Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). 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

Codesystem-eligibilityrequest-purpose.xml

Financial Management Work GroupMaturity Level: N/AStandards Status: Informative

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

Definition for Code SystemEligibilityRequestPurpose

<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="eligibilityrequest-purpose"/> 
  <meta> 
    <lastUpdated value="2022-05-28T13:47:40.239+11:00"/> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> 
  </meta> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      
      
      <h2> EligibilityRequestPurpose</h2> 
      
      
      <div> 
        
        
        <p> A code specifying the types of information being requested.</p> 

      
      
      </div> 
      
      
      <p> This code system http://hl7.org/fhir/eligibilityrequest-purpose defines the following
         codes:</p> 
      
      
      <table class="codes">
        
        
        <tr> 
          
          
          <td style="white-space:nowrap">
            
            
            <b> Code</b> 
          
          
          </td> 
          
          
          <td> 
            
            
            <b> Display</b> 
          
          
          </td> 
          
          
          <td> 
            
            
            <b> Definition</b> 
          
          
          </td> 
        
        
        </tr> 
        
        
        <tr> 
          
          
          <td style="white-space:nowrap">auth-requirements
            
            
            <a name="eligibilityrequest-purpose-auth-requirements"> </a> 
          
          
          </td> 
          
          
          <td> Coverage auth-requirements</td> 
          
          
          <td> The prior authorization requirements for the listed, or discovered if specified, converages
             for the categories of service and/or specifed biling codes are requested.</td> 
        
        
        </tr> 
        
        
        <tr> 
          
          
          <td style="white-space:nowrap">benefits
            
            
            <a name="eligibilityrequest-purpose-benefits"> </a> 
          
          
          </td> 
          
          
          <td> Coverage benefits</td> 
          
          
          <td> The plan benefits and optionally benefits consumed  for the listed, or discovered if specified,
             converages are requested.</td> 
        
        
        </tr> 
        
        
        <tr> 
          
          
          <td style="white-space:nowrap">discovery
            
            
            <a name="eligibilityrequest-purpose-discovery"> </a> 
          
          
          </td> 
          
          
          <td> Coverage Discovery</td> 
          
          
          <td> The insurer is requested to report on any coverages which they are aware of in addition
             to any specifed.</td> 
        
        
        </tr> 
        
        
        <tr> 
          
          
          <td style="white-space:nowrap">validation
            
            
            <a name="eligibilityrequest-purpose-validation"> </a> 
          
          
          </td> 
          
          
          <td> Coverage Validation</td> 
          
          
          <td> A check that the specified coverages are in-force is requested.</td> 
        
        
        </tr> 
      
      
      </table> 
    
    
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2"/> 
  </extension> 
  <url value="http://hl7.org/fhir/eligibilityrequest-purpose"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.4.1183"/> 
  </identifier> 
  <version value="4.3.0"/> 
  <name value="EligibilityRequestPurpose"/> 
  <title value="EligibilityRequestPurpose"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <date value="2021-01-17T07:06:13+11:00"/> 
  <publisher value="HL7 (FHIR Project)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <description value="A code specifying the types of information being requested."/> 
  <caseSensitive value="true"/> 
  <valueSet value="http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose"/> 
  <content value="complete"/> 
  <concept> 
    <code value="auth-requirements"/> 
    <display value="Coverage auth-requirements"/> 
    <definition value="The prior authorization requirements for the listed, or discovered if specified, converages
     for the categories of service and/or specifed biling codes are requested."/> 
  </concept> 
  <concept> 
    <code value="benefits"/> 
    <display value="Coverage benefits"/> 
    <definition value="The plan benefits and optionally benefits consumed  for the listed, or discovered if specified,
     converages are requested."/> 
  </concept> 
  <concept> 
    <code value="discovery"/> 
    <display value="Coverage Discovery"/> 
    <definition value="The insurer is requested to report on any coverages which they are aware of in addition
     to any specifed."/> 
  </concept> 
  <concept> 
    <code value="validation"/> 
    <display value="Coverage Validation"/> 
    <definition value="A check that the specified coverages are in-force is requested."/> 
  </concept> 
</CodeSystem> 

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.