Enrollment Response FHIR Resource Proposa
This page documents a Approved FHIR Resource Proposal
Contents
- 1 Enrollment Response
- 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 Response
Owning committee name
Contributing or Reviewing Work Groups
FHIR Resource Development Project Insight ID
994
Scope of coverage
Represents response to enrollment requests 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 response to enrollment requests for coverage for humans as well as animals.
RIM scope
Contract class with classCode of COV and moodCode of INT.
Resource appropriateness
Enrollment Response is a determination by a public or private healthcare insurer that initial enrollment in or maintenance of coverage is approved, and the premium payment required to procure a specified period of that coverage.
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
Enrollment Response is associated to Coverage, Patients as covered parties, and RelatedPersons or Organizations as policy holders.
Enrollment Response is referenced by Eligibility Response and Claim Payment (aka Remittance Advice, where the payee is the insurer and the payor is the policy holder.
Timelines
Part of initial DSTU.
gForge Users
N/A
