| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
CoverageEligibilityRequest
|
TU | DomainResource | CoverageEligibilityRequest resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension |
|
identifier
|
0..* | Identifier | Business Identifier for coverage eligiblity request
|
|
status
|
?! Σ | 1..1 | code | active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes ( Required) |
|
priority
|
0..1 | CodeableConcept | Desired processing priority
Binding: Process Priority Codes ( Example) |
|
|
purpose
|
Σ | 1..* | code | auth-requirements | benefits | discovery | validation
Binding: Eligibility Request Purpose ( Required) |
patient
|
Σ | 1..1 | Reference( Patient) | Intended recipient of products and services
|
event
|
0..* | BackboneElement | Event information
|
|
type
|
1..1 | CodeableConcept | Specific event
Binding: Dates Type Codes ( Example) |
|
when[x]
|
1..1 | Occurance date or period
|
||
whenDateTime
|
dateTime | |||
|
whenPeriod
|
Period | |||
|
serviced[x]
|
0..1 | Estimated date or dates of service
|
||
|
servicedDate
|
date | |||
|
servicedPeriod
|
Period | |||
|
created
|
Σ | 1..1 | dateTime | Creation date
|
|
enterer
|
0..1 | Reference( Practitioner | PractitionerRole) | Author
|
|
|
provider
|
0..1 | Reference( Practitioner | PractitionerRole | Organization) | Party responsible for the request
|
|
|
insurer
|
Σ | 1..1 | Reference( Organization) | Coverage issuer
|
|
facility
|
0..1 | Reference( Location) | Servicing facility
|
|
|
supportingInfo
|
0..* | BackboneElement | Supporting information
|
|
|
sequence
|
1..1 | positiveInt | Information instance identifier
|
|
|
information
|
1..1 | Reference( Any) | Data to be provided
|
|
|
appliesToAll
|
0..1 | boolean | Applies to all items
|
|
|
insurance
|
0..* | BackboneElement | Patient insurance information
|
|
|
focal
|
0..1 | boolean | Applicable coverage
|
|
|
coverage
|
1..1 | Reference( Coverage) | Insurance information
|
|
|
businessArrangement
|
0..1 | string | Additional provider contract number
|
|
|
item
|
0..* | BackboneElement | Item to be evaluated for eligibiity
|
|
|
supportingInfoSequence
|
0..* | positiveInt | Applicable exception or supporting information
|
|
|
category
|
0..1 | CodeableConcept | Benefit classification
Binding: Benefit Category Codes ( Example) |
|
|
productOrService
|
0..1 | CodeableConcept | Billing, service, product, or drug code
Binding: USCLS Codes ( Example) |
|
|
modifier
|
0..* | CodeableConcept | Product or service billing modifiers
Binding: Modifier type Codes ( Example) |
|
|
provider
|
0..1 | Reference( Practitioner | PractitionerRole) | Perfoming practitioner
|
|
|
quantity
|
0..1 | SimpleQuantity | Count of products or services
|
|
|
unitPrice
|
0..1 | Money | Fee, charge or cost per item
|
|
|
facility
|
0..1 | Reference( Location | Organization) | Servicing facility
|
|
|
diagnosis
|
0..* | BackboneElement | Applicable diagnosis
|
|
|
diagnosis[x]
|
0..1 | Nature of illness or problem
Binding: ICD-10 Codes ( Example) |
||
|
diagnosisCodeableConcept
|
CodeableConcept | |||
|
diagnosisReference
|
Reference( Condition) | |||
|
detail
|
0..* | Reference( Any) | Product or service details
|
|
|
Documentation for this format
|
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