{
  "resourceType" : "OperationDefinition",
  "id" : "CheckEligibility",
  "language" : "en",
  "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 ACCES##### where ##### represents exactly 5 digits (e.g., ACCES00001, ACCES12345).</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.  If the payer is Medicare, it <strong>SHALL</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://dsacms.github.io/cmmi-access-model/OperationDefinition/CheckEligibility",
  "version" : "0.9.8",
  "name" : "CheckEligibility",
  "title" : "Check Eligibility Request",
  "status" : "active",
  "kind" : "operation",
  "date" : "2026-05-20T09:30:43-04:00",
  "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://dsacms.github.io/cmmi-access-model/StructureDefinition/access-check-eligibility-in|0.9.8",
  "parameter" : [{
    "name" : "participantID",
    "use" : "in",
    "min" : 1,
    "max" : "1",
    "documentation" : "ACCESS participant identifier. Must follow the pattern ACCES##### where ##### represents exactly 5 digits (e.g., ACCES00001, ACCES12345).",
    "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.  If the payer is Medicare, it **SHALL** 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://dsacms.github.io/cmmi-access-model/ValueSet/ACCESSTrackVS|0.9.8"
    }
  },
  {
    "name" : "condition",
    "use" : "in",
    "min" : 0,
    "max" : "*",
    "documentation" : "Patient's conditions.",
    "type" : "Condition"
  }]
}