DSTU2 STU 3 Ballot
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 (v1.6.0: STU 3 Ballot 4). 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 13.4.5 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.

Summary true Summary true Summary Summary Summary Summary Summary
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
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
EligibilityRequest.status
Definition

The status of the resource instance.

Control 1..1
Binding EligibilityRequestStatus: A code specifying the state of the resource instance. ( Required )
Type code
Is Modifier true
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
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.

EligibilityRequest.created
Definition

The date when this resource was created.

Control true 0..1
Type dateTime
EligibilityRequest.created EligibilityRequest.insurer[x]
Definition

The date when this resource was created. The Insurer who is target of the request.

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

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

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

The Insurer who is target of the request. 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]
EligibilityRequest.priority
Definition

Immediate (STAT), best effort (NORMAL), deferred (DEFER).

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

The practitioner who is responsible for the services rendered to the patient. Person who created the invoice/claim/pre-determination or pre-authorization.

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

Facility where the services were provided.

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

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

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

1..1.

EligibilityRequest.coverage[x]
Definition

Financial instrument by which payment information for health care.

Control 0..1
Type Identifier | Reference ( Organization 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.

Comments

1..1.

EligibilityRequest.businessArrangement
Definition

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

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

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100. Links: Search The date or dates when the enclosed suite of services were performed or completed.

Control | Version History 0..1
Type | Table of Contents date | Compare to DSTU1 Period
[x] Note See Choice of Data Types for further information about how to use [x]
EligibilityRequest.benefitCategory
Definition

Dental, Vision, Medical, Pharmacy, Rehab etc.

Control | 0..1
Binding | Propose a change Benefit Category Codes: Benefit categories such as: oral, medical, vision etc. ( Example )
Type Coding
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