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 13.4 Resource EligibilityRequest - Content Resource EligibilityRequest - Content This resource is marked as a draft .

This resource provides the insurance eligibility details from the insurer regarding a specified coverage and optionally some class of service.
Financial Management Financial Management Work Group Work Group Maturity Level : 0 Maturity Level : 1 Compartments : Not linked to any defined compartments : Not linked to any defined compartments

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

7.4.1 Scope and Usage 13.4.1 Scope and Usage This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft. 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

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

7.4.2 Resource Content 13.4.2 Resource Content

Structure

Σ Σ Coding Σ 0..1 Σ Σ Σ
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EligibilityRequest DomainResource Eligibility request
. . . identifier 0..* DomainResource Identifier Eligibility request Business Identifier
. . identifier . status ?! Σ 0..* 1..1 Identifier code Business Identifier active | cancelled | draft | entered-in-error
EligibilityRequestStatus ( Required )
. . . ruleset 0..1 Coding Resource version
Σ Ruleset Codes ( Example )
... originalRuleset 0..1 Coding Resource version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . originalRuleset . created 0..1 dateTime Creation date
. . . insurer[x] 0..1 Target
. . . . insurerIdentifier Identifier
. . . . insurerReference Original version Ruleset Codes Reference ( Example Organization )
. created . . provider[x] 0..1 Responsible practitioner
. . . . providerIdentifier dateTime Identifier
. . . . providerReference Creation date Reference ( Practitioner )
. target . . organization[x] 0..1 Responsible organization
. . . . organizationIdentifier 0..1 Identifier
.... organizationReference Reference ( Organization )
. . . priority Insurer 0..1 Coding Desired processing priority
provider Priority Codes ( Example )
. . . enterer[x] 0..1 Author
.... entererIdentifier 0..1 Identifier
.... entererReference Reference ( Practitioner )
. . . facility[x] Responsible practitioner 0..1 Servicing Facility
organization . . . . facilityIdentifier Identifier
. . . . facilityReference Reference ( Location )
... patient[x] 0..1 The subject of the Products and Services
.... patientIdentifier Identifier
.... patientReference Reference ( Patient )
... coverage[x] 0..1 Insurance or medical plan
.... coverageIdentifier Identifier
.... coverageReference Reference ( Organization Coverage )
. . . businessArrangement Responsible organization 0..1 string Business agreement
... serviced[x] 0..1 Estimated date or dates of Service
.... servicedDate date
.... servicedPeriod Period
... benefitCategory 0..1 Coding Benefit Category
Benefit Category Codes ( Example )
... benefitSubCategory 0..1 Coding Benefit SubCategory
Benefit SubCategory Codes ( Example )

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram ( Legend )

EligibilityRequest ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required) EligibilityRequestStatus ! » 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 this resource was created The date when this resource was created created : : dateTime [0..1] [0..1] The Insurer who is target of the request The Insurer who is target of the request target insurer[x] : Type [0..1] « Identifier : | Reference [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 provider provider[x] : Type [0..1] « Identifier : | Reference [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 organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Immediate (STAT), best effort (NORMAL), deferred (DEFER) priority : Coding [0..1] « The timeliness with which processing is required: STAT, normal, Deferred (Strength=Example) Priority ?? » Person who created the invoice/claim/pre-determination or pre-authorization enterer[x] : Type [0..1] « Identifier | Reference ( Practitioner ) » Facility where the services were provided facility[x] : Type [0..1] « Identifier | Reference ( Location ) » Patient Resource patient[x] : Type [0..1] « Identifier | Reference ( Patient ) » Financial instrument by which payment information for health care coverage[x] : Type [0..1] « Identifier | Reference ( Coverage ) » The contract number of a business agreement which describes the terms and conditions businessArrangement : string [0..1] The date or dates when the enclosed suite of services were performed or completed serviced[x] : Type [0..1] « date | Period » Dental, Vision, Medical, Pharmacy, Rehab etc benefitCategory : Coding [0..1] « Benefit categories such as: oral, medical, vision etc. (Strength=Example) Benefit Category ?? » Dental: basic, major, ortho; Vision exam, glasses, contacts; etc benefitSubCategory : Coding [0..1] « Benefit subcategories such as: oral-basic, major, glasses (Strength=Example) Benefit SubCategory ?? »

