CoverageEligibilityRequest - FHIR Resource (r4)


This CoverageEligibilityRequest Resource uses the FHIR API standard for access and structure.

Validate an CoverageEligibilityRequest FHIR Resource (r4)



Resource Attributes

AttributeField is listTypeDescription
createdfalsedateTime# Creation date
entererfalseReference# Author
facilityfalseReference# Servicing facility
identifiertrueIdentifier# Business Identifier for coverage eligiblity request
insurancetrueData Type# Patient insurance information
insurerfalseReference# Coverage issuer
itemtrueData Type# Item to be evaluated for eligibiity
patientfalseReference# Intended recipient of products and services
priorityfalseCodeableConcept# Desired processing priority
providerfalseReference# Party responsible for the request
purposetruecode# auth-requirements | benefits | discovery | validation
serviced[x]falsedate|Period#undefined
statusfalsecode# active | cancelled | draft | entered-in-error
supportingInfotrueData Type# Supporting information

CoverageEligibilityRequest Example

{
  "resourceType": "CoverageEligibilityRequest",
  "id": "52345",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityRequest</div>"
  },
  "identifier": [
    {
      "system": "http://happyvalley.com/coverageelegibilityrequest",
      "value": "52345"
    }
  ],
  "status": "active",
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "purpose": [
    "validation"
  ],
  "patient": {
    "reference": "Patient/pat1"
  },
  "created": "2014-08-16",
  "provider": {
    "reference": "Organization/1"
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ]
}

CoverageEligibilityRequest Structure

{
  "resourceType" : "CoverageEligibilityRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for coverage eligiblity request
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "priority" : { CodeableConcept }, // Desired processing priority
  "purpose" : ["<code>"], // R!  auth-requirements | benefits | discovery | validation
  "patient" : { Reference(Patient) }, // R!  Intended recipient of products and services
  // serviced[x]: Estimated date or dates of service. One of these 2:
  "servicedDate" : "<date>",
  "servicedPeriod" : { Period },
  "created" : "<dateTime>", // R!  Creation date
  "enterer" : { Reference(Practitioner|PractitionerRole) }, // Author
  "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // Party responsible for the request
  "insurer" : { Reference(Organization) }, // R!  Coverage issuer
  "facility" : { Reference(Location) }, // Servicing facility
  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "information" : { Reference(Any) }, // R!  Data to be provided
    "appliesToAll" : <boolean> // Applies to all items
  }],
  "insurance" : [{ // Patient insurance information
    "focal" : <boolean>, // Applicable coverage
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>" // Additional provider contract number
  }],
  "item" : [{ // Item to be evaluated for eligibiity
    "supportingInfoSequence" : ["<positiveInt>"], // Applicable exception or supporting information
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "provider" : { Reference(Practitioner|PractitionerRole) }, // Perfoming practitioner
    "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "facility" : { Reference(Location|Organization) }, // Servicing facility
    "diagnosis" : [{ // Applicable diagnosis
      // diagnosis[x]: Nature of illness or problem. One of these 2:
      "diagnosisCodeableConcept" : { CodeableConcept }
      "diagnosisReference" : { Reference(Condition) }
    }],
    "detail" : [{ Reference(Any) }] // Product or service details
  }]
}

CoverageEligibilityRequest Search Parameters

The following search parameters can be used to query CoverageEligibilityRequest resources. Just submit them like so:

https://api.1up.health/fhir/r4/CoverageEligibilityRequest?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
createddatecreated
entererreferenceenterer
facilityreferencefacility
identifiertextidentifier
patientreferencepatient
providerreferenceprovider
statustextstatus