CoverageEligibilityResponse
CoverageEligibilityResponse
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
Properties
| Name | Required | Type | Description |
|---|---|---|---|
| identifier | No | Identifier[] | Business Identifier for coverage eligiblity request |
| status | Yes | code | active / cancelled / draft / entered-in-error |
| 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 | Response creation date |
| requestor | No | Reference<Practitioner / PractitionerRole / Organization> | Party responsible for the request |
| request | Yes | Reference<CoverageEligibilityRequest> | Eligibility request reference |
| outcome | Yes | code | queued / complete / error / partial |
| disposition | No | string | Disposition Message |
| insurer | Yes | Reference<Organization> | Coverage issuer |
| insurance | No | CoverageEligibilityResponseInsurance | 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 |
| - coverage | Yes | Reference<Coverage> | Insurance information |
| - inforce | No | boolean | Coverage inforce indicator |
| - benefitPeriod | No | Period | When the benefits are applicable |
| - item | No | CoverageEligibilityResponseInsuranceItem | Benefits and authorization details |
| - 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 |
| - 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> | Performing practitioner |
| - excluded | No | boolean | Excluded from the plan |
| - name | No | string | Short name for the benefit |
| - description | No | string | Description of the benefit or services covered |
| - network | No | CodeableConcept | In or out of network |
| - unit | No | CodeableConcept | Individual or family |
| - term | No | CodeableConcept | Annual or lifetime |
| - benefit | No | CoverageEligibilityResponseInsuranceItemBenefit | Benefit Summary |
| - 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 |
| - type | Yes | CodeableConcept | Benefit classification |
| - allowed[x] | No | unsignedInt, string, Money | Benefits allowed |
| - used[x] | No | unsignedInt, string, Money | Benefits used |
| - authorizationRequired | No | boolean | Authorization required flag |
| - authorizationSupporting | No | CodeableConcept[] | Type of required supporting materials |
| - authorizationUrl | No | uri | Preauthorization requirements endpoint |
| preAuthRef | No | string | Preauthorization reference |
| form | No | CodeableConcept | Printed form identifier |
| error | No | CoverageEligibilityResponseError | Processing errors |
| - 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 |
| - code | Yes | CodeableConcept | Error code detailing processing issues |
Search Parameters
| Name | Type | Description | Expression |
|---|---|---|---|
| created | date | The creation date | CoverageEligibilityResponse.created |
| disposition | string | The contents of the disposition message | CoverageEligibilityResponse.disposition |
| identifier | token | The business identifier | CoverageEligibilityResponse.identifier |
| insurer | reference | The organization which generated this resource | CoverageEligibilityResponse.insurer |
| outcome | token | The processing outcome | CoverageEligibilityResponse.outcome |
| patient | reference | The reference to the patient | CoverageEligibilityResponse.patient |
| request | reference | The EligibilityRequest reference | CoverageEligibilityResponse.request |
| requestor | reference | The EligibilityRequest provider | CoverageEligibilityResponse.requestor |
| status | token | The EligibilityRequest status | CoverageEligibilityResponse.status |
Inherited Properties
| Name | Required | Type | Description |
|---|---|---|---|
| id | No | string | Logical id of this artifact |
| meta | No | Meta | Metadata about the resource |
| implicitRules | No | uri | A set of rules under which this content was created |
| language | No | code | Language of the resource content |
| text | No | Narrative | Text summary of the resource, for human interpretation |
| contained | No | Resource[] | Contained, inline Resources |
| extension | No | Extension[] | Additional content defined by implementations |
| modifierExtension | No | Extension[] | Extensions that cannot be ignored |
To view the FHIR specification for this resource, see CoverageEligibilityResponse.