Resources
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.