Data Model Libraries
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    Class CoverageEligibilityRequestInsuranceComponent

    CoverageEligibilityRequestInsuranceComponent Class

    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.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    focal?: BooleanType

    CoverageEligibilityRequest.insurance.focal Element

    FHIR Specification

    • Short: Applicable coverage
    • Definition: A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.
    • Comment: A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.
    • Requirements: To identify which coverage in the list is being used to evaluate this request.
    • FHIR Type: boolean
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    coverage: null | Reference

    CoverageEligibilityRequest.insurance.coverage Element

    FHIR Specification

    • Short: Insurance information
    • Definition: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
    • Requirements: Required to allow the adjudicator to locate the correct policy and history within their information system.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: false
    businessArrangement?: StringType

    CoverageEligibilityRequest.insurance.businessArrangement Element

    FHIR Specification

    • Short: Additional provider contract number
    • Definition: A business agreement number established between the provider and the insurer for special business processing purposes.
    • Requirements: Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    Methods

    • Parse the provided CoverageEligibilityRequestInsuranceComponent JSON to instantiate the CoverageEligibilityRequestInsuranceComponent data model.

      Parameters

      • sourceJson: Value

        JSON representing FHIR CoverageEligibilityRequestInsuranceComponent

      • OptionaloptSourceField: string

        Optional data source field (e.g. <complexTypeName>.<complexTypeFieldName>); defaults to CoverageEligibilityRequestInsuranceComponent

      Returns undefined | CoverageEligibilityRequestInsuranceComponent

      CoverageEligibilityRequestInsuranceComponent data model or undefined for CoverageEligibilityRequestInsuranceComponent

      JsonError if the provided JSON is not a valid JSON object

    • 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; 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 modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Returns undefined | string

      the id property value

    • Assigns the provided value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid value

    • Returns boolean

      true if id exists and has a value; false otherwise

    • 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

    • Determines if the extension property exists.

      Parameters

      • url: string

        the url that identifies a specific Extension

      Returns undefined | IExtension

      an Extension having 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 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

    • Returns boolean

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