Release 5 Draft Ballot

This page is part of the FHIR Specification (v4.6.0: R5 Draft Ballot). 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.json

Financial Management Work Group

Maturity Level: N/A

Standards Status: Informative

Compartments: Patient, Practitioner

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

Primary Coverage specifying Benefit Example

{
  "resourceType": "CoverageEligibilityRequest",
  "id": "52346",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityRequest</div>"
  },
  "identifier": [
    {
      "system": "http://happyvalley.com/coverageelegibilityrequest",
      "value": "52346"
    }
  ],
  "status": "active",
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "purpose": [
    "validation",
    "benefits"
  ],
  "patient": {
    "reference": "Patient/pat1"
  },
  "servicedDate": "2014-09-17",
  "created": "2014-08-16",
  "enterer": {
    "identifier": {
      "system": "http://happyvalleyclinic.com/staff",
      "value": "14"
    }
  },
  "provider": {
    "reference": "Organization/1"
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "facility": {
    "identifier": {
      "system": "http://statecliniclicensor.com/clinicid",
      "value": "G35B9"
    }
  },
  "insurance": [
    {
      "coverage": {
        "reference": "Coverage/9876B1"
      },
      "businessArrangement": "NB8742"
    }
  ],
  "item": [
    {
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
            "code": "69",
            "display": "Maternity"
          }
        ]
      }
    }
  ]
}

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.