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

13.5 Resource EnrollmentResponse - Content

Financial Management

Work Group

Maturity Level: 0

Trial Use

Security Category: Patient

Compartments: Not linked to any defined compartments

This resource provides enrollment and plan details from the processing of an EnrollmentRequest resource.

13.5.1 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 EnrollmentResponse resource provides enrollment and plan details from the processing of an Enrollment resource.

13.5.2 References

No resources refer to this resource directly.

This resource implements the Event pattern.

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentResponse	TU		DomainResource	EnrollmentResponse resource 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)
request		0..1	Reference(EnrollmentRequest)	Claim reference
outcome		0..1	code	complete \| error \| partial RemittanceOutcome (Required)
disposition		0..1	string	Disposition Message
created		0..1	dateTime	Creation date
organization		0..1	Reference(Organization)	Insurer
requestProvider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentResponse 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 -->
 <request><!-- 0..1 Reference(EnrollmentRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestProvider>
</EnrollmentResponse>

JSON Template

{
  "resourceType" : "EnrollmentResponse",
  // 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
  "request" : { Reference(EnrollmentRequest) }, // Claim reference
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "created" : "<dateTime>", // Creation date
  "organization" : { Reference(Organization) }, // Insurer
  "requestProvider" : { Reference(Organization|Practitioner|PractitionerRole) } // Responsible practitioner
}

Turtle Template

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


[ a fhir:EnrollmentResponse;
  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:EnrollmentResponse.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentResponse.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentResponse.request [ Reference(EnrollmentRequest) ]; # 0..1 Claim reference
  fhir:EnrollmentResponse.outcome [ code ]; # 0..1 complete | error | partial
  fhir:EnrollmentResponse.disposition [ string ]; # 0..1 Disposition Message
  fhir:EnrollmentResponse.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentResponse.organization [ Reference(Organization) ]; # 0..1 Insurer
  fhir:EnrollmentResponse.requestProvider [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
]

Changes since R3

EnrollmentResponse

EnrollmentResponse.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

EnrollmentResponse.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to http://hl7.org/fhir/ValueSet/remittance-outcome|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. All tests pass round-trip testing and all r3 resources are valid.)

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentResponse	TU		DomainResource	EnrollmentResponse resource 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)
request		0..1	Reference(EnrollmentRequest)	Claim reference
outcome		0..1	code	complete \| error \| partial RemittanceOutcome (Required)
disposition		0..1	string	Disposition Message
created		0..1	dateTime	Creation date
organization		0..1	Reference(Organization)	Insurer
requestProvider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentResponse 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 -->
 <request><!-- 0..1 Reference(EnrollmentRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestProvider>
</EnrollmentResponse>

JSON Template

{
  "resourceType" : "EnrollmentResponse",
  // 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
  "request" : { Reference(EnrollmentRequest) }, // Claim reference
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "created" : "<dateTime>", // Creation date
  "organization" : { Reference(Organization) }, // Insurer
  "requestProvider" : { Reference(Organization|Practitioner|PractitionerRole) } // Responsible practitioner
}

Turtle Template

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


[ a fhir:EnrollmentResponse;
  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:EnrollmentResponse.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentResponse.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentResponse.request [ Reference(EnrollmentRequest) ]; # 0..1 Claim reference
  fhir:EnrollmentResponse.outcome [ code ]; # 0..1 complete | error | partial
  fhir:EnrollmentResponse.disposition [ string ]; # 0..1 Disposition Message
  fhir:EnrollmentResponse.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentResponse.organization [ Reference(Organization) ]; # 0..1 Insurer
  fhir:EnrollmentResponse.requestProvider [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
]

Changes since Release 3

EnrollmentResponse

EnrollmentResponse.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

EnrollmentResponse.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to http://hl7.org/fhir/ValueSet/remittance-outcome|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. All tests pass 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

13.5.3.1 Terminology Bindings

Path	Definition	Type	Reference
EnrollmentResponse.status	A code specifying the state of the resource instance.	Required	FinancialResourceStatusCodes
EnrollmentResponse.outcome	The outcome of the processing.	Required	RemittanceOutcome

Path

Definition

Type

Reference

EnrollmentResponse.status

A code specifying the state of the resource instance.

Required

FinancialResourceStatusCodes

EnrollmentResponse.outcome

The outcome of the processing.

Required

RemittanceOutcome

13.5.4 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 EnrollmentResponse	EnrollmentResponse.identifier
request	reference	The reference to the claim	EnrollmentResponse.request (EnrollmentRequest)
status	token	The status of the enrollment response	EnrollmentResponse.status