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.
Endpoints
alpha
https://api.dev.ovok.com/fhir/R4/CoverageEligibilityRequest| Interaction | Method | Path |
|---|---|---|
| Read | GET | /fhir/R4/CoverageEligibilityRequest/[id] |
| Vread | GET | /fhir/R4/CoverageEligibilityRequest/[id]/_history/[vid] |
| Update | PUT | /fhir/R4/CoverageEligibilityRequest/[id] |
| Patch | PATCH | /fhir/R4/CoverageEligibilityRequest/[id] |
| Delete | DELETE | /fhir/R4/CoverageEligibilityRequest/[id] |
| Create | POST | /fhir/R4/CoverageEligibilityRequest |
| Search | GET | /fhir/R4/CoverageEligibilityRequest |
| History | GET | /fhir/R4/CoverageEligibilityRequest/[id]/_history |
Top-level elements
| Element | Type(s) | Cardinality | Description |
|---|---|---|---|
identifier | Identifier | 0..* | Business Identifier for coverage eligiblity request |
status | code | 1..1 | active | cancelled | draft | entered-in-error modifier |
priority | CodeableConcept | 0..1 | Desired processing priority |
purpose | code | 1..* | auth-requirements | benefits | discovery | validation |
patient | Reference | 1..1 | Intended recipient of products and services |
serviced[x] | date / Period | 0..1 | Estimated date or dates of service |
created | dateTime | 1..1 | Creation date |
enterer | Reference | 0..1 | Author |
provider | Reference | 0..1 | Party responsible for the request |
insurer | Reference | 1..1 | Coverage issuer |
facility | Reference | 0..1 | Servicing facility |
supportingInfo | BackboneElement | 0..* | Supporting information |
insurance | BackboneElement | 0..* | Patient insurance information |
item | BackboneElement | 0..* | Item to be evaluated for eligibiity |
Resource-specific search parameters
| Parameter | Type | Description |
|---|---|---|
_compartment | string | |
_count | string | https://www.hl7.org/fhir/search.html#_count |
_elements | string | https://www.hl7.org/fhir/search.html#_elements |
_id | string | |
_lastUpdated | string | |
_profile | string | |
_security | string | |
_sort | string | https://www.hl7.org/fhir/search.html#_sort |
_source | string | |
_summary | string | https://www.hl7.org/fhir/search.html#_summary |
_tag | string | |
_total | string | https://www.hl7.org/fhir/search.html#_total |
created | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-created |
enterer | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-enterer |
facility | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-facility |
identifier | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-identifier |
patient | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-patient |
provider | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-provider |
status | string | http://hl7.org/fhir/SearchParameter/CoverageEligibilityRequest-status |
Reference
- Official FHIR R4 spec:
CoverageEligibilityRequest - Maturity: Trial Use 2 (FMM 2).