CoverageEligibilityResponse
FinancialThis resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
| Path | Card. | Type | Description & Constraints |
|---|---|---|---|
| CoverageEligibilityResponse | 0..* | — | CoverageEligibilityResponse resource |
| .idΣ | 0..1 | String | Logical id of this artifact |
| .metaΣ | 0..1 | Meta | Metadata about the resource |
| .implicitRules?!Σ | 0..1 | uri | A set of rules under which this content was created |
| .language | 0..1 | code | Language of the resource content Bindinglanguages(preferred) |
| .text | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| .contained | 0..* | Resource | Contained, inline Resources |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?! | 0..* | Extension | Extensions that cannot be ignored |
| .identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request |
| .status?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Bindingfm-status(required) |
| .purposeΣ | 1..* | code | auth-requirements | benefits | discovery | validation Bindingeligibilityresponse-purpose(required) |
| .patientΣ | 1..1 | Reference(Patient) | Intended recipient of products and services |
| .serviced[x] | 0..1 | date | Period | Estimated date or dates of service |
| .createdΣ | 1..1 | dateTime | Response creation date |
| .requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request |
| .requestΣ | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference |
| .outcomeΣ | 1..1 | code | queued | complete | error | partial Bindingremittance-outcome(required) |
| .disposition | 0..1 | string | Disposition Message |
| .insurerΣ | 1..1 | Reference(Organization) | Coverage issuer |
| .insurance | 0..* | BackboneElement | Patient insurance information |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .coverageΣ | 1..1 | Reference(Coverage) | Insurance information |
| .inforce | 0..1 | boolean | Coverage inforce indicator |
| .benefitPeriod | 0..1 | Period | When the benefits are applicable |
| .item | 0..* | BackboneElement | Benefits and authorization details |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .category | 0..1 | CodeableConcept | Benefit classification Bindingex-benefitcategory(example) |
| .productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Bindingservice-uscls(example) |
| .modifier | 0..* | CodeableConcept | Product or service billing modifiers Bindingclaim-modifiers(example) |
| .provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner |
| .excluded | 0..1 | boolean | Excluded from the plan |
| .name | 0..1 | string | Short name for the benefit |
| .description | 0..1 | string | Description of the benefit or services covered |
| .network | 0..1 | CodeableConcept | In or out of network Bindingbenefit-network(example) |
| .unit | 0..1 | CodeableConcept | Individual or family Bindingbenefit-unit(example) |
| .term | 0..1 | CodeableConcept | Annual or lifetime Bindingbenefit-term(example) |
| .benefit | 0..* | BackboneElement | Benefit Summary |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .type | 1..1 | CodeableConcept | Benefit classification Bindingbenefit-type(example) |
| .allowed[x] | 0..1 | unsignedInt | string | Money | Benefits allowed |
| .used[x] | 0..1 | unsignedInt | string | Money | Benefits used |
| .authorizationRequired | 0..1 | boolean | Authorization required flag |
| .authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Bindingcoverageeligibilityresponse-ex-auth-support(example) |
| .authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint |
| .preAuthRef | 0..1 | string | Preauthorization reference |
| .form | 0..1 | CodeableConcept | Printed form identifier Bindingforms(example) |
| .error | 0..* | BackboneElement | Processing errors |
| .id | 0..1 | String | Unique id for inter-element referencing |
| .extension | 0..* | Extension | Additional content defined by implementations |
| .modifierExtension?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| .code | 1..1 | CodeableConcept | Error code detailing processing issues Bindingadjudication-error(example) |