http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest|4.0.1
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.
| Name | Flags | Card | Type | Description & Constraints |
|---|---|---|---|---|
CoverageEligibilityRequest | 0..* | CoverageEligibilityRequest resource | ||
| 0..* | Identifier | Business Identifier for coverage eligiblity request | ||
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error EligibilityRequestStatus (required) | |
| 0..1 | CodeableConcept | Desired processing priority ProcessPriority (example) | ||
Σ | 1..* | code | auth-requirements | benefits | discovery | validation EligibilityRequestPurpose (required) | |
Σ | 1..1 | Reference | Intended recipient of products and services | |
| 0..1 | Estimated date or dates of service | |||
| 0..1 | date | |||
| 0..1 | Period | |||
Σ | 1..1 | dateTime | Creation date | |
| 0..1 | Reference | Author | ||
| 0..1 | Reference | Party responsible for the request | ||
Σ | 1..1 | Reference | Coverage issuer | |
| 0..1 | Reference | Servicing facility | ||
| 0..* | BackboneElement | Supporting information | ||
| 1..1 | positiveInt | Information instance identifier | ||
| 1..1 | Reference | Data to be provided | ||
| 0..1 | boolean | Applies to all items | ||
| 0..* | BackboneElement | Patient insurance information | ||
| 0..1 | boolean | Applicable coverage | ||
| 1..1 | Reference | Insurance information | ||
| 0..1 | string | Additional provider contract number | ||
| 0..* | BackboneElement | Item to be evaluated for eligibiity | ||
| 0..* | positiveInt | Applicable exception or supporting information | ||
| 0..1 | CodeableConcept | Benefit classification BenefitCategory (example) | ||
| 0..1 | CodeableConcept | Billing, service, product, or drug code ServiceProduct (example) | ||
| 0..* | CodeableConcept | Product or service billing modifiers Modifiers (example) | ||
| 0..1 | Reference | Perfoming practitioner | ||
| 0..1 | Quantity | Count of products or services | ||
| 0..1 | Money | Fee, charge or cost per item | ||
| 0..1 | Reference | Servicing facility | ||
| 0..* | BackboneElement | Applicable diagnosis | ||
| 0..1 | Nature of illness or problem ICD10 (example) | |||
| 0..1 | CodeableConcept | ICD10 (example) | ||
| 0..1 | Reference | ICD10 (example) | ||
| 0..* | Reference | Product or service details |