This page is part of the FHIR Specification (v3.0.2: STU 3). 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: R3 R2
The EligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an EligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.
The EligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an Eligibility Response, with information regarding whether the stated coverage is valid and in-force, and potentially the amount of coverage which may be available to any services classes identified in this request. Todo
This resource is referenced by eligibilityresponse
Structure
| Name | Flags | Card. | Type | Description & Constraints doco |
|---|---|---|---|---|
| .. EligibilityRequest | DomainResource | Determine insurance validity and scope of 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 Financial Resource Status Codes (Required) |
| ... priority | 0..1 | CodeableConcept | Desired processing priority Process Priority Codes (Example) | |
| ... patient | 0..1 | Reference(Patient) | The subject of the Products and Services | |
| ... serviced[x] | 0..1 | Estimated date or dates of Service | ||
| .... servicedDate | date | |||
| .... servicedPeriod | Period | |||
| ... created | 0..1 | dateTime | Creation date | |
| ... enterer | 0..1 | Reference(Practitioner) | Author | |
| ... provider | 0..1 | Reference(Practitioner) | Responsible practitioner | |
| ... organization | 0..1 | Reference(Organization) | Responsible organization | |
| ... insurer | 0..1 | Reference(Organization) | Target | |
| ... facility | 0..1 | Reference(Location) | Servicing Facility | |
| ... coverage | 0..1 | Reference(Coverage) | Insurance or medical plan | |
| ... businessArrangement | 0..1 | string | Business agreement | |
| ... benefitCategory | 0..1 | CodeableConcept | Type of services covered Benefit Category Codes (Example) | |
| ... benefitSubCategory | 0..1 | CodeableConcept | Detailed services covered within the type Benefit SubCategory Codes (Example) | |
doco Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<EligibilityRequest xmlns="http://hl7.org/fhir"> doco <!-- 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 --> <priority><!-- 0..1 CodeableConcept Desired processing priority --></priority> <patient><!-- 0..1 Reference(Patient) The subject of the Products and Services --></patient> <serviced[x]><!-- 0..1 date|Period Estimated date or dates of Service --></serviced[x]> <created value="[dateTime ]"/><!-- 0..1 Creation date --> <enterer><!-- 0..1 Reference(Practitioner) Author --></enterer> <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider> <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization> <insurer><!-- 0..1 Reference(Organization) Target --></insurer> <facility><!-- 0..1 Reference(Location) Servicing Facility --></facility> <coverage><!-- 0..1 Reference(Coverage) Insurance or medical plan --></coverage> <businessArrangement value="[string ]"/><!-- 0..1 Business agreement --> <benefitCategory><!-- 0..1 CodeableConcept Type of services covered --></benefitCategory> <benefitSubCategory><!-- 0..1 CodeableConcept Detailed services covered within the type --></benefitSubCategory> </EligibilityRequest>
JSON Template
{doco
"resourceType" : "EligibilityRequest",
// 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
"priority" : { CodeableConcept }, // Desired processing priority
"patient" : { Reference(Patient) }, // The subject of the Products and Services
// serviced[x]: Estimated date or dates of Service. One of these 2:
"servicedDate" : "<date >",
"servicedPeriod" : { Period },
"created" : "<dateTime >", // Creation date
"enterer" : { Reference(Practitioner) }, // Author
"provider" : { Reference(Practitioner) }, // Responsible practitioner
"organization" : { Reference(Organization) }, // Responsible organization
"insurer" : { Reference(Organization) }, // Target
"facility" : { Reference(Location) }, // Servicing Facility
"coverage" : { Reference(Coverage) }, // Insurance or medical plan
"businessArrangement" : "<string >", // Business agreement
"benefitCategory" : { CodeableConcept }, // Type of services covered
"benefitSubCategory" : { CodeableConcept } // Detailed services covered within the type
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .doco [ a fhir:EligibilityRequest; 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:EligibilityRequest.identifier[ Identifier ], ... ; # 0..* Business Identifier fhir:EligibilityRequest.status[ code ]; # 0..1 active | cancelled | draft | entered-in-error fhir:EligibilityRequest.priority[ CodeableConcept ]; # 0..1 Desired processing priority fhir:EligibilityRequest.patient[ Reference(Patient) ]; # 0..1 The subject of the Products and Services # EligibilityRequest.serviced[x]: 0..1 Estimated date or dates of Service. One of these 2 fhir:EligibilityRequest.servicedDate[ date ] fhir:EligibilityRequest.servicedPeriod[ Period ] fhir:EligibilityRequest.created[ dateTime ]; # 0..1 Creation date fhir:EligibilityRequest.enterer[ Reference(Practitioner) ]; # 0..1 Author fhir:EligibilityRequest.provider[ Reference(Practitioner) ]; # 0..1 Responsible practitioner fhir:EligibilityRequest.organization[ Reference(Organization) ]; # 0..1 Responsible organization fhir:EligibilityRequest.insurer[ Reference(Organization) ]; # 0..1 Target fhir:EligibilityRequest.facility[ Reference(Location) ]; # 0..1 Servicing Facility fhir:EligibilityRequest.coverage[ Reference(Coverage) ]; # 0..1 Insurance or medical plan fhir:EligibilityRequest.businessArrangement[ string ]; # 0..1 Business agreement fhir:EligibilityRequest.benefitCategory[ CodeableConcept ]; # 0..1 Type of services covered fhir:EligibilityRequest.benefitSubCategory[ CodeableConcept ]; # 0..1 Detailed services covered within the type ]
Changes since DSTU2
See the Full Difference for further information
Structure
| Name | Flags | Card. | Type | Description & Constraints doco |
