| identifier | No | Identifier[] | Business Identifier for coverage eligiblity request |
| status | Yes | code | active / cancelled / draft / entered-in-error |
| priority | No | CodeableConcept | Desired processing priority |
| purpose | Yes | code[] | auth-requirements / benefits / discovery / validation |
| patient | Yes | Reference<Patient> | Intended recipient of products and services |
| serviced[x] | No | date, Period | Estimated date or dates of service |
| created | Yes | dateTime | Creation date |
| enterer | No | Reference<Practitioner / PractitionerRole> | Author |
| provider | No | Reference<Practitioner / PractitionerRole / Organization> | Party responsible for the request |
| insurer | Yes | Reference<Organization> | Coverage issuer |
| facility | No | Reference<Location> | Servicing facility |
| supportingInfo | No | CoverageEligibilityRequestSupportingInfo | Supporting information |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - sequence | Yes | positiveInt | Information instance identifier |
| - information | Yes | Reference<Resource> | Data to be provided |
| - appliesToAll | No | boolean | Applies to all items |
| insurance | No | CoverageEligibilityRequestInsurance | Patient insurance information |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - focal | No | boolean | Applicable coverage |
| - coverage | Yes | Reference<Coverage> | Insurance information |
| - businessArrangement | No | string | Additional provider contract number |
| item | No | CoverageEligibilityRequestItem | Item to be evaluated for eligibiity |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - supportingInfoSequence | No | positiveInt[] | Applicable exception or supporting information |
| - category | No | CodeableConcept | Benefit classification |
| - productOrService | No | CodeableConcept | Billing, service, product, or drug code |
| - modifier | No | CodeableConcept[] | Product or service billing modifiers |
| - provider | No | Reference<Practitioner / PractitionerRole> | Perfoming practitioner |
| - quantity | No | Quantity | Count of products or services |
| - unitPrice | No | Money | Fee, charge or cost per item |
| - facility | No | Reference<Location / Organization> | Servicing facility |
| - diagnosis | No | CoverageEligibilityRequestItemDiagnosis | Applicable diagnosis |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | Extension[] | Additional content defined by implementations |
| - modifierExtension | No | Extension[] | Extensions that cannot be ignored even if unrecognized |
| - diagnosis[x] | No | CodeableConcept, Reference<Condition> | Nature of illness or problem |
| - detail | No | Reference<Resource>[] | Product or service details |
