R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

13.4 Resource EnrollmentRequest - Content

Financial Management icon

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 to this Resource

Implements: Request
Resource References: DocumentReference, EnrollmentResponse and GuidanceResponse

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 Binding: 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

See the Extensions for this resource

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

Changes from both R4 and R4B

EnrollmentRequest

No Changes

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

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 Binding: 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

See the Extensions for this resource

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

Changes from both R4 and R4B

EnrollmentRequest

No Changes

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

13.4.3.1 Terminology Bindings

Path	ValueSet	Type	Documentation
EnrollmentRequest.status	FinancialResourceStatusCodes	Required	This value set includes Status codes.

Path

ValueSet

Type

Documentation

EnrollmentRequest.status

FinancialResourceStatusCodes

Required

This value set includes Status codes.

13.4.4 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to 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	65 Resources
patient	reference	The party to be enrolled	EnrollmentRequest.candidate (Patient)	66 Resources
status	token	The status of the enrollment	EnrollmentRequest.status
subject	reference	The party to be enrolled	EnrollmentRequest.candidate (Patient)