CoverageEligibilityRequest resource (FHIR R4)

CoverageEligibilityRequest is the FHIR R4 resource for the CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.

Example

{
  "resourceType": "CoverageEligibilityRequest",
  "id": "coverageeligibilityrequest-91672ab844a711adcb5ed6833cc5130e",
  "status": "active",
  "purpose": [
    "auth-requirements"
  ],
  "patient": {
    "reference": "Patient/patient-46db58503c970497bd0ad9cbdfaf407c"
  },
  "created": "2026-07-01T12:00:00Z",
  "insurer": {
    "reference": "Organization/organization-8ef4c2f2a5938ddb434a764c8d9a6395"
  }
}

Generated by the Pidgeon engine: pidgeon generate CoverageEligibilityRequest --seed 20260722.

Validation context

• strict pidgeon validate grades a CoverageEligibilityRequest instance against the base R4 structure definition: missing required elements raise REQUIRED_FIELD_MISSING and cardinality violations raise CARDINALITY_MIN or CARDINALITY_MAX.(REQUIRED_FIELD_MISSING)