CoverageEligibilityRequest
FinancialThe CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.
| Path | Card. | Type | Description & Constraints |
|---|---|---|---|
| CoverageEligibilityRequest | 0..* | — | CoverageEligibilityRequest resource |
| .idΣ | 0..1 | String | Logical id of this artifact |
| .metaΣ | 0..1 | Meta | Metadata about the resource |
| .implicitRules?!Σ | 0..1 | uri | A set of rules under which this content was created |
| .language | 0..1 | code | Language of the resource content Bindinglanguages(preferred) |
| .text | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| .contained | 0..* | Resource | Contained, inline Resources |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?! | 0..* | Extension | Extensions that cannot be ignored |
| .identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request |
| .status?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Bindingfm-status(required) |
| .priority | 0..1 | CodeableConcept | Desired processing priority Bindingprocess-priority(example) |
| .purposeΣ | 1..* | code | auth-requirements | benefits | discovery | validation Bindingeligibilityrequest-purpose(required) |
| .patientΣ | 1..1 | Reference(Patient) | Intended recipient of products and services |
| .serviced[x] | 0..1 | date | Period | Estimated date or dates of service |
| .createdΣ | 1..1 | dateTime | Creation date |
| .enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author |
| .provider | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request |
| .insurerΣ | 1..1 | Reference(Organization) | Coverage issuer |
| .facility | 0..1 | Reference(Location) | Servicing facility |
| .supportingInfo | 0..* | BackboneElement | Supporting information |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .sequence | 1..1 | positiveInt | Information instance identifier |
| .information | 1..1 | Reference(Resource) | Data to be provided |
| .appliesToAll | 0..1 | boolean | Applies to all items |
| .insurance | 0..* | BackboneElement | Patient insurance information |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .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 |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .supportingInfoSequence | 0..* | positiveInt | Applicable exception or supporting information |
| .category | 0..1 | CodeableConcept | Benefit classification Bindingex-benefitcategory(example) |
| .productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Bindingservice-uscls(example) |
| .modifier | 0..* | CodeableConcept | Product or service billing modifiers Bindingclaim-modifiers(example) |
| .provider | 0..1 | Reference(Practitioner | PractitionerRole) | Perfoming practitioner |
| .quantity | 0..1 | Quantity | 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 |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .diagnosis[x] | 0..1 | CodeableConcept | Reference(Condition) | Nature of illness or problem Bindingicd-10(example) |
| .detail | 0..* | Reference(Resource) | Product or service details |