http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest|4.0.1

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: {short: Intended recipient of products and services, isSummary: true, index: 4}
  insurance:
    short: Patient insurance information
    array: true
    index: 16
    elements:
      focal: {short: Applicable coverage, index: 17}
      coverage: {short: Insurance information, index: 18}
      businessArrangement: {short: Additional provider contract number, index: 19}
    required: [coverage]
  facility: {short: Servicing facility, index: 11}
  enterer: {short: Author, index: 8}
  supportingInfo:
    short: Supporting information
    array: true
    index: 12
    elements:
      sequence: {short: Information instance identifier, index: 13}
      information: {short: Data to be provided, index: 14}
      appliesToAll: {short: Applies to all items, index: 15}
    required: [sequence, information]
  purpose:
    min: 1
    short: auth-requirements | benefits | discovery | validation
    array: true
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1'}
    isSummary: true
    index: 3
  item:
    short: Item to be evaluated for eligibiity
    array: true
    index: 20
    elements:
      category:
        short: Benefit classification
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        index: 22
      facility: {short: Servicing facility, index: 28}
      diagnosis:
        short: Applicable diagnosis
        array: true
        index: 29
        elements:
          diagnosis:
            short: Nature of illness or problem
            choices: []
            index: 31
      modifier:
        short: Product or service billing modifiers
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        index: 24
      productOrService:
        short: Billing, service, product, or drug code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        index: 23
      quantity: {short: Count of products or services, index: 26}
      provider: {short: Perfoming practitioner, index: 25}
      supportingInfoSequence: {short: Applicable exception or supporting information, array: true, index: 21}
      unitPrice: {short: 'Fee, charge or cost per item', index: 27}
      detail: {short: Product or service details, array: true, index: 32}
  created: {short: Creation date, isSummary: true, index: 7}
  serviced:
    short: Estimated date or dates of service
    choices: []
    index: 6
  insurer: {short: Coverage issuer, isSummary: true, index: 10}
  priority:
    short: Desired processing priority
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    index: 2
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|4.0.1'}
    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: {short: Business Identifier for coverage eligiblity request, array: true, index: 0}
  provider: {short: Party responsible for the request, index: 9}
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 4.0.1
required: [created, insurer, status, patient, purpose]