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StructureDefinitionsCoverageEligibilityResponse

http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse|5.0.0

This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
StructureJSONDependenciesFHIRSchemaOther VersionsDependant (0)ElementsSummary
NameFlagsCardTypeDescription & Constraints
CoverageEligibilityResponse
0..*CoverageEligibilityResponse resource
 
identifier
0..*IdentifierBusiness Identifier for coverage eligiblity request
 
status *
?!Σ
1..1codeactive | cancelled | draft | entered-in-error EligibilityResponseStatus (required)
 
purpose *
Σ
1..*codeauth-requirements | benefits | discovery | validation EligibilityResponsePurpose (required)
 
patient *
Σ
1..1ReferenceIntended recipient of products and services
 
event
0..*BackboneElementEvent information
 
 
type *
1..1CodeableConceptSpecific event DatesType (example)
 
 
when[x] *
1..1Occurance date or period
 
 
 
whenDateTime *
1..1dateTime
 
 
 
whenPeriod *
1..1Period
 
serviced[x]
0..1Estimated date or dates of service
 
 
servicedDate
0..1date
 
 
servicedPeriod
0..1Period
 
created *
Σ
1..1dateTimeResponse creation date
 
requestor
0..1ReferenceParty responsible for the request
 
request *
Σ
1..1ReferenceEligibility request reference
 
outcome *
Σ
1..1codequeued | complete | error | partial EligibilityOutcome (required)
 
disposition
0..1stringDisposition Message
 
insurer *
Σ
1..1ReferenceCoverage issuer
 
insurance
0..*BackboneElementPatient insurance information
 
 
coverage *
Σ
1..1ReferenceInsurance information
 
 
inforce
0..1booleanCoverage inforce indicator
 
 
benefitPeriod
0..1PeriodWhen the benefits are applicable
 
 
item
0..*BackboneElementBenefits and authorization details
 
 
 
category
0..1CodeableConceptBenefit classification BenefitCategory (example)
 
 
 
productOrService
0..1CodeableConceptBilling, service, product, or drug code ServiceProduct (example)
 
 
 
modifier
0..*CodeableConceptProduct or service billing modifiers Modifiers (example)
 
 
 
provider
0..1ReferencePerforming practitioner
 
 
 
excluded
0..1booleanExcluded from the plan
 
 
 
name
0..1stringShort name for the benefit
 
 
 
description
0..1stringDescription of the benefit or services covered
 
 
 
network
0..1CodeableConceptIn or out of network BenefitNetwork (example)
 
 
 
unit
0..1CodeableConceptIndividual or family BenefitUnit (example)
 
 
 
term
0..1CodeableConceptAnnual or lifetime BenefitTerm (example)
 
 
 
benefit
0..*BackboneElementBenefit Summary
 
 
 
 
type *
1..1CodeableConceptBenefit classification BenefitType (example)
 
 
 
 
allowed[x]
0..1Benefits allowed
 
 
 
 
 
allowedUnsignedInt
0..1unsignedInt
 
 
 
 
 
allowedString
0..1string
 
 
 
 
 
allowedMoney
0..1Money
 
 
 
 
used[x]
0..1Benefits used
 
 
 
 
 
usedUnsignedInt
0..1unsignedInt
 
 
 
 
 
usedString
0..1string
 
 
 
 
 
usedMoney
0..1Money
 
 
 
authorizationRequired
0..1booleanAuthorization required flag
 
 
 
authorizationSupporting
0..*CodeableConceptType of required supporting materials AuthSupporting (example)
 
 
 
authorizationUrl
0..1uriPreauthorization requirements endpoint
 
preAuthRef
0..1stringPreauthorization reference
 
form
0..1CodeableConceptPrinted form identifier Forms (example)
 
error
0..*BackboneElementProcessing errors
 
 
code *
Σ
1..1CodeableConceptError code detailing processing issues AdjudicationError (example)
 
 
expression
Σ
0..*stringFHIRPath of element(s) related to issue