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.
package_name: hl7.fhir.core
derivation: specialization
name: CoverageEligibilityRequest
type: CoverageEligibilityRequest
elements:
  patient:
    short: The subject of the Products and Services
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
    type: Reference
    index: 4
  insurance:
    type: BackboneElement
    short: Patient's Insurance or medical plan(s)
    array: true
    index: 18
    elements:
      focal: {type: boolean, short: Is the focal Coverage, index: 19}
      coverage:
        short: Insurance or medical plan
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        index: 20
      businessArrangement: {type: string, short: Business agreement, index: 21}
    required: [coverage]
  facility:
    short: Servicing Facility
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    index: 13
  enterer:
    short: Author
    refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    index: 10
  purpose:
    min: 1
    short: auth-requirements | benefits | discovery | validation
    type: code
    array: true
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose'}
    isSummary: true
    index: 3
  item:
    type: BackboneElement
    short: Service types, codes and supporting information
    array: true
    index: 22
    elements:
      category:
        type: CodeableConcept
        short: Type of service
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        index: 24
      facility:
        type: Reference
        short: Servicing Facility
        refers: ['http://hl7.org/fhir/StructureDefinition/Location', 'http://hl7.org/fhir/StructureDefinition/Organization']
        index: 30
      diagnosis:
        short: List of Diagnosis
        type: BackboneElement
        array: true
        index: 31
        elements:
          diagnosis:
            short: Patient's diagnosis
            choices: [diagnosisCodeableConcept, diagnosisReference]
            index: 33
          diagnosisCodeableConcept: {short: Patient's diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 34}
          diagnosisReference:
            short: Patient's diagnosis
            refers: ['http://hl7.org/fhir/StructureDefinition/Condition']
            type: Reference
            choiceOf: diagnosis
            index: 35
      modifier:
        type: CodeableConcept
        short: Service/Product billing modifiers
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        array: true
        index: 26
      supportingInformationSequence: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 23}
      quantity: {type: Quantity, short: Count of products or services, index: 28}
      billcode:
        type: CodeableConcept
        short: Billing Code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        index: 25
      provider:
        short: Perfoming practitioner
        refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        index: 27
      unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 29}
      detail:
        short: Product or service details
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        array: true
        index: 36
  created: {type: dateTime, short: Creation date, index: 9}
  serviced:
    short: Estimated date or dates of Service
    choices: [servicedDate, servicedPeriod]
    index: 6
  supportingInformation:
    short: Exceptions, special considerations, the condition, situation, prior or concurrent issues
    type: BackboneElement
    array: true
    index: 14
    elements:
      sequence: {type: positiveInt, short: Information instance identifier, index: 15}
      information:
        type: Reference
        short: Additional Data or supporting information
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        index: 16
      appliesToAll: {type: boolean, short: Applies to all items, index: 17}
    required: [sequence, information]
  insurer:
    short: Target
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    index: 12
  priority:
    short: Desired processing priority
    type: CodeableConcept
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    index: 2
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    type: code
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status'}
    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
  servicedDate: {short: Estimated date or dates of Service, type: date, choiceOf: serviced, index: 7}
  identifier: {type: Identifier, short: Business Identifier, array: true, index: 0}
  provider:
    short: Responsible provider
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    index: 11
  servicedPeriod: {short: Estimated date or dates of Service, type: Period, choiceOf: serviced, index: 8}
package_version: 3.5.0
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: null
required: [purpose]