description: null
package_name: hl7.fhir.r4b.core
derivation: specialization
name: CoverageEligibilityRequest
type: CoverageEligibilityRequest
elements:
  patient:
    isModifier: false
    short: Intended recipient of products and services
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 4
  insurance:
    isModifier: false
    short: Patient insurance information
    index: 18
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      focal: {isModifier: false, short: Applicable coverage, type: boolean, mustSupport: false, isSummary: false, index: 19}
      coverage:
        isModifier: false
        short: Insurance information
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 20
      businessArrangement: {isModifier: false, short: Additional provider contract number, type: string, mustSupport: false, isSummary: false, index: 21}
    required: [coverage]
    isSummary: false
  facility:
    isModifier: false
    short: Servicing facility
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 13
  enterer:
    isModifier: false
    short: Author
    refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 10
  supportingInfo:
    isModifier: false
    short: Supporting information
    index: 14
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Information instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 15}
      information:
        isModifier: false
        short: Data to be provided
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 16
      appliesToAll: {isModifier: false, short: Applies to all items, type: boolean, mustSupport: false, isSummary: false, index: 17}
    required: [sequence, information]
    isSummary: false
  purpose:
    min: 1
    isModifier: false
    short: auth-requirements | benefits | discovery | validation
    index: 3
    type: code
    mustSupport: false
    array: true
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.1.0'}
    isSummary: true
  item:
    isModifier: false
    short: Item to be evaluated for eligibiity
    type: BackboneElement
    mustSupport: false
    array: true
    isSummary: false
    index: 22
    elements:
      category:
        isModifier: false
        short: Benefit classification
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        isSummary: false
        index: 24
      facility:
        isModifier: false
        short: Servicing facility
        refers: ['http://hl7.org/fhir/StructureDefinition/Location', 'http://hl7.org/fhir/StructureDefinition/Organization']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 30
      diagnosis:
        isModifier: false
        short: Applicable diagnosis
        type: BackboneElement
        mustSupport: false
        array: true
        isSummary: false
        index: 31
        elements:
          diagnosis:
            isModifier: false
            short: Nature of illness or problem
            mustSupport: false
            choices: [diagnosisCodeableConcept, diagnosisReference]
            isSummary: false
            index: 33
          diagnosisCodeableConcept: {isModifier: false, short: Nature of illness or problem, type: CodeableConcept, mustSupport: false, choiceOf: diagnosis, isSummary: false, index: 34}
          diagnosisReference:
            isModifier: false
            short: Nature of illness or problem
            refers: ['http://hl7.org/fhir/StructureDefinition/Condition']
            type: Reference
            mustSupport: false
            choiceOf: diagnosis
            isSummary: false
            index: 35
      modifier:
        isModifier: false
        short: Product or service billing modifiers
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        isSummary: false
        index: 26
      productOrService:
        isModifier: false
        short: Billing, service, product, or drug code
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        isSummary: false
        index: 25
      quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 28}
      provider:
        isModifier: false
        short: Perfoming practitioner
        refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 27
      supportingInfoSequence: {isModifier: false, short: Applicable exception or supporting information, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 23}
      unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 29}
      detail:
        isModifier: false
        short: Product or service details
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 36
  created: {isModifier: false, short: Creation date, type: dateTime, mustSupport: false, isSummary: true, index: 9}
  serviced:
    isModifier: false
    short: Estimated date or dates of service
    mustSupport: false
    choices: [servicedDate, servicedPeriod]
    isSummary: false
    index: 6
  insurer:
    isModifier: false
    short: Coverage issuer
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 12
  priority:
    isModifier: false
    short: Desired processing priority
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    isSummary: false
    index: 2
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    index: 1
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|4.1.0'}
    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
  servicedDate: {isModifier: false, short: Estimated date or dates of service, type: date, mustSupport: false, choiceOf: serviced, isSummary: false, index: 7}
  identifier: {isModifier: false, short: Business Identifier for coverage eligiblity request, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 0}
  provider:
    isModifier: false
    short: Party responsible for the request
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 11
  servicedPeriod: {isModifier: false, short: Estimated date or dates of service, type: Period, mustSupport: false, choiceOf: serviced, isSummary: false, index: 8}
package_version: 4.1.0
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 4.1.0
required: [created, insurer, status, patient, purpose]