Enrollment FHIR Resource Proposal
Contents
- 1 Enrollment
- 1.1 Owning committee name
- 1.2 Contributing or Reviewing Work Groups
- 1.3 FHIR Resource Development Project Insight ID
- 1.4 Scope of coverage
- 1.5 RIM scope
- 1.6 Resource appropriateness
- 1.7 Expected implementations
- 1.8 Content sources
- 1.9 Example Scenarios
- 1.10 Resource Relationships
- 1.11 Timelines
- 1.12 gForge Users
Enrollment
Owning committee name
Contributing or Reviewing Work Groups
FHIR Resource Development Project Insight ID
994
Scope of coverage
Represents enrollment for all types of insurance coverage for healthcare-related services. This includes purchased coverage, employer plans, government funded plans, identifiers for state-funded healthcare not modelled/identified as insurance, etc. It includes enrollment for coverage for humans as well as animals.
Enrollment records are the basis upon which verification of eligibility are made.
RIM scope
Contract class with classCode of COV and moodCode of RQO.
Resource appropriateness
Enrollment is used to request initial enrollment in and subsequent maintenance of coverage for one or more applicants/insureds under a public healthcare program or private health insurance policy.
Expected implementations
Referenced by CCDA in situations where coverage has is not yet effective, is effective, or has lapsed.
Content sources
- v2 IN1, IN2, IN3 segments
- v3 Eligibility and Coverage models
- X12 270, 271, 834, 820
- NCPDP
Example Scenarios
Initial, periodic, and yearly enrollment in public health programs (e.g., Medicaid/Medicare) or private health insurance in the individual or group insurance markets.
Resource Relationships
Timelines
Part of initial DSTU.
gForge Users
N/A
