Release 4B Ballot #1

This page is part of the FHIR Specification v4.1.0: R4B Ballot. About the R4B version of FHIR. 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

13.4 Resource EnrollmentRequest - Content

Financial Management

Work Group

Maturity Level: 0

Trial Use

Security Category: Patient

Compartments: Patient

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

13.4.1 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

13.4.2 References

This resource is referenced by EnrollmentResponse.

This resource implements the Request pattern.

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest	TU		DomainResource	Enroll in coverage Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
created		0..1	dateTime	Creation date
insurer		0..1	Reference(Organization)	Target
provider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
candidate		0..1	Reference(Patient)	The subject to be enrolled
coverage		0..1	Reference(Coverage)	Insurance information
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <provider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></provider>
 <candidate><!-- 0..1 Reference(Patient) The subject to be enrolled --></candidate>
 <coverage><!-- 0..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "candidate" : { Reference(Patient) }, // The subject to be enrolled
  "coverage" : { Reference(Coverage) } // Insurance information
}

Turtle Template

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


[ 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 ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentRequest.insurer [ Reference(Organization) ]; # 0..1 Target
  fhir:EnrollmentRequest.provider [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
  fhir:EnrollmentRequest.candidate [ Reference(Patient) ]; # 0..1 The subject to be enrolled
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 0..1 Insurance information
]

Changes since R3

EnrollmentRequest

EnrollmentRequest.status

Change value set from http://hl7.org/fhir/ValueSet/fm-status|4.0.0 to http://hl7.org/fhir/ValueSet/fm-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.)

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest	TU		DomainResource	Enroll in coverage Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
created		0..1	dateTime	Creation date
insurer		0..1	Reference(Organization)	Target
provider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
candidate		0..1	Reference(Patient)	The subject to be enrolled
coverage		0..1	Reference(Coverage)	Insurance information
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <provider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></provider>
 <candidate><!-- 0..1 Reference(Patient) The subject to be enrolled --></candidate>
 <coverage><!-- 0..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "candidate" : { Reference(Patient) }, // The subject to be enrolled
  "coverage" : { Reference(Coverage) } // Insurance information
}

Turtle Template

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


[ 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 ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentRequest.insurer [ Reference(Organization) ]; # 0..1 Target
  fhir:EnrollmentRequest.provider [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
  fhir:EnrollmentRequest.candidate [ Reference(Patient) ]; # 0..1 The subject to be enrolled
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 0..1 Insurance information
]

Changes since Release 3

EnrollmentRequest

EnrollmentRequest.status

Change value set from http://hl7.org/fhir/ValueSet/fm-status|4.0.0 to http://hl7.org/fhir/ValueSet/fm-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.)

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

13.4.3.1 Terminology Bindings

Path	Definition	Type	Reference
EnrollmentRequest.status	A code specifying the state of the resource instance.	Required	FinancialResourceStatusCodes

Path

Definition

Type

Reference

EnrollmentRequest.status

A code specifying the state of the resource instance.

Required

FinancialResourceStatusCodes

13.4.4 Search Parameters

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

Name	Type	Description	Expression	In Common
identifier	token	The business identifier of the Enrollment	EnrollmentRequest.identifier
patient	reference	The party to be enrolled	EnrollmentRequest.candidate (Patient)
status	token	The status of the enrollment	EnrollmentRequest.status
subject	reference	The party to be enrolled	EnrollmentRequest.candidate (Patient)