CMS ACCESS Model API - Local Development build (v0.9.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

• Narrative Content
• XML
• JSON

: Check Eligibility Request - JSON Representation

Active as of 2026-03-06

Raw json | Download

{
  "resourceType" : "OperationDefinition",
  "id" : "CheckEligibility",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: OperationDefinition CheckEligibility</b></p><a name=\"CheckEligibility\"> </a><a name=\"hcCheckEligibility\"> </a><p>URL: [base]/Patient/$check-eligibility</p><p>Input parameters Profile:<a href=\"StructureDefinition-access-check-eligibility-in.html\">ACCESS Check Eligibility Request Parameters</a></p><h3>Parameters</h3><table class=\"grid\"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>participantID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Identifier\">Identifier</a></td><td/><td><div><p>ACCESS participant identifier. Must follow the pattern ACCESS#### where #### represents exactly 4 digits (e.g., ACCESS0001, ACCESS1234).</p>\n</div></td></tr><tr><td>IN</td><td>payerID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Identifier\">Identifier</a></td><td/><td><div><p>Payer ID for the patient.</p>\n</div></td></tr><tr><td>IN</td><td>patient</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/patient.html\">Patient</a></td><td/><td><div><p>Patient information.  It <strong>SHOULD</strong> contain the Medicare Beneficiary Identifier (MBI).</p>\n</div></td></tr><tr><td>IN</td><td>track</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td><a href=\"ValueSet-ACCESSTrackVS.html\">ACCESS Model Tracks Value Set</a> (Required)</td><td><div><p>ACCESS track for which eligibility is being checked.</p>\n</div></td></tr><tr><td>IN</td><td>condition</td><td/><td>0..*</td><td><a href=\"http://hl7.org/fhir/R4/condition.html\">Condition</a></td><td/><td><div><p>Patient's conditions.</p>\n</div></td></tr></table></div>"
  },
  "url" : "https://globalalliantinc.com/access/OperationDefinition/CheckEligibility",
  "version" : "0.9.0",
  "name" : "CheckEligibility",
  "title" : "Check Eligibility Request",
  "status" : "active",
  "kind" : "operation",
  "date" : "2026-03-06T16:03:26-05:00",
  "publisher" : "Global Alliant, Inc.",
  "contact" : [
    {
      "name" : "Global Alliant, Inc.",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://globalalliantinc.com"
        },
        {
          "system" : "email",
          "value" : "david.h@globalalliantinc.org"
        }
      ]
    }
  ],
  "description" : "The **$check-eligibility** operation allows a participant to submit basic information on a patient who they believe will be a good candidate for the ACCESS model and who wants to be part of the ACCESS Model. The participant can use this API to do a quick check on which patients may be eligible before officially submitting the patient's information for consideration and inclusion in the ACCESS Model.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "code" : "check-eligibility",
  "resource" : [
    "Patient"
  ],
  "system" : false,
  "type" : true,
  "instance" : false,
  "inputProfile" : "https://globalalliantinc.com/access/StructureDefinition/access-check-eligibility-in|0.9.0",
  "parameter" : [
    {
      "name" : "participantID",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "ACCESS participant identifier. Must follow the pattern ACCESS#### where #### represents exactly 4 digits (e.g., ACCESS0001, ACCESS1234).",
      "type" : "Identifier"
    },
    {
      "name" : "payerID",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Payer ID for the patient.",
      "type" : "Identifier"
    },
    {
      "name" : "patient",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Patient information.  It **SHOULD** contain the Medicare Beneficiary Identifier (MBI).",
      "type" : "Patient"
    },
    {
      "name" : "track",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "ACCESS track for which eligibility is being checked.",
      "type" : "CodeableConcept",
      "binding" : {
        "strength" : "required",
        "valueSet" : "https://globalalliantinc.com/access/ValueSet/ACCESSTrackVS|0.9.0"
      }
    },
    {
      "name" : "condition",
      "use" : "in",
      "min" : 0,
      "max" : "*",
      "documentation" : "Patient's conditions.",
      "type" : "Condition"
    }
  ]
}