Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CoverageEligibilityRequest | TU | DomainResource | CoverageEligibilityRequest resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension |
|
identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request
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status | ?! Σ | 1..1 | code | active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes ( Required) |
priority | 0..1 | CodeableConcept | Desired processing priority
Binding: Process Priority Codes ( Example) |
|
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation
Binding: Eligibility Request Purpose ( Required) |
patient | Σ | 1..1 | Reference( Patient) | Intended recipient of products and services
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event | 0..* | BackboneElement | Event information
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type | 1..1 | CodeableConcept | Specific event
Binding: Dates Type Codes ( Example) |
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when[x] | 1..1 | Occurance date or period
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||
whenDateTime | dateTime | |||
whenPeriod | Period | |||
serviced[x] | 0..1 | Estimated date or dates of service
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||
servicedDate | date | |||
servicedPeriod | Period | |||
created | Σ | 1..1 | dateTime | Creation date
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enterer | 0..1 | Reference( Practitioner | PractitionerRole) | Author
|
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provider | 0..1 | Reference( Practitioner | PractitionerRole | Organization) | Party responsible for the request
|
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insurer | Σ | 1..1 | Reference( Organization) | Coverage issuer
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facility | 0..1 | Reference( Location) | Servicing facility
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supportingInfo | 0..* | BackboneElement | Supporting information
|
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sequence | 1..1 | positiveInt | Information instance identifier
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information | 1..1 | Reference( Any) | Data to be provided
|
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appliesToAll | 0..1 | boolean | Applies to all items
|
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insurance | 0..* | BackboneElement | Patient insurance information
|
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focal | 0..1 | boolean | Applicable coverage
|
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coverage | 1..1 | Reference( Coverage) | Insurance information
|
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businessArrangement | 0..1 | string | Additional provider contract number
|
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item | 0..* | BackboneElement | Item to be evaluated for eligibiity
|
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supportingInfoSequence | 0..* | positiveInt | Applicable exception or supporting information
|
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category | 0..1 | CodeableConcept | Benefit classification
Binding: Benefit Category Codes ( Example) |
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productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code
Binding: USCLS Codes ( Example) |
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modifier | 0..* | CodeableConcept | Product or service billing modifiers
Binding: Modifier type Codes ( Example) |
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provider | 0..1 | Reference( Practitioner | PractitionerRole) | Perfoming practitioner
|
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quantity | 0..1 | SimpleQuantity | Count of products or services
|
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unitPrice | 0..1 | Money | Fee, charge or cost per item
|
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facility | 0..1 | Reference( Location | Organization) | Servicing facility
|
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diagnosis | 0..* | BackboneElement | Applicable diagnosis
|
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diagnosis[x] | 0..1 | Nature of illness or problem
Binding: ICD-10 Codes ( Example) |
||
diagnosisCodeableConcept | CodeableConcept | |||
diagnosisReference | Reference( Condition) | |||
detail | 0..* | Reference( Any) | Product or service details
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Documentation for this format |