DSTU2 STU 3 Candidate
This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 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 . For a full list of available versions, see the Directory of published versions . Page versions: . Page versions: R3 R2

7.4.5 Resource EligibilityRequest - Detailed Descriptions Resource EligibilityRequest - Detailed Descriptions Detailed Descriptions for the elements in the EligibilityRequest resource.

Detailed Descriptions for the elements in the EligibilityRequest resource.

EligibilityRequest
Definition

This resource provides the insurance eligibility details from the insurer regarding a specified coverage and optionally some class of service. This resource provides the insurance eligibility details from the insurer regarding a specified coverage and optionally some class of service.

Control 1..1
Summary true
EligibilityRequest.identifier
Definition

The Response business identifier. The Response business identifier.

Note This is a business identifer, not a resource identifier (see This is a business identifer, not a resource identifier (see discussion )
Control 0..*
Type Identifier
Summary true
EligibilityRequest.ruleset
Definition

The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources. The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.

Control 0..1
Binding Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Example )
Type Coding
Summary true
EligibilityRequest.originalRuleset
Definition

The style (standard) and version of the original material which was converted into this resource. The style (standard) and version of the original material which was converted into this resource.

Control 0..1
Binding Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Example )
Type Coding
Requirements

Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.

Summary true
EligibilityRequest.created
Definition

The date when this resource was created. The date when this resource was created.

Control 0..1
Type dateTime
Summary true
EligibilityRequest.target EligibilityRequest.target[x]
Definition

The Insurer who is target of the request. The Insurer who is target of the request.

Control 0..1
Type Identifier | Reference ( Organization )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.provider EligibilityRequest.provider[x]
Definition

The practitioner who is responsible for the services rendered to the patient. The practitioner who is responsible for the services rendered to the patient.

Control 0..1
Type Identifier | Reference ( Practitioner )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.organization EligibilityRequest.organization[x]
Definition

The organization which is responsible for the services rendered to the patient. The organization which is responsible for the services rendered to the patient.

Control 0..1
Type Identifier | Reference ( Organization )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.priority
Definition

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100. Links: Search Immediate (STAT), best effort (NORMAL), deferred (DEFER).

Control 0..1
Binding Priority Codes: The timeliness with which processing is required: STAT, normal, Deferred ( Example )
Type Coding
Summary true
EligibilityRequest.enterer[x]
Definition

Person who created the invoice/claim/pre-determination or pre-authorization.

Control 0..1
Type Identifier | Version History Reference ( Practitioner )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.facility[x]
Definition

Facility where the services were provided.

Control 0..1
Type Identifier | Table of Contents Reference ( Location )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.patient[x]
Definition

Patient Resource.

Control 0..1
Type Identifier | Compare to DSTU1 Reference ( Patient )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
Comments

1..1.

EligibilityRequest.coverage[x]
Definition

Financial instrument by which payment information for health care.

Control 0..1
Type Identifier | Reference ( Coverage )
[x] Note See Choice of Data Types for further information about how to use [x]
Requirements

Need to identify the issuer to target for processing and for coordination of benefit processing.

Summary true
Comments

1..1.

EligibilityRequest.businessArrangement
Definition

The contract number of a business agreement which describes the terms and conditions.

Control 0..1
Type string
Summary true
EligibilityRequest.serviced[x]
Definition

The date or dates when the enclosed suite of services were performed or completed.

Control 0..1
Type date | Propose a change Period
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
EligibilityRequest.benefitCategory
Definition

Dental, Vision, Medical, Pharmacy, Rehab etc.

Control 0..1
Binding Benefit Category Codes: Benefit categories such as: oral, medical, vision etc. ( Example )
Type Coding
Summary true
EligibilityRequest.benefitSubCategory
Definition

Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.

Control 0..1
Binding Benefit SubCategory Codes: Benefit subcategories such as: oral-basic, major, glasses ( Example )
Type Coding
Summary true