This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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
Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative |
Raw XML (canonical form + also see XML Format Specification)
Definition for Code SystemEligibilityResponsePurpose
<?xml version="1.0" encoding="UTF-8"?> <CodeSystem xmlns="http://hl7.org/fhir"> <id value="eligibilityresponse-purpose"/> <meta> <lastUpdated value="2022-09-07T10:58:29.429+10:00"/> <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <p> This code system <code> http://hl7.org/fhir/eligibilityresponse-purpose</code> defines the following codes: </p> <table class="codes"> <tr> <td style="white-space:nowrap"> <b> Code</b> </td> <td> <b> Display</b> </td> <td> <b> Definition</b> </td> </tr> <tr> <td style="white-space:nowrap">auth-requirements <a name="eligibilityresponse-purpose-auth-requirements"> </a> </td> <td> Coverage auth-requirements</td> <td> The prior authorization requirements for the listed, or discovered if specified, converages for the categories of service and/or specifed biling codes are requested.</td> </tr> <tr> <td style="white-space:nowrap">benefits <a name="eligibilityresponse-purpose-benefits"> </a> </td> <td> Coverage benefits</td> <td> The plan benefits and optionally benefits consumed for the listed, or discovered if specified, converages are requested.</td> </tr> <tr> <td style="white-space:nowrap">discovery <a name="eligibilityresponse-purpose-discovery"> </a> </td> <td> Coverage Discovery</td> <td> The insurer is requested to report on any coverages which they are aware of in addition to any specifed.</td> </tr> <tr> <td style="white-space:nowrap">validation <a name="eligibilityresponse-purpose-validation"> </a> </td> <td> Coverage Validation</td> <td> A check that the specified coverages are in-force is requested.</td> </tr> </table> </div> </text> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"> <valueCode value="fm"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="trial-use"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"> <valueInteger value="2"/> </extension> <url value="http://hl7.org/fhir/eligibilityresponse-purpose"/> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:oid:2.16.840.1.113883.4.642.4.1185"/> </identifier> <version value="5.0.0-ballot"/> <name value="EligibilityResponsePurpose"/> <title value="EligibilityResponsePurpose"/> <status value="draft"/> <experimental value="false"/> <date value="2021-01-05T10:01:24+11:00"/> <publisher value="HL7 (FHIR Project)"/> <contact> <telecom> <system value="url"/> <value value="http://hl7.org/fhir"/> </telecom> <telecom> <system value="email"/> <value value="fhir@lists.hl7.org"/> </telecom> </contact> <description value="A code specifying the types of information being requested."/> <caseSensitive value="true"/> <valueSet value="http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose"/> <content value="complete"/> <concept> <code value="auth-requirements"/> <display value="Coverage auth-requirements"/> <definition value="The prior authorization requirements for the listed, or discovered if specified, converages for the categories of service and/or specifed biling codes are requested."/> </concept> <concept> <code value="benefits"/> <display value="Coverage benefits"/> <definition value="The plan benefits and optionally benefits consumed for the listed, or discovered if specified, converages are requested."/> </concept> <concept> <code value="discovery"/> <display value="Coverage Discovery"/> <definition value="The insurer is requested to report on any coverages which they are aware of in addition to any specifed."/> </concept> <concept> <code value="validation"/> <display value="Coverage Validation"/> <definition value="A check that the specified coverages are in-force is requested."/> </concept> </CodeSystem>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.