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

• Narrative Content
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: Check Eligibility Request

Active as of 2026-05-20

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<OperationDefinition xmlns="http://hl7.org/fhir">
  <id value="CheckEligibility"/>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
</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>
</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>
</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>
</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>
</div></td></tr></table></div>
  </text>
  <url
       value="https://dsacms.github.io/cmmi-access-model/OperationDefinition/CheckEligibility"/>
  <version value="0.9.8"/>
  <name value="CheckEligibility"/>
  <title value="Check Eligibility Request"/>
  <status value="active"/>
  <kind value="operation"/>
  <date value="2026-05-20T09:30:43-04:00"/>
  <publisher value="Global Alliant, Inc."/>
  <contact>
    <name value="Global Alliant, Inc."/>
    <telecom>
      <system value="url"/>
      <value value="https://globalalliantinc.com"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="david.h@globalalliantinc.org"/>
    </telecom>
  </contact>
  <description
               value="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 value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <code value="check-eligibility"/>
  <resource value="Patient"/>
  <system value="false"/>
  <type value="true"/>
  <instance value="false"/>
  <inputProfile
                value="https://dsacms.github.io/cmmi-access-model/StructureDefinition/access-check-eligibility-in|0.9.8"/>
  <parameter>
    <name value="participantID"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="ACCESS participant identifier. Must follow the pattern ACCES##### where ##### represents exactly 5 digits (e.g., ACCES00001, ACCES12345)."/>
    <type value="Identifier"/>
  </parameter>
  <parameter>
    <name value="payerID"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation value="Payer ID for the patient."/>
    <type value="Identifier"/>
  </parameter>
  <parameter>
    <name value="patient"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Patient information.  If the payer is Medicare, it **SHALL** contain the Medicare Beneficiary Identifier (MBI)."/>
    <type value="Patient"/>
  </parameter>
  <parameter>
    <name value="track"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="ACCESS track for which eligibility is being checked."/>
    <type value="CodeableConcept"/>
    <binding>
      <strength value="required"/>
      <valueSet
                value="https://dsacms.github.io/cmmi-access-model/ValueSet/ACCESSTrackVS|0.9.8"/>
    </binding>
  </parameter>
  <parameter>
    <name value="condition"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation value="Patient's conditions."/>
    <type value="Condition"/>
  </parameter>
</OperationDefinition>