Release 4

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU) in it's permanent home (it will always be available at this URL). 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

Coverageeligibilityrequest-example-2.xml

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Patient, Practitioner

Raw XML (canonical form + also see XML Format Specification)

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Primary Coverage specifying Benefit Example (id = "52346")

<?xml version="1.0" encoding="UTF-8"?>

<CoverageEligibilityRequest xmlns="http://hl7.org/fhir">
  <id value="52346"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityRequest</div> 
  </text> 

  <identifier> 
    <system value="http://happyvalley.com/coverageelegibilityrequest"/> 
    <value value="52346"/> 
  </identifier> 

  <status value="active"/> 

  <priority> 
    <coding> 
      <code value="normal"/> 
    </coding> 
  </priority> 

  <purpose value="validation"/> 
  <purpose value="benefits"/> 

  <patient> 
    <reference value="Patient/pat1"/> 
  </patient> 

  <servicedDate value="2014-09-17"/>  <!--   Anticipated service date   -->

  <created value="2014-08-16"/> 

  <enterer> 
    <identifier> 
      <system value="http://happyvalleyclinic.com/staff"/> 
      <value value="14"/> 
    </identifier> 
  </enterer> 

  <provider> 
    <reference value="Organization/1"/> 
  </provider> 

  <insurer> 
    <reference value="Organization/2"/> 
  </insurer> 

  <facility> 
    <identifier> 
      <system value="http://statecliniclicensor.com/clinicid"/> 
      <value value="G35B9"/> 
    </identifier> 
  </facility> 

  <insurance> 
    <coverage> 
      <reference value="Coverage/9876B1"/> 
    </coverage> 

    <businessArrangement value="NB8742"/> 
  </insurance> 

  <item> 
    <category> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> 
        <code value="69"/> 
        <display value="Maternity"/> 
      </coding> 
    </category> 
  </item> 

</CoverageEligibilityRequest>

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.