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

13.5 Resource EnrollmentResponse - Content

Financial Management icon

Work Group

Maturity Level: 0

Trial Use

Security Category: Patient

Compartments: No 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 to this Resource

Implements: Event

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 Binding: Financial Resource Status Codes (Required)
request		0..1	Reference(EnrollmentRequest)	Claim reference
outcome		0..1	code	queued \| complete \| error \| partial Binding: Enrollment Outcome (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

See the Extensions for this resource

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

Changes from both R4 and R4B

EnrollmentResponse

EnrollmentResponse.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Enrollment Outcome

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
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 Binding: Financial Resource Status Codes (Required)
request		0..1	Reference(EnrollmentRequest)	Claim reference
outcome		0..1	code	queued \| complete \| error \| partial Binding: Enrollment Outcome (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

See the Extensions for this resource

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

Changes from both R4 and R4B

EnrollmentResponse

EnrollmentResponse.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Enrollment Outcome

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

13.5.3.1 Terminology Bindings

Path	ValueSet	Type	Documentation
EnrollmentResponse.status	FinancialResourceStatusCodes	Required	This value set includes Status codes.
EnrollmentResponse.outcome	EnrollmentOutcome (a valid code from Claim Processing Codes)	Required	The outcome of the processing.

Path

ValueSet

Type

Documentation

EnrollmentResponse.status

FinancialResourceStatusCodes

Required

This value set includes Status codes.

EnrollmentResponse.outcome

EnrollmentOutcome (a valid code from Claim Processing Codes)

Required

The outcome of the processing.

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