coverage eligibility requests

Create Coverage Eligibility Request

post
/organizations/{organizationId}/fhir/4/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.

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug

Body

resourceType*This is a CoverageEligibilityRequest resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this coverage eligiblity request.
statuscodeThe status of the resource instance.
priorityCodeableConceptWhen the requestor expects the processor to complete processing.
purposearray()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.
patient*ReferenceThe party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
servicedDatestringThe date or dates when the enclosed suite of services were performed or completed.
servicedPeriodPeriodThe date or dates when the enclosed suite of services were performed or completed.
createddateTimeThe date when this resource was created.
entererReferencePerson who created the request.
providerReferenceThe provider which is responsible for the request.
insurer*ReferenceThe Insurer who issued the coverage in question and is the recipient of the request.
facilityReferenceFacility where the services are intended to be provided.
supportingInfoarray(CoverageEligibilityRequest_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
insurancearray(CoverageEligibilityRequest_Insurance)Financial instruments for reimbursement for the health care products and services.
itemarray(CoverageEligibilityRequest_Item)Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.

Response

Patch Coverage Eligibility Request

patch
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}

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.

Request

Headers

content-type*stringapplication/json-patch+jsonapplication/json-patch+json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*This is a CoverageEligibilityRequest resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this coverage eligiblity request.
statuscodeThe status of the resource instance.
priorityCodeableConceptWhen the requestor expects the processor to complete processing.
purposearray()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.
patient*ReferenceThe party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
servicedDatestringThe date or dates when the enclosed suite of services were performed or completed.
servicedPeriodPeriodThe date or dates when the enclosed suite of services were performed or completed.
createddateTimeThe date when this resource was created.
entererReferencePerson who created the request.
providerReferenceThe provider which is responsible for the request.
insurer*ReferenceThe Insurer who issued the coverage in question and is the recipient of the request.
facilityReferenceFacility where the services are intended to be provided.
supportingInfoarray(CoverageEligibilityRequest_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
insurancearray(CoverageEligibilityRequest_Insurance)Financial instruments for reimbursement for the health care products and services.
itemarray(CoverageEligibilityRequest_Item)Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.

Response

Read Coverage Eligibility Request

get
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Response

Read History Coverage Eligibility Request

get
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}/_history

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_countstring
_sincestring

Params

organizationId*string|stringid|slug
resourceId*

Response

Read Version Coverage Eligibility Request

get
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}/_history/{versionId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*
versionId*

Response

Remove Coverage Eligibility Request

delete
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Response

Search Get Coverage Eligibility Request

get
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_idstring
_languagestring
createdstring
entererstring
facilitystring
identifierstring
patientstring
providerstring
statusstring

Params

organizationId*string|stringid|slug

Response

Search History Coverage Eligibility Request

get
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/_history

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_countstring
_sincestring

Params

organizationId*string|stringid|slug

Response

Search Post Coverage Eligibility Request

post
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/_search

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.

Request

Headers

content-type*stringapplication/json|application/x-www-form-urlencodedapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_idstring
_languagestring
createdstring
entererstring
facilitystring
identifierstring
patientstring
providerstring
statusstring

Params

organizationId*string|stringid|slug

Body

resourceType*This is a CoverageEligibilityRequest resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this coverage eligiblity request.
statuscodeThe status of the resource instance.
priorityCodeableConceptWhen the requestor expects the processor to complete processing.
purposearray()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.
patient*ReferenceThe party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
servicedDatestringThe date or dates when the enclosed suite of services were performed or completed.
servicedPeriodPeriodThe date or dates when the enclosed suite of services were performed or completed.
createddateTimeThe date when this resource was created.
entererReferencePerson who created the request.
providerReferenceThe provider which is responsible for the request.
insurer*ReferenceThe Insurer who issued the coverage in question and is the recipient of the request.
facilityReferenceFacility where the services are intended to be provided.
supportingInfoarray(CoverageEligibilityRequest_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
insurancearray(CoverageEligibilityRequest_Insurance)Financial instruments for reimbursement for the health care products and services.
itemarray(CoverageEligibilityRequest_Item)Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.

Response

Update Coverage Eligibility Request

put
/organizations/{organizationId}/fhir/4/CoverageEligibilityRequest/{resourceId}

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.

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*This is a CoverageEligibilityRequest resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this coverage eligiblity request.
statuscodeThe status of the resource instance.
priorityCodeableConceptWhen the requestor expects the processor to complete processing.
purposearray()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.
patient*ReferenceThe party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
servicedDatestringThe date or dates when the enclosed suite of services were performed or completed.
servicedPeriodPeriodThe date or dates when the enclosed suite of services were performed or completed.
createddateTimeThe date when this resource was created.
entererReferencePerson who created the request.
providerReferenceThe provider which is responsible for the request.
insurer*ReferenceThe Insurer who issued the coverage in question and is the recipient of the request.
facilityReferenceFacility where the services are intended to be provided.
supportingInfoarray(CoverageEligibilityRequest_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
insurancearray(CoverageEligibilityRequest_Insurance)Financial instruments for reimbursement for the health care products and services.
itemarray(CoverageEligibilityRequest_Item)Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.

Response