EnrollmentRequest
The request to enroll a beneficiary into a health insurance coverage. Submission to the payer for activation.
Purpose
EnrollmentRequest formalises the administrative enrollment of a patient in a health coverage: an employer organisation adding a new employee, an insurer registering a new member, a family contract extended to a new member. The payer receives the EnrollmentRequest, validates eligibility and replies with an EnrollmentResponse.
Key elements
| Field | Type | Cardinality | Role |
|---|---|---|---|
identifier | Identifier[] | 0..* | External identifiers. |
status | code | 0..1 | `active`, `cancelled`, `draft`, `entered-in-error`. |
created | dateTime | 0..1 | Request creation date. |
insurer | Reference(Organization) | 0..1 | Target payer. |
provider | Reference(Practitioner | PractitionerRole | Organization) | 0..1 | Requesting party. |
candidate | Reference(Patient) | 0..1 | Beneficiary to enroll. |
coverage | Reference(Coverage) | 0..1 | Concerned coverage. |
JSON example
{
"resourceType": "EnrollmentRequest",
"id": "example-enroll-001",
"status": "active",
"created": "2026-05-15",
"insurer": {
"reference": "Organization/payer-bcbs"
},
"provider": {
"reference": "Organization/employer-acme"
},
"candidate": {
"reference": "Patient/new-hire-12345"
},
"coverage": {
"reference": "Coverage/family-plan-acme-2026"
}
}Common pitfalls
- EnrollmentRequest without Coverage: the payer cannot know which policy to create/update.
- Confusing EnrollmentRequest (administrative) with Claim (reimbursement).
- Status 'active' on the sender side; the payer returns the effective status via EnrollmentResponse.
Related resources
- enrollmentresponse — payer reply.
- coverage — created / updated coverage.
- patient — beneficiary.
- organization — payer or employer.