http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse|4.0.1

description: This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
derivation: specialization
name: CoverageEligibilityResponse
type: CoverageEligibilityResponse
elements:
  patient: {short: Intended recipient of products and services, isSummary: true, index: 3}
  requestor: {short: Party responsible for the request, index: 7}
  insurance:
    short: Patient insurance information
    array: true
    index: 12
    elements:
      coverage: {short: Insurance information, isSummary: true, index: 13}
      inforce: {short: Coverage inforce indicator, index: 14}
      benefitPeriod: {short: When the benefits are applicable, index: 15}
      item:
        constraint:
          ces-1: {human: SHALL contain a category or a billcode but not both., severity: error, expression: category.exists() xor productOrService.exists()}
        short: Benefits and authorization details
        array: true
        index: 16
        elements:
          description: {short: Description of the benefit or services covered, index: 23}
          category:
            short: Benefit classification
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
            index: 17
          authorizationRequired: {short: Authorization required flag, index: 33}
          modifier:
            short: Product or service billing modifiers
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
            index: 19
          authorizationSupporting:
            short: Type of required supporting materials
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support'}
            index: 34
          unit:
            short: Individual or family
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-unit'}
            index: 25
          excluded: {short: Excluded from the plan, index: 21}
          name: {short: Short name for the benefit, index: 22}
          productOrService:
            short: Billing, service, product, or drug code
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            index: 18
          term:
            short: Annual or lifetime
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-term'}
            index: 26
          benefit:
            short: Benefit Summary
            array: true
            index: 27
            elements:
              type:
                short: Benefit classification
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-type'}
                index: 28
              allowed:
                short: Benefits allowed
                choices: []
                index: 30
              used:
                short: Benefits used
                choices: []
                index: 32
            required: [type]
          authorizationUrl: {short: Preauthorization requirements endpoint, index: 35}
          network:
            short: In or out of network
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-network'}
            index: 24
          provider: {short: Performing practitioner, index: 20}
    required: [coverage]
  request: {short: Eligibility request reference, isSummary: true, index: 8}
  preAuthRef: {short: Preauthorization reference, index: 36}
  purpose:
    min: 1
    short: auth-requirements | benefits | discovery | validation
    array: true
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|4.0.1'}
    isSummary: true
    index: 2
  created: {short: Response creation date, isSummary: true, index: 6}
  serviced:
    short: Estimated date or dates of service
    choices: []
    index: 5
  outcome:
    short: queued | complete | error | partial
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1'}
    isSummary: true
    index: 9
  disposition: {short: Disposition Message, index: 10}
  insurer: {short: Coverage issuer, isSummary: true, index: 11}
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|4.0.1'}
    isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    isSummary: true
    index: 1
  identifier: {short: Business Identifier for coverage eligiblity request, array: true, index: 0}
  error:
    short: Processing errors
    array: true
    index: 38
    elements:
      code:
        short: Error code detailing processing issues
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication-error'}
        index: 39
    required: [code]
  form:
    short: Printed form identifier
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/forms'}
    index: 37
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 4.0.1
required: [created, insurer, status, request, patient, outcome, purpose]