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    Class CoverageEligibilityRequest

    CoverageEligibilityRequest Class

    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.

    FHIR Specification

    • Short: CoverageEligibilityRequest resource
    • Definition: 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.
    • FHIR Version: 4.0.1

    FHIR CoverageEligibilityRequest

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    constructor

    Properties

    identifier? fmStatusEnum status priority? eligibilityrequestPurposeEnum purpose patient serviced? created enterer? provider? insurer facility? supportingInfo? insurance? item?

    Methods

    parse getIdentifier setIdentifier addIdentifier hasIdentifier getStatusEnumType setStatusEnumType hasStatusEnumType getStatusElement setStatusElement hasStatusElement getStatus setStatus hasStatus getPriority setPriority hasPriority getPurposeEnumType setPurposeEnumType addPurposeEnumType hasPurposeEnumType getPurposeElement setPurposeElement addPurposeElement hasPurposeElement getPurpose setPurpose addPurpose hasPurpose getPatient setPatient hasPatient getServiced setServiced hasServiced getServicedDateType hasServicedDateType getServicedPeriod hasServicedPeriod getCreatedElement setCreatedElement hasCreatedElement getCreated setCreated hasCreated getEnterer setEnterer hasEnterer getProvider setProvider hasProvider getInsurer setInsurer hasInsurer getFacility setFacility hasFacility getSupportingInfo setSupportingInfo addSupportingInfo hasSupportingInfo getInsurance setInsurance addInsurance hasInsurance getItem setItem addItem hasItem fhirType isEmpty isRequiredFieldsEmpty copy toJSON getText setText hasText getContained setContained addContained hasContained getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension resourceType getIdElement setIdElement hasIdElement getId setId hasId getMeta setMeta hasMeta getImplicitRulesElement setImplicitRulesElement hasImplicitRulesElement getImplicitRules setImplicitRules hasImplicitRules getLanguageElement setLanguageElement hasLanguageElement getLanguage setLanguage hasLanguage isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initIdentifier initPurpose initSupportingInfo initInsurance initItem

    Constructors

    Properties

    identifier?: Identifier[]

    CoverageEligibilityRequest.identifier Element

    FHIR Specification

    • Short: Business Identifier for coverage eligiblity request
    • Definition: A unique identifier assigned to this coverage eligiblity request.
    • Requirements: Allows coverage eligibility requests to be distinguished and referenced.
    • FHIR Type: Identifier
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    fmStatusEnum: FmStatusEnum

    FHIR CodeSystem: FmStatus

    FmStatusEnum

    status: null | EnumCodeType

    CoverageEligibilityRequest.status Element

    FHIR Specification

    • Short: active | cancelled | draft | entered-in-error
    • Definition: The status of the resource instance.
    • Comment: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
    • Requirements: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: true
    • 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

    CodeSystem Enumeration: FmStatusEnum

    priority?: CodeableConcept

    CoverageEligibilityRequest.priority Element

    FHIR Specification

    • Short: Desired processing priority
    • Definition: When the requestor expects the processor to complete processing.
    • Requirements: Needed to advise the prossesor on the urgency of the request.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    eligibilityrequestPurposeEnum: EligibilityrequestPurposeEnum

    FHIR CodeSystem: EligibilityrequestPurpose

    EligibilityrequestPurposeEnum

    purpose: null | EnumCodeType[]

    CoverageEligibilityRequest.purpose Element

    FHIR Specification

    • Short: auth-requirements | benefits | discovery | validation
    • Definition: 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.
    • Requirements: To indicate the processing actions requested.
    • FHIR Type: code
    • Cardinality: 1..*
    • isModifier: false
    • isSummary: true

    CodeSystem Enumeration: EligibilityrequestPurposeEnum

    patient: null | Reference

    CoverageEligibilityRequest.patient Element

    FHIR Specification

    • Short: Intended recipient of products and services
    • Definition: The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
    • Comment: 1..1.
    • Requirements: Required to provide context and coverage validation.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    serviced?: IDataType

