EnrollmentResponse

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 EnrollmentResponse resource provides enrollment and plan details from the processing of an Enrollment resource.

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)

• EnrollmentResponse [0..*]: - EnrollmentResponse resource
• EnrollmentResponse.identifier [0..*]: Identifier Business Identifier
• EnrollmentResponse.status [0..1]: code required:fm-status active | cancelled | draft | entered-in-error
• EnrollmentResponse.request [0..1]: Reference(EnrollmentRequest) Claim reference
• EnrollmentResponse.outcome [0..1]: code required:enrollment-outcome queued | complete | error | partial
• EnrollmentResponse.disposition [0..1]: string Disposition Message
• EnrollmentResponse.created [0..1]: dateTime Creation date
• EnrollmentResponse.organization [0..1]: Reference(Organization) Insurer
• EnrollmentResponse.requestProvider [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization)) Responsible practitioner
• EnrollmentResponse.candidate [0..1]: [Reference(Patient](/Reference(Patient), Group)) The subject(s)to be enrolled

Mappings

• EnrollmentResponse Mappings — 14 mapping entries

Resource Packs

list-EnrollmentResponse-packs.xml

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

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

Search Parameters

• identifier — token — The business identifier of the EnrollmentResponse — EnrollmentResponse.identifier
• request — reference — The reference to the claim — EnrollmentResponse.request
• status — token — The status of the enrollment response — EnrollmentResponse.status
• patient — reference — The party to be enrolled — EnrollmentResponse.candidate.where(resolve() is Patient)
• group — reference — The parties to be enrolled — EnrollmentResponse.candidate.where(resolve() is Group)

Full Search Parameters

Examples

• enrollmentresponse-example — enrollmentresponse-example
• enrollmentresponse-examples-header — enrollmentresponse-examples-header
• ER2500 — enrollmentresponse-example — General Person Enrollment Response Example

Full Examples

Mapping Exceptions

enrollmentresponse-event-mapping-exceptions.xml

Divergent Elements

• Event.identifier → EnrollmentResponse.identifier
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Business identifier for enrollment response | resource=Business Identifier
  • definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this enrollment response by the performer 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=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 response as it is known by various participating systems and in a way that remains consistent across servers.
• Event.basedOn → EnrollmentResponse.request
  • missingTypes | reason=Unknown | pattern=Reference(Request)
  • extraTypes | reason=Unknown
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Fulfills plan, proposal or order | resource=Claim reference
  • definitionUnmatched | reason=Unknown | pattern=A plan, proposal or order that is fulfilled in whole or in part by this enrollment response. | resource=Original request resource reference.
  • requirementsUnmatched | reason=Unknown | pattern=Allows tracing of authorization for the enrollment response and tracking whether proposals/recommendations were acted upon.
• Event.status → EnrollmentResponse.status
  • shortUnmatched | reason=Unknown | pattern=preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown | resource=active | cancelled | draft | entered-in-error
  • definitionUnmatched | reason=Unknown | pattern=The current state of the enrollment response. | resource=The status of the resource instance.
  • commentsUnmatched | reason=Unknown | pattern=A nominal state-transition diagram can be found in the (Event pattern 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. | resource=This element is labeled as a modifier because the status contains codes that mark the response as not currently valid.

• Event.code → EnrollmentResponse.disposition
  • missingTypes | reason=Unknown | pattern=CodeableConcept
  • extraTypes | reason=Unknown
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=What service was done | resource=Disposition Message
  • definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action that was or is being performed. | resource=A description of the status of the adjudication.
• Event.occurrence[x] → EnrollmentResponse.created
  • missingTypes | reason=Unknown | pattern=Period, Timing
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=When enrollment response occurred/is occurring | resource=Creation date
  • definitionUnmatched | reason=Unknown | pattern=The date, period or timing when the enrollment response did occur or is occurring. | resource=The date when the enclosed suite of services were performed or completed.
  • commentsUnmatched | reason=Unknown | pattern=This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. .
• Event.performer.actor → EnrollmentResponse.organization
  • missingTypes | reason=Unknown | pattern=Reference(Practitioner, PractitionerRole, CareTeam, Patient, Device, RelatedPerson)
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Who performed enrollment response | resource=Insurer
  • definitionUnmatched | reason=Unknown | pattern=Indicates who or what performed the enrollment response. | resource=The Insurer who produced this adjudicated response.

Unmapped Elements

• Event.partOf — Unknown
• Event.reported — Unknown
• Event.reason — Unknown
• Event.relevantHistory — Unknown
• Event.location — Unknown
• Event.subject — Unknown
• Event.statusReason — Unknown
• Event.performer.function — Unknown
• Event.note — Unknown
• Event.category — Unknown
• Event.encounter — Unknown
• Event.recorded — Unknown
• Event.product — Unknown
• Event.performer — Unknown
• Event.researchStudy — Unknown

enrollmentresponse-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

enrollmentresponse-request-mapping-exceptions.xml

Divergent Elements

• Request.subject → EnrollmentResponse.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.

Unmapped Elements

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