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: R5 R4B R4 R3 R2

7.8 Resource EnrollmentResponse - Content Resource EnrollmentResponse - Content This resource is marked as a draft

This resource is marked as a draft .

This resource provides enrollment and plan details from the processing of an Enrollment resource.
Financial Management Financial Management Work Group Work Group Maturity Level : 0 Maturity Level : 0 Compartments : Not linked to any defined compartments : Not linked to any defined compartments

This resource provides enrollment and plan details from the processing of an Enrollment resource.

7.8.1 Scope and Usage Scope and Usage

This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft. This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft. The EnrollmentResponse resource provides enrollment and plan details from the processing of an Enrollment resource. It combines key information from a payor as to whether a Coverage or Policy is in-force, and optionally the nature of the Policy details. Todo

The EnrollmentResponse resource provides enrollment and plan details from the processing of an Enrollment resource. It combines key information from a payor as to whether a Coverage or Policy is in-force, and optionally the nature of the Policy details.

Todo

7.8.2 Resource Content Resource Content

Structure

Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EnrollmentResponse Σ DomainResource EnrollmentResponse resource EnrollmentResponse resource
. . . identifier Σ 0..* Identifier Business Identifier Business Identifier
. . . request Σ 0..1 Reference ( EnrollmentRequest ) Claim reference Claim reference
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . . organization Σ 0..1 Reference ( Organization ) Insurer
. . . requestProvider Σ 0..1 Reference ( Practitioner ) Responsible practitioner Responsible practitioner
. . . requestOrganization Σ 0..1 Reference ( Organization ) Responsible organization Responsible organization

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

EnrollmentResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference Original request resource reference request : : Reference [0..1] « [0..1] « EnrollmentRequest » » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] 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 ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » 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 originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization : : Reference [0..1] « [0..1] « Organization » » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider : : Reference [0..1] « [0..1] « Practitioner » » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization : : Reference [0..1] « [0..1] « Organization » »

XML Template XML Template 

<EnrollmentResponse 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>
 <request><!-- 0..1 Reference(EnrollmentRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>
</EnrollmentResponse>

Structure

Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EnrollmentResponse Σ DomainResource EnrollmentResponse resource EnrollmentResponse resource
. . . identifier Σ 0..* Identifier Business Identifier Business Identifier
. . . request Σ 0..1 Reference ( EnrollmentRequest ) Claim reference Claim reference
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . . organization Σ 0..1 Reference ( Organization ) Insurer
. . . requestProvider Σ 0..1 Reference ( Practitioner ) Responsible practitioner Responsible practitioner
. . . requestOrganization Σ 0..1 Reference ( Organization ) Responsible organization Responsible organization

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

EnrollmentResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference Original request resource reference request : : Reference [0..1] « [0..1] « EnrollmentRequest » » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] 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 ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » 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 originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization : : Reference [0..1] « [0..1] « Organization » » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider : : Reference [0..1] « [0..1] « Practitioner » » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization : : Reference [0..1] « [0..1] « Organization » »

XML Template XML Template 

<EnrollmentResponse 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>
 <request><!-- 0..1 Reference(EnrollmentRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>
</EnrollmentResponse>

  Alternate definitions:

Alternate definitions: Schema / Schematron , Resource Profile ( , Resource Profile ( XML , , JSON ), ), Questionnaire

7.8.2.1 Terminology Bindings Terminology Bindings

Path Definition Type Reference
EnrollmentResponse.outcome EnrollmentResponse.outcome The outcome of the processing. The outcome of the processing. Required RemittanceOutcome
EnrollmentResponse.ruleset
EnrollmentResponse.originalRuleset EnrollmentResponse.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard/version. The static and dynamic model to which contents conform, which may be business version or standard/version. Example Ruleset Codes Ruleset Codes

7.8.3 Search Parameters Search Parameters Search parameters for this resource. The common parameters also apply. See

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services. for more information about searching in REST, messaging, and services.

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100. Links: Search
Name Type Description Paths
identifier token The business identifier of the Explanation of Benefit The business identifier of the Explanation of Benefit EnrollmentResponse.identifier