XML Template XML Template < 

<EligibilityRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</ruleset>
 <</originalRuleset>
 <
 <</target>
 <</provider>
 <</organization>

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer[x]><!-- 0..1 Identifier|Reference(Organization) Target --></insurer[x]>
 <provider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></provider[x]>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></organization[x]>
 <priority><!-- 0..1 Coding Desired processing priority --></priority>
 <enterer[x]><!-- 0..1 Identifier|Reference(Practitioner) Author --></enterer[x]>
 <facility[x]><!-- 0..1 Identifier|Reference(Location) Servicing Facility --></facility[x]>
 <patient[x]><!-- 0..1 Identifier|Reference(Patient) The subject of the Products and Services --></patient[x]>
 <coverage[x]><!-- 0..1 Identifier|Reference(Coverage) Insurance or medical plan --></coverage[x]>
 <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
 <serviced[x]><!-- 0..1 date|Period Estimated date or dates of Service --></serviced[x]>
 <benefitCategory><!-- 0..1 Coding Benefit Category --></benefitCategory>
 <benefitSubCategory><!-- 0..1 Coding Benefit SubCategory --></benefitSubCategory>

</EligibilityRequest>

JSON Template JSON Template { "resourceType" : "", 

{doco
  "resourceType" : "EligibilityRequest",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "

  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  // insurer[x]: Target. One of these 2:

  "insurerIdentifier" : { Identifier },
  "insurerReference" : { Reference(Organization) },
  // provider[x]: Responsible practitioner. One of these 2:

  "providerIdentifier" : { Identifier },
  "providerReference" : { Reference(Practitioner) },
  // organization[x]: Responsible organization. One of these 2:

  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  "priority" : { Coding }, // Desired processing priority
  // enterer[x]: Author. One of these 2:

  "entererIdentifier" : { Identifier },
  "entererReference" : { Reference(Practitioner) },
  // facility[x]: Servicing Facility. One of these 2:

  "facilityIdentifier" : { Identifier },
  "facilityReference" : { Reference(Location) },
  // patient[x]: The subject of the Products and Services. One of these 2:

  "patientIdentifier" : { Identifier },
  "patientReference" : { Reference(Patient) },
  // coverage[x]: Insurance or medical plan. One of these 2:

  "coverageIdentifier" : { Identifier },
  "coverageReference" : { Reference(Coverage) },
  "businessArrangement" : "<string>", // Business agreement
  // serviced[x]: Estimated date or dates of Service. One of these 2:

  "servicedDate" : "<date>",
  "servicedPeriod" : { Period },
  "benefitCategory" : { Coding }, // Benefit Category
  "benefitSubCategory" : { Coding } // Benefit SubCategory

}

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 ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:EligibilityRequest.ruleset [ Coding ]; # 0..1 Resource version
  fhir:EligibilityRequest.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:EligibilityRequest.created [ dateTime ]; # 0..1 Creation date
  # EligibilityRequest.insurer[x] : 0..1 Target. One of these 2
    fhir:EligibilityRequest.insurerIdentifier [ Identifier ]
    fhir:EligibilityRequest.insurerReference [ Reference(Organization) ]
  # EligibilityRequest.provider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:EligibilityRequest.providerIdentifier [ Identifier ]
    fhir:EligibilityRequest.providerReference [ Reference(Practitioner) ]
  # EligibilityRequest.organization[x] : 0..1 Responsible organization. One of these 2
    fhir:EligibilityRequest.organizationIdentifier [ Identifier ]
    fhir:EligibilityRequest.organizationReference [ Reference(Organization) ]
  fhir:EligibilityRequest.priority [ Coding ]; # 0..1 Desired processing priority
  # EligibilityRequest.enterer[x] : 0..1 Author. One of these 2
    fhir:EligibilityRequest.entererIdentifier [ Identifier ]
    fhir:EligibilityRequest.entererReference [ Reference(Practitioner) ]
  # EligibilityRequest.facility[x] : 0..1 Servicing Facility. One of these 2
    fhir:EligibilityRequest.facilityIdentifier [ Identifier ]
    fhir:EligibilityRequest.facilityReference [ Reference(Location) ]
  # EligibilityRequest.patient[x] : 0..1 The subject of the Products and Services. One of these 2
    fhir:EligibilityRequest.patientIdentifier [ Identifier ]
    fhir:EligibilityRequest.patientReference [ Reference(Patient) ]
  # EligibilityRequest.coverage[x] : 0..1 Insurance or medical plan. One of these 2
    fhir:EligibilityRequest.coverageIdentifier [ Identifier ]
    fhir:EligibilityRequest.coverageReference [ Reference(Coverage) ]
  fhir:EligibilityRequest.businessArrangement [ string ]; # 0..1 Business agreement
  # 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.benefitCategory [ Coding ]; # 0..1 Benefit Category
  fhir:EligibilityRequest.benefitSubCategory [ Coding ]; # 0..1 Benefit SubCategory
]

