EnrollmentRequest

Introduction

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

Boundaries and Relationships

Explains how this resource relates to others. Particularly important is to differentiate between appropriate usages for related resources when an implementer might be confused about what to reference when.

Background and Context

Provides additional detail on exactly how the resource is to be used

StructureDefinition

Elements (Simplified)

• EnrollmentRequest [0..*]: - Enroll in coverage
• EnrollmentRequest.identifier [0..*]: Identifier Business Identifier
• EnrollmentRequest.status [0..1]: code required:fm-status active | cancelled | draft | entered-in-error
• EnrollmentRequest.created [0..1]: dateTime Creation date
• EnrollmentRequest.insurer [0..1]: Reference(Organization) Target
• EnrollmentRequest.provider [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization)) Responsible practitioner
• EnrollmentRequest.candidate [0..1]: [Reference(Patient](/Reference(Patient), Group)) The subject(s)to be enrolled
• EnrollmentRequest.coverage [0..1]: Reference(Coverage) Insurance information

Mappings

• EnrollmentRequest Mappings — 13 mapping entries

Resource Packs

list-EnrollmentRequest-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir">
  <id value="EnrollmentRequest-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

• identifier — token — The business identifier of the Enrollment — EnrollmentRequest.identifier
• patient — reference — The party to be enrolled — EnrollmentRequest.candidate.where(resolve() is Patient)
• group — reference — The parties to be enrolled — EnrollmentRequest.candidate.where(resolve() is Group)
• status — token — The status of the enrollment — EnrollmentRequest.status
• subject — reference — The party to be enrolled — EnrollmentRequest.candidate

Full Search Parameters

Examples

• 22345 — enrollmentrequest-example — General Simple Enrollment Example
• enrollmentrequest-example — enrollmentrequest-example
• enrollmentrequest-examples-header — enrollmentrequest-examples-header

Full Examples

Mapping Exceptions

enrollmentrequest-fivews-mapping-exceptions.xml

Unmapped Elements

• FiveWs.what — Unknown
• FiveWs.recorded — Unknown
• FiveWs.author — Unknown
• FiveWs.cause — Unknown
• FiveWs.version — Unknown
• FiveWs.witness — Unknown
• FiveWs.class — Unknown
• FiveWs.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.why — Unknown
• FiveWs.identifier — Unknown
• FiveWs.source — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.status — Unknown
• FiveWs.planned — Unknown
• FiveWs.done — Unknown
• FiveWs.subject — Unknown

enrollmentrequest-request-mapping-exceptions.xml

Divergent Elements

• Request.identifier → EnrollmentRequest.identifier
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Business Identifier for enrollment request | resource=Business Identifier
  • definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this enrollment request by the author and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=The Response business identifier.
  • commentsUnmatched | reason=Unknown | pattern=The identifier.type element is used to distinguish between the identifiers assigned by the requester/placer and the performer/filler.

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

• requirementsUnmatched | reason=Unknown | pattern=Allows identification of the enrollment request as it is known by various participating systems and in a way that remains consistent across servers.
• Request.status → EnrollmentRequest.status
  • shortUnmatched | reason=Unknown | pattern=draft | active | on-hold | revoked | completed | entered-in-error | unknown | resource=active | cancelled | draft | entered-in-error
  • definitionUnmatched | reason=Unknown | pattern=The current state of the enrollment request. | resource=The status of the resource instance.
  • commentsUnmatched | reason=Unknown | pattern=The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, completed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding]](s) or using the]] resource. A nominal state-transition diagram can be found in the] documentation Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. A status of 'active' when doNotPerform is true means that the request to not perform is currently in force.

A status of completed for a "doNotPerform" request indicates that the period of non-performance is now satisfied and the request no longer holds. | resource=This element is labeled as a modifier because the status contains codes that mark the request as not currently valid.

• Request.subject → EnrollmentRequest.candidate
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Individual the service is ordered/prohibited for | resource=The subject(s)to be enrolled
  • definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is to be performed/not performed on or for. | resource=The subject or group of subjects to be enrolled.
  • requirementsUnmatched | reason=Unknown | pattern=Links the request to the Patient context.
• Request.authoredOn → EnrollmentRequest.created
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=When request was created/transitioned to active | resource=Creation date
  • definitionUnmatched | reason=Unknown | pattern=For draft enrollment requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation. | resource=The date when this resource was created.
• Request.requester → EnrollmentRequest.provider
  • missingTypes | reason=Unknown | pattern=Reference(Patient, RelatedPerson, Device)
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Who/what is requesting service | resource=Responsible practitioner
  • definitionUnmatched | reason=Unknown | pattern=Who initiated the {{request}} and has responsibility for its activation. | resource=The practitioner who is responsible for the services rendered to the patient.
• Request.performer → EnrollmentRequest.insurer
  • missingTypes | reason=Unknown | pattern=Reference(Practitioner, PractitionerRole, CareTeam, HealthcareService, Patient, Device, RelatedPerson)
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Specific desired (non)performer | resource=Target
  • definitionUnmatched | reason=Unknown | pattern=Indicates who or what is being asked to perform (or not perform) the {{request}}. | resource=The Insurer who is target of the request.
• Request.insurance → EnrollmentRequest.coverage
  • missingTypes | reason=Unknown | pattern=Reference(ClaimResponse)
  • shortUnmatched | reason=Unknown | pattern=Associated insurance coverage | resource=Insurance information
  • definitionUnmatched | reason=Unknown | pattern=Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be relevant in delivering the requested service. | resource=Reference to the program or plan identification, underwriter or payor.

Unmapped Elements

• Request.intent — Unknown
• Request.priority — Unknown
• Request.occurrence — Unknown
• Request.groupIdentifier — Unknown
• Request.deliverTo — Unknown
• Request.replaces — Unknown
• Request.supportingInfo — Unknown
• Request.note — Unknown
• Request.basedOn — Unknown
• Request.encounter — Unknown
• Request.category — Unknown
• Request.reason — Unknown
• Request.reported — Unknown
• Request.relevantHistory — Unknown
• Request.code — Unknown
• Request.statusReason — Unknown
• Request.performerType — Unknown
• Request.doNotPerform — Unknown
• Request.product — Unknown