R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 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

13.2.8 Resource EligibilityRequest - Operations

Financial Management Work GroupMaturity Level: 2 Trial Use Compartments: Patient, Practitioner

This resource has 1 operation associated with it:

$submitSubmit an EligibilityRequest resource for assessment

For more information about operations, including how they are invoked, see Operations.

13.2.8.1 Submit an EligibilityRequest resource for assessment

This operation is used to submit an EligibilityRequest for assessment either as a single EligibilityRequest resource instance or as a Bundle containing the EligibilityRequest and other referenced resources, or Bundle containing a batch of EligibilityRequest resources, either as single EligibilityRequests resources or Bundle resources, for processing. The only input parameter is the single EligibilityRequest or Bundle resource and the only output is a single EligibilityResponse, Bundle of EligibilityResponses or an OperationOutcome resource.

The official URL for this operation definition is

 http://hl7.org/fhir/OperationDefinition/EligibilityRequest-submit

Formal Definition (as a OperationDefinition).

URL: [base]/EligibilityRequest/$submit

This is not an idempotent operation

In Parameters:
NameCardinalityTypeBindingProfileDocumentation
resource1..1Resource

An EligibilityRequest resource or Bundle of EligibilityRequests, either as individual EligibilityRequest resources or as Bundles each containing a single EligibilityRequest plus referenced resources.

Out Parameters:
NameCardinalityTypeBindingProfileDocumentation
return1..1Resource

An EligibilityResponse resource or Bundle of EligibilityResponse responses, either as individual EligibilityResponse resources or as Bundles each containing a single EligibilityResponse plus referenced resources.

13.2.8.1.1 Examples

Request:

POST [baseurl]/EligibilityRequest/$submit
[headers]

<?xml version="1.0" encoding="UTF-8"?>
<EligibilityRequest xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
	<id value="52345"/>

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

	<identifier>
		<system value="http://happyvalley.com/elegibilityrequest"/>
		<value value="52345"/>
	</identifier>

	<status value="active"/>

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

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

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

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

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

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

</EligibilityRequest>

Response:

HTTP/1.1 200 OK
[headers]

<?xml version="1.0" encoding="UTF-8"?>
<EligibilityResponse xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
	<id value="E2500"/>

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

	<identifier>
		<system value="http://www.BenefitsInc.com/fhir/eligibilityresponse"/>
		<value value="881234"/>
	</identifier>

	<status value="active"/>

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

	<request>
		<reference value="http://www.BenefitsInc.com/fhir/eligibility/52345"/>
	</request>

	<outcome value="complete"/>

	<disposition value="Policy is currently in-force."/>

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

	<inforce value="true"/>

</EligibilityResponse>