Changes since DSTU2

EligibilityRequest
EligibilityRequest.status added
EligibilityRequest.insurer[x] added
EligibilityRequest.provider[x] Renamed from provider to provider[x]
Add Identifier
EligibilityRequest.organization[x] Renamed from organization to organization[x]
Add Identifier
EligibilityRequest.priority added
EligibilityRequest.enterer[x] added
EligibilityRequest.facility[x] added
EligibilityRequest.patient[x] added
EligibilityRequest.coverage[x] added
EligibilityRequest.businessArrangement added
EligibilityRequest.serviced[x] added
EligibilityRequest.benefitCategory added
EligibilityRequest.benefitSubCategory added
EligibilityRequest.target deleted

See the Full Difference for further information

Structure

Σ DomainResource Σ Coding Σ 0..1 Σ Σ Σ
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EligibilityRequest DomainResource Eligibility request
. . . identifier 0..* Identifier Eligibility request Business Identifier
. . identifier . status ?! Σ 0..* 1..1 Identifier code Business Identifier active | cancelled | draft | entered-in-error
EligibilityRequestStatus ( Required )
. . . ruleset 0..1 Coding Resource version
Σ Ruleset Codes ( Example )
... originalRuleset 0..1 Coding Resource version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . originalRuleset . created 0..1 dateTime Creation date
. . . insurer[x] 0..1 Target
. . . . insurerIdentifier Identifier
. . . . insurerReference Original version Ruleset Codes Reference ( Example Organization )
. created . . provider[x] 0..1 Responsible practitioner
. . . . providerIdentifier dateTime Identifier
. . . . providerReference Creation date Reference ( Practitioner )
. target . . organization[x] 0..1 Responsible organization
.... organizationIdentifier 0..1 Identifier
.... organizationReference Reference ( Organization )
. . . priority Insurer 0..1 Coding Desired processing priority
provider Priority Codes ( Example )
. . . enterer[x] 0..1 Author
.... entererIdentifier 0..1 Identifier
. . . . entererReference Reference ( Practitioner )
. . . facility[x] Responsible practitioner 0..1 Servicing Facility
organization . . . . facilityIdentifier Identifier
. . . . facilityReference Reference ( Location )
... patient[x] 0..1 The subject of the Products and Services
.... patientIdentifier Identifier
.... patientReference Reference ( Patient )
... coverage[x] 0..1 Insurance or medical plan
.... coverageIdentifier Identifier
.... coverageReference Reference ( Organization Coverage )
. . . businessArrangement 0..1 Responsible organization string Business agreement
... serviced[x] 0..1 Estimated date or dates of Service
.... servicedDate date
.... servicedPeriod Period
... benefitCategory 0..1 Coding Benefit Category
Benefit Category Codes ( Example )
... benefitSubCategory 0..1 Coding Benefit SubCategory
Benefit SubCategory Codes ( Example )

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram ( Legend )

