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Enrollment FHIR Resource Proposal

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Enrollment

Owning committee name

Financial Management

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