhir:EnrollmentRequest.providerReference [ Reference(Practitioner) ]
  # EnrollmentRequest.organization[x] : 0..1 Responsible organization. One of these 2
    fhir:EnrollmentRequest.organizationIdentifier [ Identifier ]
    fhir:EnrollmentRequest.organizationReference [ Reference(Organization) ]
  # EnrollmentRequest.subject[x] : 1..1 The subject of the Products and Services. One of these 2
    fhir:EnrollmentRequest.subjectIdentifier [ Identifier ]
    fhir:EnrollmentRequest.subjectReference [ Reference(Patient) ]
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 1..1 Insurance information
]

Changes since DSTU2

EnrollmentRequest
EnrollmentRequest.status added
EnrollmentRequest.insurer[x] added
EnrollmentRequest.provider[x] Renamed from provider to provider[x]
Add Identifier
EnrollmentRequest.organization[x] Renamed from organization to organization[x]
Add Identifier
EnrollmentRequest.subject[x] Renamed from subject to subject[x]
Add Identifier
EnrollmentRequest.target deleted
EnrollmentRequest.relationship deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

13.7.2.1 Terminology Bindings

PathDefinitionTypeReference
EnrollmentRequest.status A code specifying the state of the resource instance.RequiredEnrollmentRequestStatus
EnrollmentRequest.ruleset
EnrollmentRequest.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard/version.ExampleRuleset Codes

13.7.3 Search Parameters

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

NameTypeDescriptionPaths
identifiertokenThe business identifier of the EnrollmentEnrollmentRequest.identifier
patient-identifiertokenThe party to be enrolledEnrollmentRequest.subjectidentifier
patient-referencereferenceThe party to be enrolledEnrollmentRequest.subjectreference
(Patient)
subject-identifiertokenThe party to be enrolledEnrollmentRequest.subjectidentifier
subject-referencereferenceThe party to be enrolledEnrollmentRequest.subjectreference
(Patient)