|---|---|---|---|---|
| .. EligibilityRequest | DomainResource | Determine insurance validity and scope of 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 Financial Resource Status Codes (Required) |
| ... priority | 0..1 | CodeableConcept | Desired processing priority Process Priority Codes (Example) | |
| ... patient | 0..1 | Reference(Patient) | The subject of the Products and Services | |
| ... serviced[x] | 0..1 | Estimated date or dates of Service | ||
| .... servicedDate | date | |||
| .... servicedPeriod | Period | |||
| ... created | 0..1 | dateTime | Creation date | |
| ... enterer | 0..1 | Reference(Practitioner) | Author | |
| ... provider | 0..1 | Reference(Practitioner) | Responsible practitioner | |
| ... organization | 0..1 | Reference(Organization) | Responsible organization | |
| ... insurer | 0..1 | Reference(Organization) | Target | |
| ... facility | 0..1 | Reference(Location) | Servicing Facility | |
| ... coverage | 0..1 | Reference(Coverage) | Insurance or medical plan | |
| ... businessArrangement | 0..1 | string | Business agreement | |
| ... benefitCategory | 0..1 | CodeableConcept | Type of services covered Benefit Category Codes (Example) | |
| ... benefitSubCategory | 0..1 | CodeableConcept | Detailed services covered within the type Benefit SubCategory Codes (Example) | |
doco Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<EligibilityRequest xmlns="http://hl7.org/fhir"> doco <!-- 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 --> <priority><!-- 0..1 CodeableConcept Desired processing priority --></priority> <patient><!-- 0..1 Reference(Patient) The subject of the Products and Services --></patient> <serviced[x]><!-- 0..1 date|Period Estimated date or dates of Service --></serviced[x]> <created value="[dateTime ]"/><!-- 0..1 Creation date --> <enterer><!-- 0..1 Reference(Practitioner) Author --></enterer> <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider> <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization> <insurer><!-- 0..1 Reference(Organization) Target --></insurer> <facility><!-- 0..1 Reference(Location) Servicing Facility --></facility> <coverage><!-- 0..1 Reference(Coverage) Insurance or medical plan --></coverage> <businessArrangement value="[string ]"/><!-- 0..1 Business agreement --> <benefitCategory><!-- 0..1 CodeableConcept Type of services covered --></benefitCategory> <benefitSubCategory><!-- 0..1 CodeableConcept Detailed services covered within the type --></benefitSubCategory> </EligibilityRequest>
JSON Template
{doco
"resourceType" : "EligibilityRequest",
// 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
"priority" : { CodeableConcept }, // Desired processing priority
"patient" : { Reference(Patient) }, // The subject of the Products and Services
// serviced[x]: Estimated date or dates of Service. One of these 2:
"servicedDate" : "<date >",
"servicedPeriod" : { Period },
"created" : "<dateTime >", // Creation date
"enterer" : { Reference(Practitioner) }, // Author
"provider" : { Reference(Practitioner) }, // Responsible practitioner
"organization" : { Reference(Organization) }, // Responsible organization
"insurer" : { Reference(Organization) }, // Target
"facility" : { Reference(Location) }, // Servicing Facility
"coverage" : { Reference(Coverage) }, // Insurance or medical plan
"businessArrangement" : "<string >", // Business agreement
"benefitCategory" : { CodeableConcept }, // Type of services covered
"benefitSubCategory" : { CodeableConcept } // Detailed services covered within the type
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .doco [ a fhir:EligibilityRequest; 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:EligibilityRequest.identifier[ Identifier ], ... ; # 0..* Business Identifier fhir:EligibilityRequest.status[ code ]; # 0..1 active | cancelled | draft | entered-in-error fhir:EligibilityRequest.priority[ CodeableConcept ]; # 0..1 Desired processing priority fhir:EligibilityRequest.patient[ Reference(Patient) ]; # 0..1 The subject of the Products and Services # EligibilityRequest.serviced[x]: 0..1 Estimated date or dates of Service. One of these 2 fhir:EligibilityRequest.servicedDate[ date ] fhir:EligibilityRequest.servicedPeriod[ Period ] fhir:EligibilityRequest.created[ dateTime ]; # 0..1 Creation date fhir:EligibilityRequest.enterer[ Reference(Practitioner) ]; # 0..1 Author fhir:EligibilityRequest.provider[ Reference(Practitioner) ]; # 0..1 Responsible practitioner fhir:EligibilityRequest.organization[ Reference(Organization) ]; # 0..1 Responsible organization fhir:EligibilityRequest.insurer[ Reference(Organization) ]; # 0..1 Target fhir:EligibilityRequest.facility[ Reference(Location) ]; # 0..1 Servicing Facility fhir:EligibilityRequest.coverage[ Reference(Coverage) ]; # 0..1 Insurance or medical plan fhir:EligibilityRequest.businessArrangement[ string ]; # 0..1 Business agreement fhir:EligibilityRequest.benefitCategory[ CodeableConcept ]; # 0..1 Type of services covered fhir:EligibilityRequest.benefitSubCategory[ CodeableConcept ]; # 0..1 Detailed services covered within the type ]
Changes since DSTU2
See the Full Difference for further information
Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)
| Path | Definition | Type | Reference |
|---|---|---|---|
| EligibilityRequest.status | A code specifying the state of the resource instance. | Required | Financial Resource Status Codes |
| EligibilityRequest.priority | The timeliness with which processing is required: STAT, normal, Deferred | Example | Process Priority Codes |
| EligibilityRequest.benefitCategory | Benefit categories such as: oral, medical, vision etc. | Example | Benefit Category Codes |
| EligibilityRequest.benefitSubCategory | Benefit subcategories such as: oral-basic, major, glasses | Example | Benefit SubCategory Codes |
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.