http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest|5.0.0
The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.
description: The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy. derivation: specialization name: CoverageEligibilityRequest type: CoverageEligibilityRequest elements: patient: {isModifier: false, short: Intended recipient of products and services, mustSupport: false, isSummary: true, index: 4} insurance: isModifier: false short: Patient insurance information mustSupport: false array: true isSummary: false index: 20 elements: focal: {isModifier: false, short: Applicable coverage, mustSupport: false, isSummary: false, index: 21} coverage: {isModifier: false, short: Insurance information, mustSupport: false, isSummary: false, index: 22} businessArrangement: {isModifier: false, short: Additional provider contract number, mustSupport: false, isSummary: false, index: 23} required: [coverage] facility: {isModifier: false, short: Servicing facility, mustSupport: false, isSummary: false, index: 15} enterer: {isModifier: false, short: Author, mustSupport: false, isSummary: false, index: 12} supportingInfo: isModifier: false short: Supporting information mustSupport: false array: true isSummary: false index: 16 elements: sequence: {isModifier: false, short: Information instance identifier, mustSupport: false, isSummary: false, index: 17} information: {isModifier: false, short: Data to be provided, mustSupport: false, isSummary: false, index: 18} appliesToAll: {isModifier: false, short: Applies to all items, mustSupport: false, isSummary: false, index: 19} required: [sequence, information] purpose: min: 1 isModifier: false short: auth-requirements | benefits | discovery | validation index: 3 mustSupport: false array: true binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0'} isSummary: true item: isModifier: false short: Item to be evaluated for eligibiity mustSupport: false array: true isSummary: false index: 24 elements: category: isModifier: false short: Benefit classification mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'} isSummary: false index: 26 facility: {isModifier: false, short: Servicing facility, mustSupport: false, isSummary: false, index: 32} diagnosis: isModifier: false short: Applicable diagnosis mustSupport: false array: true isSummary: false index: 33 elements: diagnosis: isModifier: false short: Nature of illness or problem mustSupport: false choices: [] isSummary: false index: 35 modifier: isModifier: false short: Product or service billing modifiers mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'} isSummary: false index: 28 productOrService: isModifier: false short: Billing, service, product, or drug code mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'} isSummary: false index: 27 quantity: {isModifier: false, short: Count of products or services, mustSupport: false, isSummary: false, index: 30} provider: {isModifier: false, short: Perfoming practitioner, mustSupport: false, isSummary: false, index: 29} supportingInfoSequence: {isModifier: false, short: Applicable exception or supporting information, mustSupport: false, array: true, isSummary: false, index: 25} unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', mustSupport: false, isSummary: false, index: 31} detail: {isModifier: false, short: Product or service details, mustSupport: false, array: true, isSummary: false, index: 36} created: {isModifier: false, short: Creation date, mustSupport: false, isSummary: true, index: 11} serviced: isModifier: false short: Estimated date or dates of service mustSupport: false choices: [] isSummary: false index: 10 event: isModifier: false short: Event information mustSupport: false array: true isSummary: false index: 5 elements: type: isModifier: false short: Specific event mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/datestype'} isSummary: false index: 6 when: isModifier: false short: Occurance date or period mustSupport: false choices: [] isSummary: false index: 8 required: [when, type] insurer: {isModifier: false, short: Coverage issuer, mustSupport: false, isSummary: true, index: 14} priority: isModifier: false short: Desired processing priority mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'} isSummary: false index: 2 status: isModifier: true short: active | cancelled | draft | entered-in-error mustSupport: false binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|5.0.0'} isModifierReason: This element is labeled 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 isSummary: true index: 1 identifier: {isModifier: false, short: Business Identifier for coverage eligiblity request, mustSupport: false, array: true, isSummary: false, index: 0} provider: {isModifier: false, short: Party responsible for the request, mustSupport: false, isSummary: false, index: 13} class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest base: http://hl7.org/fhir/StructureDefinition/DomainResource version: 5.0.0 required: [created, insurer, status, patient, purpose]