CMS ACCESS Model API
0.9.8 - draft
US
This page is part of the ACCESS Model IG v0.9.8 DRAFT (v0.9.8: Releases Draft) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
| Official URL: https://dsacms.github.io/cmmi-access-model/OperationDefinition/CheckEligibility | Version: 0.9.8 | ||||
| Active as of 2026-05-20 | Computable Name: CheckEligibility | ||||
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.
These define constraints on FHIR resources for systems conforming to the ACCESS Eligibility API.
| ACCESS Check Eligibility Request Parameters | Input parameters for the $check-eligibility operation |
| ACCESS Check Eligibility Response Parameters | Output parameters for the $check-eligibility operation |
These define sets of codes used by systems conforming to the ACCESS Eligibility API.
| ACCESS Eligibility Result Value Set | Value set including all eligibility result codes |
These define new code systems used by systems conforming to the ACCESS Eligibility API.
| ACCESS Eligibility Result Code System | Codes indicating the result of an eligibility check |
These are example instances demonstrating the use of the Eligibility API.
| Check Eligibility Request Example | Example request for checking patient eligibility including participant ID, payer ID, patient details, and track |
| Check Eligibility Response - Eligible | Example successful response indicating patient is eligible for the ACCESS Model |
Language: en
URL: [base]/Patient/$check-eligibility
Input parameters Profile:ACCESS Check Eligibility Request Parameters
| Use | Name | Scope | Cardinality | Type | Binding | Documentation |
| IN | participantID | 1..1 | Identifier | ACCESS participant identifier. Must follow the pattern ACCES##### where ##### represents exactly 5 digits (e.g., ACCES00001, ACCES12345). | ||
| IN | payerID | 1..1 | Identifier | Payer ID for the patient. | ||
| IN | patient | 1..1 | Patient | Patient information. If the payer is Medicare, it SHALL contain the Medicare Beneficiary Identifier (MBI). | ||
| IN | track | 1..1 | CodeableConcept | ACCESS Model Tracks Value Set (Required) | ACCESS track for which eligibility is being checked. | |
| IN | condition | 0..* | Condition | Patient's conditions. |