EligibilityRequest ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required) EligibilityRequestStatus ! » 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 this resource was created The date when this resource was created created : : dateTime [0..1] [0..1] The Insurer who is target of the request The Insurer who is target of the request target insurer[x] : Type [0..1] « Identifier : | Reference [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 provider provider[x] : Type [0..1] « Identifier : | Reference [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 organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Immediate (STAT), best effort (NORMAL), deferred (DEFER) priority : Coding [0..1] « The timeliness with which processing is required: STAT, normal, Deferred (Strength=Example) Priority ?? » Person who created the invoice/claim/pre-determination or pre-authorization enterer[x] : Type [0..1] « Identifier | Reference ( Practitioner ) » Facility where the services were provided facility[x] : Type [0..1] « Identifier | Reference ( Location ) » Patient Resource patient[x] : Type [0..1] « Identifier | Reference ( Patient ) » Financial instrument by which payment information for health care coverage[x] : Type [0..1] « Identifier | Reference ( Coverage ) » The contract number of a business agreement which describes the terms and conditions businessArrangement : string [0..1] The date or dates when the enclosed suite of services were performed or completed serviced[x] : Type [0..1] « date | Period » Dental, Vision, Medical, Pharmacy, Rehab etc benefitCategory : Coding [0..1] « Benefit categories such as: oral, medical, vision etc. (Strength=Example) Benefit Category ?? » Dental: basic, major, ortho; Vision exam, glasses, contacts; etc benefitSubCategory : Coding [0..1] « Benefit subcategories such as: oral-basic, major, glasses (Strength=Example) Benefit SubCategory ?? »

XML Template XML Template < 

<EligibilityRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</ruleset>
 <</originalRuleset>
 <
 <</target>
 <</provider>
 <</organization>

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer[x]><!-- 0..1 Identifier|Reference(Organization) Target --></insurer[x]>
 <provider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></provider[x]>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></organization[x]>
 <priority><!-- 0..1 Coding Desired processing priority --></priority>
 <enterer[x]><!-- 0..1 Identifier|Reference(Practitioner) Author --></enterer[x]>
 <facility[x]><!-- 0..1 Identifier|Reference(Location) Servicing Facility --></facility[x]>
 <patient[x]><!-- 0..1 Identifier|Reference(Patient) The subject of the Products and Services --></patient[x]>
 <coverage[x]><!-- 0..1 Identifier|Reference(Coverage) Insurance or medical plan --></coverage[x]>
 <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
 <serviced[x]><!-- 0..1 date|Period Estimated date or dates of Service --></serviced[x]>
 <benefitCategory><!-- 0..1 Coding Benefit Category --></benefitCategory>
 <benefitSubCategory><!-- 0..1 Coding Benefit SubCategory --></benefitSubCategory>

</EligibilityRequest>

JSON Template JSON Template { "resourceType" : "", 

{doco
  "resourceType" : "EligibilityRequest",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "

  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  // insurer[x]: Target. One of these 2:

  "insurerIdentifier" : { Identifier },
  "insurerReference" : { Reference(Organization) },
  // provider[x]: Responsible practitioner. One of these 2:

  "providerIdentifier" : { Identifier },
  "providerReference" : { Reference(Practitioner) },
  // organization[x]: Responsible organization. One of these 2:

  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  "priority" : { Coding }, // Desired processing priority
  // enterer[x]: Author. One of these 2:

  "entererIdentifier" : { Identifier },
  "entererReference" : { Reference(Practitioner) },
  // facility[x]: Servicing Facility. One of these 2:

  "facilityIdentifier" : { Identifier },
  "facilityReference" : { Reference(Location) },
  // patient[x]: The subject of the Products and Services. One of these 2:

  "patientIdentifier" : { Identifier },
  "patientReference" : { Reference(Patient) },
  // coverage[x]: Insurance or medical plan. One of these 2:

  "coverageIdentifier" : { Identifier },
  "coverageReference" : { Reference(Coverage) },
  "businessArrangement" : "<string>", // Business agreement
  // serviced[x]: Estimated date or dates of Service. One of these 2:

  "servicedDate" : "<date>",
  "servicedPeriod" : { Period },
  "benefitCategory" : { Coding }, // Benefit Category
  "benefitSubCategory" : { Coding } // Benefit SubCategory

}
 
Alternate
definitions:

