FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.4 Resource EnrollmentRequest - Content

Financial Management

Work Group

Maturity Level: 0

Draft

Compartments: Patient

This resource provides the insurance enrollment details to the insurer regarding a specified coverage.

13.4.1 Scope and Usage

This resource has not yet undergone proper review by FM. At this time it is a 'stub', is known to be incomplete, and is to be considered as a draft.

The EnrollmentRequest resource allows for the addition and removal of plan subscribers and their dependents to health insurance coverage.

Todo

This resource is referenced by enrollmentresponse

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest			DomainResource	Enrollment request Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
created		0..1	dateTime	Creation date
insurer		0..1	Reference(Organization)	Target
provider		0..1	Reference(Practitioner)	Responsible practitioner
organization		0..1	Reference(Organization)	Responsible organization
subject		0..1	Reference(Patient)	The subject of the Products and Services
coverage		0..1	Reference(Coverage)	Insurance information
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <subject><!-- 0..1 Reference(Patient) The subject of the Products and Services --></subject>
 <coverage><!-- 0..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "subject" : { Reference(Patient) }, // The subject of the Products and Services
  "coverage" : { Reference(Coverage) } // Insurance information
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:EnrollmentRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EnrollmentRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentRequest.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentRequest.insurer [ Reference(Organization) ]; # 0..1 Target
  fhir:EnrollmentRequest.provider [ Reference(Practitioner) ]; # 0..1 Responsible practitioner
  fhir:EnrollmentRequest.organization [ Reference(Organization) ]; # 0..1 Responsible organization
  fhir:EnrollmentRequest.subject [ Reference(Patient) ]; # 0..1 The subject of the Products and Services
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 0..1 Insurance information
]

Changes since DSTU2

EnrollmentRequest

EnrollmentRequest.status

Added Element

EnrollmentRequest.insurer

Added Element

EnrollmentRequest.subject

Min Cardinality changed from 1 to 0

EnrollmentRequest.coverage

Min Cardinality changed from 1 to 0

EnrollmentRequest.ruleset

deleted

EnrollmentRequest.originalRuleset

deleted

EnrollmentRequest.target

deleted

EnrollmentRequest.relationship

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.).

Structure

Name	Flags	Card.	Type	Description & Constraints
EnrollmentRequest			DomainResource	Enrollment request Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
created		0..1	dateTime	Creation date
insurer		0..1	Reference(Organization)	Target
provider		0..1	Reference(Practitioner)	Responsible practitioner
organization		0..1	Reference(Organization)	Responsible organization
subject		0..1	Reference(Patient)	The subject of the Products and Services
coverage		0..1	Reference(Coverage)	Insurance information
Documentation for this format

UML Diagram (Legend)

XML Template

<EnrollmentRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <subject><!-- 0..1 Reference(Patient) The subject of the Products and Services --></subject>
 <coverage><!-- 0..1 Reference(Coverage) Insurance information --></coverage>
</EnrollmentRequest>

JSON Template

{
  "resourceType" : "EnrollmentRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "subject" : { Reference(Patient) }, // The subject of the Products and Services
  "coverage" : { Reference(Coverage) } // Insurance information
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:EnrollmentRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EnrollmentRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:EnrollmentRequest.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:EnrollmentRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:EnrollmentRequest.insurer [ Reference(Organization) ]; # 0..1 Target
  fhir:EnrollmentRequest.provider [ Reference(Practitioner) ]; # 0..1 Responsible practitioner
  fhir:EnrollmentRequest.organization [ Reference(Organization) ]; # 0..1 Responsible organization
  fhir:EnrollmentRequest.subject [ Reference(Patient) ]; # 0..1 The subject of the Products and Services
  fhir:EnrollmentRequest.coverage [ Reference(Coverage) ]; # 0..1 Insurance information
]

Changes since DSTU2

EnrollmentRequest

EnrollmentRequest.status

Added Element

EnrollmentRequest.insurer

Added Element

EnrollmentRequest.subject

Min Cardinality changed from 1 to 0

EnrollmentRequest.coverage

Min Cardinality changed from 1 to 0

EnrollmentRequest.ruleset

deleted

EnrollmentRequest.originalRuleset

deleted

EnrollmentRequest.target

deleted

EnrollmentRequest.relationship

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.).

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

13.4.2.1 Terminology Bindings

Path	Definition	Type	Reference
EnrollmentRequest.status	A code specifying the state of the resource instance.	Required	Financial Resource Status Codes

Path

Definition

Type

Reference

EnrollmentRequest.status

A code specifying the state of the resource instance.

Required

Financial Resource Status Codes

13.4.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
identifier	token	The business identifier of the Enrollment	EnrollmentRequest.identifier
organization	reference	The organization who generated this resource	EnrollmentRequest.organization (Organization)
patient	reference	The party to be enrolled	EnrollmentRequest.subject (Patient)
subject	reference	The party to be enrolled	EnrollmentRequest.subject (Patient)