    CoverageEligibilityRequest.serviced[x] Element

    @ChoiceDataTypesMeta('CoverageEligibilityRequest.serviced[x]', ['date','Period',]

    FHIR Specification

    • Short: Estimated date or dates of service
    • Definition: The date or dates when the enclosed suite of services were performed or completed.
    • Requirements: Required to provide time context for the request.
    • FHIR Types: 'date', 'Period',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    created: null | DateTimeType

    CoverageEligibilityRequest.created Element

    FHIR Specification

    • Short: Creation date
    • Definition: The date when this resource was created.
    • Requirements: Need to record a timestamp for use by both the recipient and the issuer.
    • FHIR Type: dateTime
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    enterer?: Reference

    CoverageEligibilityRequest.enterer Element

    FHIR Specification

    provider?: Reference

    CoverageEligibilityRequest.provider Element

    FHIR Specification

    insurer: null | Reference

    CoverageEligibilityRequest.insurer Element

    FHIR Specification

    • Short: Coverage issuer
    • Definition: The Insurer who issued the coverage in question and is the recipient of the request.
    • Requirements: Need to identify the recipient.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    facility?: Reference

    CoverageEligibilityRequest.facility Element

    FHIR Specification

    • Short: Servicing facility
    • Definition: Facility where the services are intended to be provided.
    • Requirements: Insurance adjudication can be dependant on where services were delivered.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    supportingInfo?: CoverageEligibilityRequestSupportingInfoComponent[]

    CoverageEligibilityRequest.supportingInfo Element

    FHIR Specification

    • Short: Supporting information
    • Definition: Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
    • Comment: Often there are multiple jurisdiction specific valuesets which are required.
    • Requirements: Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    insurance?: CoverageEligibilityRequestInsuranceComponent[]

    CoverageEligibilityRequest.insurance Element

    FHIR Specification

    • Short: Patient insurance information
    • Definition: Financial instruments for reimbursement for the health care products and services.
    • Comment: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
    • Requirements: There must be at least one coverage for which eligibility is requested.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    item?: CoverageEligibilityRequestItemComponent[]

    CoverageEligibilityRequest.item Element

    FHIR Specification

    • Short: Item to be evaluated for eligibiity
    • Definition: Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.
    • Requirements: The items to be processed for the request.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

    • Assigns the provided value to the text property.

      Parameters

      Returns this

      this

    • Returns boolean

      true if the text property exists and has a value; false otherwise

    • Assigns the provided Resource array value to the contained property.

      Parameters

      • value: undefined | IResource[]

        the contained array value

      Returns this

      this

    • Returns boolean

      true if the contained property exists and has a value; false otherwise

    • Assigns the provided array of Extension values to the extension property.

      Parameters

      • extension: undefined | IExtension[]

        array of Extensions

      Returns this

      this

    • Determines if the extension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Adds the provided Extension to the extension property array.

      Parameters

      • extension: undefined | IExtension

        the Extension value to add to the extension property array

      Returns this

      this

    • Removes the Extension having the provided url from the extension property array.

      Parameters

      • url: string

        the url that identifies a specific Extension to remove

      Returns void

      AssertionError for invalid url

    • Determines if the modifierExtension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Assigns the provided PrimitiveType value to the id property.

      Parameters

      • element: undefined | IdType

        the id value

      Returns this

      this

    • Returns undefined | string

      the id property value as a primitive value

    • Assigns the provided primitive value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the id property exists and has a value; false otherwise

    • Assigns the provided value to the meta property.

      Parameters

      • value: undefined | Meta

        the meta value

      Returns this

      this

    • Returns boolean

      true if the meta property exists and has a value; false otherwise

    • Assigns the provided primitive value to the implicitRules property.

      Parameters

      • value: undefined | string

        the implicitRules value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns undefined | string

      the language property value as a primitive value

    • Assigns the provided primitive value to the language property.

      Parameters

      • value: undefined | string

        the language value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the language property exists and has a value; false otherwise

    • Returns boolean

      true if the instance is a FHIR complex or primitive datatype; false otherwise

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