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 ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:EligibilityRequest.ruleset [ Coding ]; # 0..1 Resource version
  fhir:EligibilityRequest.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:EligibilityRequest.created [ dateTime ]; # 0..1 Creation date
  # EligibilityRequest.insurer[x] : 0..1 Target. One of these 2
    fhir:EligibilityRequest.insurerIdentifier [ Identifier ]
    fhir:EligibilityRequest.insurerReference [ Reference(Organization) ]
  # EligibilityRequest.provider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:EligibilityRequest.providerIdentifier [ Identifier ]
    fhir:EligibilityRequest.providerReference [ Reference(Practitioner) ]
  # EligibilityRequest.organization[x] : 0..1 Responsible organization. One of these 2
    fhir:EligibilityRequest.organizationIdentifier [ Identifier ]
    fhir:EligibilityRequest.organizationReference [ Reference(Organization) ]
  fhir:EligibilityRequest.priority [ Coding ]; # 0..1 Desired processing priority
  # EligibilityRequest.enterer[x] : 0..1 Author. One of these 2
    fhir:EligibilityRequest.entererIdentifier [ Identifier ]
    fhir:EligibilityRequest.entererReference [ Reference(Practitioner) ]
  # EligibilityRequest.facility[x] : 0..1 Servicing Facility. One of these 2
    fhir:EligibilityRequest.facilityIdentifier [ Identifier ]
    fhir:EligibilityRequest.facilityReference [ Reference(Location) ]
  # EligibilityRequest.patient[x] : 0..1 The subject of the Products and Services. One of these 2
    fhir:EligibilityRequest.patientIdentifier [ Identifier ]
    fhir:EligibilityRequest.patientReference [ Reference(Patient) ]
  # EligibilityRequest.coverage[x] : 0..1 Insurance or medical plan. One of these 2
    fhir:EligibilityRequest.coverageIdentifier [ Identifier ]
    fhir:EligibilityRequest.coverageReference [ Reference(Coverage) ]
  fhir:EligibilityRequest.businessArrangement [ string ]; # 0..1 Business agreement
  # 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.benefitCategory [ Coding ]; # 0..1 Benefit Category
  fhir:EligibilityRequest.benefitSubCategory [ Coding ]; # 0..1 Benefit SubCategory
]

Changes since DSTU2

EligibilityRequest
EligibilityRequest.status added
EligibilityRequest.insurer[x] added
EligibilityRequest.provider[x] Renamed from provider to provider[x]
Add Identifier
EligibilityRequest.organization[x] Renamed from organization to organization[x]
Add Identifier
EligibilityRequest.priority added
EligibilityRequest.enterer[x] added
EligibilityRequest.facility[x] added
EligibilityRequest.patient[x] added
EligibilityRequest.coverage[x] added
EligibilityRequest.businessArrangement added
EligibilityRequest.serviced[x] added
EligibilityRequest.benefitCategory added
EligibilityRequest.benefitSubCategory added
EligibilityRequest.target deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition ( XML , JSON ), XML Schema / Schematron , Resource Profile ( XML , (for ) + JSON Schema , ShEx (for Turtle ), Questionnaire )

7.4.2.1 Terminology Bindings 13.4.2.1 Terminology Bindings

Path Definition Type Reference
EligibilityRequest.status A code specifying the state of the resource instance. Required EligibilityRequestStatus
EligibilityRequest.ruleset
EligibilityRequest.originalRuleset EligibilityRequest.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
EligibilityRequest.priority The timeliness with which processing is required: STAT, normal, Deferred Example 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

7.4.3 Search Parameters 13.4.3 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.
Name Type Description Paths
identifier created date The creation date for the EOB EligibilityRequest.created
facility-identifier token The business Facility responsible for the goods and services EligibilityRequest.facilityidentifier
facility-reference reference Facility responsible for the goods and services EligibilityRequest.facilityReference
( Location )
identifier of the Eligibility token The business identifier of the Eligibility EligibilityRequest.identifier
organization-identifier token The reference to the providing organization EligibilityRequest.organizationidentifier
organization-reference reference The reference to the providing organization EligibilityRequest.organizationReference
Links: Search ( Organization )
patient-identifier token | Version History The reference to the patient EligibilityRequest.patientIdentifier
patient-reference reference | Table of Contents The reference to the patient EligibilityRequest.patientReference
( Patient | Compare to DSTU1 )
provider-identifier token | The reference to the provider EligibilityRequest.provideridentifier
provider-reference reference | Propose a change The reference to the provider EligibilityRequest.providerReference
( Practitioner try { var currentTabIndex = sessionStorage.getItem('fhir-resource-tab-index'); } catch(exception){ } if (!currentTabIndex) currentTabIndex = '0'; $( '#tabs' ).tabs({ active: currentTabIndex, activate: function( event, ui ) { var active = $('.selector').tabs('option', 'active'); currentTabIndex = ui.newTab.index(); document.activeElement.blur(); try { sessionStorage.setItem('fhir-resource-tab-index', currentTabIndex); } catch(exception){ } } });