CoverageEligibilityRequest - FHIR Resource (r4)
This CoverageEligibilityRequest Resource uses the FHIR API standard for access and structure.
Validate an CoverageEligibilityRequest FHIR Resource (r4)
CoverageEligibilityRequest Attributes
AttributeField is listTypeDescription
Description: Business Identifier for coverage eligiblity request
FHIR Version: r4
Attribute Type : Identifier
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"identifier": [
{
"system": "http://happyvalley.com/coverageelegibilityrequest",
"value": "52345"
}
]Learn more about the (CoverageEligibilityRequest) identifier FHIR attribute
Description: active | cancelled | draft | entered-in-error
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"status": "active"Learn more about the (CoverageEligibilityRequest) status FHIR attribute
Description: Desired processing priority
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"priority": {
"coding": [
{
"code": "normal"
}
]
}Learn more about the (CoverageEligibilityRequest) priority FHIR attribute
Description: auth-requirements | benefits | discovery | validation
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"purpose": [
"validation"
]Learn more about the (CoverageEligibilityRequest) purpose FHIR attribute
Description: Intended recipient of products and services
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"patient": {
"reference": "Patient/pat1"
}Learn more about the (CoverageEligibilityRequest) patient FHIR attribute
Description:
FHIR Version: r4
Attribute Type : date|Period
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"serviced[x]": Learn more about the (CoverageEligibilityRequest) serviced[x] FHIR attribute
Description: Creation date
FHIR Version: r4
Attribute Type : dateTime
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"created": "2014-08-16"Learn more about the (CoverageEligibilityRequest) created FHIR attribute
Description: Author
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"enterer": Learn more about the (CoverageEligibilityRequest) enterer FHIR attribute
Description: Party responsible for the request
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"provider": {
"reference": "Organization/1"
}Learn more about the (CoverageEligibilityRequest) provider FHIR attribute
Description: Coverage issuer
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurer": {
"reference": "Organization/2"
}Learn more about the (CoverageEligibilityRequest) insurer FHIR attribute
Description: Servicing facility
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"facility": Learn more about the (CoverageEligibilityRequest) facility FHIR attribute
Description: Supporting information
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"supportingInfo": Learn more about the (CoverageEligibilityRequest) supportingInfo FHIR attribute
Description: Patient insurance information
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurance": [
{
"focal": true,
"coverage": {
"reference": "Coverage/9876B1"
}
}
]Learn more about the (CoverageEligibilityRequest) insurance FHIR attribute
Description: Item to be evaluated for eligibiity
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"item": Learn more about the (CoverageEligibilityRequest) item FHIR attribute
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 Parameter | Field Type | Resource Fields Searched |
|---|---|---|
created | date | created |
enterer | reference | enterer |
facility | reference | facility |
identifier | text | identifier |
patient | reference | patient |
provider | reference | provider |
status | text | status |
