CoverageEligibilityRequest

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. If the element is present, it must have either a @value, an @id, or extensions

type CoverageEligibilityRequest implements Resource {
  identifier: [Identifier]
  status: String
  priority: CodeableConcept
  purpose: [String]
  patient: Reference
  servicedDate: Date
  servicedPeriod: Period
  created: Date
  enterer: Reference
  provider: Reference
  insurer: Reference
  facility: Reference
  supportingInfo: [CoverageEligibilityRequestSupportingInfo]
  insurance: [CoverageEligibilityRequestInsurance]
  item: [CoverageEligibilityRequestItem]
  text: Narrative
  contained: [Resource]
  extension: [Extension]
  modifierExtension: [Extension]
  id: String
  meta: Meta
  implicitRules: Uri
  language: String
}

Fields

CoverageEligibilityRequest.identifier ● [Identifier] list object

A unique identifier assigned to this coverage eligiblity request.

CoverageEligibilityRequest.status ● String scalar

The status of the resource instance.

CoverageEligibilityRequest.priority ● CodeableConcept object

When the requestor expects the processor to complete processing.

CoverageEligibilityRequest.purpose ● [String] list scalar

Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or now if not specified.

CoverageEligibilityRequest.patient ● Reference object

The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.

CoverageEligibilityRequest.servicedDate ● Date scalar

The date or dates when the enclosed suite of services were performed or completed. (choose any one of serviced*, but only one)

CoverageEligibilityRequest.servicedPeriod ● Period object

The date or dates when the enclosed suite of services were performed or completed. (choose any one of serviced*, but only one)

CoverageEligibilityRequest.created ● Date scalar

The date when this resource was created.

CoverageEligibilityRequest.enterer ● Reference object

Person who created the request.

CoverageEligibilityRequest.provider ● Reference object

The provider which is responsible for the request.

CoverageEligibilityRequest.insurer ● Reference object

The Insurer who issued the coverage in question and is the recipient of the request.

CoverageEligibilityRequest.facility ● Reference object

Facility where the services are intended to be provided.

CoverageEligibilityRequest.supportingInfo ● [CoverageEligibilityRequestSupportingInfo] list object

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

CoverageEligibilityRequest.insurance ● [CoverageEligibilityRequestInsurance] list object

Financial instruments for reimbursement for the health care products and services.

CoverageEligibilityRequest.item ● [CoverageEligibilityRequestItem] list object

Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.

CoverageEligibilityRequest.text ● Narrative object

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it clinically safe for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

CoverageEligibilityRequest.contained ● [Resource] list interface

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

CoverageEligibilityRequest.extension ● [Extension] list object

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

CoverageEligibilityRequest.modifierExtension ● [Extension] list object

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

CoverageEligibilityRequest.id ● String scalar

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

CoverageEligibilityRequest.meta ● Meta object

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

CoverageEligibilityRequest.implicitRules ● Uri scalar

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

CoverageEligibilityRequest.language ● String scalar

The base language in which the resource is written.

Interfaces

Resource interface

This is the base resource type for everything.

Returned By

CoverageEligibilityRequest query ● CoverageEligibilityRequestCreate mutation ● CoverageEligibilityRequestList query ● CoverageEligibilityRequestUpdate mutation