Financial
This
page
is
part
of
the
FHIR
Specification
(v3.0.2:
STU
3).
(v3.3.0:
R4
Ballot
2).
The
current
version
which
supercedes
this
version
is
5.0.0
.
For
a
full
list
of
available
versions,
see
the
Directory
of
published
versions
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Page
versions:
R3
R2
|
Financial
Management
Work
Group
|
Maturity Level : 2 | Trial Use | Compartments : Patient , Practitioner |
Detailed Descriptions for the elements in the EligibilityRequest resource.
| EligibilityRequest | |
| Element Id | EligibilityRequest |
| Definition |
The EligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an EligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy. |
| Control | 1..1 |
| EligibilityRequest.identifier | |
| Element Id | EligibilityRequest.identifier |
| Definition |
The Response business identifier. |
| Note | This is a business identifer, not a resource identifier (see discussion ) |
| Control | 0..* |
| Type | Identifier |
| EligibilityRequest.status | |
| Element Id | EligibilityRequest.status |
| Definition |
The status of the resource instance. |
| Control | 0..1 |
| Terminology Binding | Financial Resource Status Codes ( Required ) |
| Type | code |
| Is Modifier | true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid) |
| Requirements |
This element is labeled as a modifier because the status contains codes that mark the request as not currently valid. |
| Summary | true |
| EligibilityRequest.priority | |
| Element Id | EligibilityRequest.priority |
| Definition |
Immediate (STAT), best effort (NORMAL), deferred (DEFER). |
| Control | 0..1 |
| Terminology Binding | Process Priority Codes ( Example ) |
| Type | CodeableConcept |
| EligibilityRequest.patient | |
| Element Id | EligibilityRequest.patient |
| Definition |
Patient Resource. |
| Control | 0..1 |
| Type | Reference ( Patient ) |
| Comments |
1..1. |
| EligibilityRequest.serviced[x] | |
| Element Id | EligibilityRequest.serviced[x] |
| Definition |
The date or dates when the enclosed suite of services were performed or completed. |
| Control | 0..1 |
| Type | date | Period |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityRequest.created | |
| Element Id | EligibilityRequest.created |
| Definition |
The date when this resource was created. |
| Control | 0..1 |
| Type | dateTime |
| EligibilityRequest.enterer | |
| Element Id | EligibilityRequest.enterer |
| Definition |
Person who created the invoice/claim/pre-determination or pre-authorization. |
| Control | 0..1 |
| Type | Reference ( Practitioner | PractitionerRole ) |
| EligibilityRequest.provider | |
| Element Id | EligibilityRequest.provider |
| Definition |
The practitioner who is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Reference ( Practitioner | PractitionerRole | Organization ) |
|
|
|
|
|
|
| Definition |
The Insurer who is target of the request. |
| Control | 0..1 |
| Type | Reference ( Organization ) |
| EligibilityRequest.facility | |
| Element Id | EligibilityRequest.facility |
| Definition |
Facility where the services were provided. |
| Control | 0..1 |
| Type | Reference ( Location ) |
| EligibilityRequest.coverage | |
| Element Id | EligibilityRequest.coverage |
| Definition |
Financial instrument by which payment information for health care. |
| Control | 0..1 |
| Type | Reference ( Coverage ) |
| Requirements |
Need to identify the issuer to target for processing and for coordination of benefit processing. |
| Comments |
1..1. |
| EligibilityRequest.businessArrangement | |
| Element Id | EligibilityRequest.businessArrangement |
| Definition |
The contract number of a business agreement which describes the terms and conditions. |
| Control | 0..1 |
| Type | string |
| EligibilityRequest.benefitCategory | |
| Element Id | EligibilityRequest.benefitCategory |
| Definition |
Dental, Vision, Medical, Pharmacy, Rehab etc. |
| Control | 0..1 |
| Terminology Binding | Benefit Category Codes ( Example ) |
| Type | CodeableConcept |
| EligibilityRequest.benefitSubCategory | |
| Element Id | EligibilityRequest.benefitSubCategory |
| Definition |
Dental: basic, major, ortho; Vision exam, glasses, contacts; etc. |
| Control | 0..1 |
| Terminology Binding | Benefit SubCategory Codes ( Example ) |
| Type | CodeableConcept |
| EligibilityRequest.authorization | |
| Element Id | EligibilityRequest.authorization |
| Definition | A list of billable services for which an authorization prior to service delivery may be required by the payor. |
| Control | 0..* |
| EligibilityRequest.authorization.sequence | |
| Element Id | EligibilityRequest.authorization.sequence |
| Definition | Sequence of procedures which serves to order and provide a link. |
| Control | 1..1 |
| Type | positiveInt |
| EligibilityRequest.authorization.service | |
| Element Id | EligibilityRequest.authorization.service |
| Definition | A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). |
| Control | 1..1 |
| Terminology Binding | USCLS Codes ( Example ) |
| Type | CodeableConcept |
| EligibilityRequest.authorization.modifier | |
| Element Id | EligibilityRequest.authorization.modifier |
| Definition | Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours. |
| Control | 0..* |
| Terminology Binding | Modifier type Codes ( Example ) |
| Type | CodeableConcept |
| EligibilityRequest.authorization.quantity | |
| Element Id | EligibilityRequest.authorization.quantity |
| Definition | The number of repetitions of a service or product. |
| Control | 0..1 |
| Type | SimpleQuantity |
| EligibilityRequest.authorization.unitPrice | |
| Element Id | EligibilityRequest.authorization.unitPrice |
| Definition | The fee for an addittional service or product or charge. |
| Control | 0..1 |
| Type | Money |
| EligibilityRequest.authorization.facility | |
| Element Id | EligibilityRequest.authorization.facility |
| Definition | Facility where the services were provided. |
| Control | 0..1 |
| Type | Reference ( Location | Organization ) |
| EligibilityRequest.authorization.diagnosis | |
| Element Id | EligibilityRequest.authorization.diagnosis |
| Definition | List of patient diagnosis for which care is sought. |
| Control | 0..* |
| EligibilityRequest.authorization.diagnosis.diagnosis[x] | |
| Element Id | EligibilityRequest.authorization.diagnosis.diagnosis[x] |
| Definition | The diagnosis. |
| Control | 0..1 |
| Terminology Binding | ICD-10 Codes ( Example ) |
| Type | CodeableConcept | Reference ( Condition ) |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| Requirements | Required to adjudicate services rendered to condition presented. |
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HL7.org
2011+.
FHIR
Release
3
(STU;
v3.0.2-11200)
Mixed
Nomative/Trial
Use
Ballot
(v3.3.0-13671)
generated
on
Thurs,
Oct
24,
2019
11:53+1100.
Tue,
Apr
3,
2018
12:15+1000.
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