CoverageEligibilityResponse

ResourceFinancial · SupportTrial useMaturity 2

This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.

StructureSearch parametersHL7 specificationStructureDefinition JSON

Tested supportFull test results →

Backends

PostgreSQLElasticsearch

Interactions

CreateReadUpdatePatchDelete

Search

9 of 9 parameters tested

Structure

Show inherited elements (20)

Element	Card.	Type	Description
identifier	0..*	Identifier	Business Identifier for coverage eligiblity request
statusRequired?!Σ	1..1	code	active | cancelled | draft | entered-in-errorBinding (required): fm-status
purposeRequiredΣ	1..*	code	auth-requirements | benefits | discovery | validationBinding (required): eligibilityresponse-purpose
patientRequiredΣ	1..1	Reference(Patient)	Intended recipient of products and services
serviced[x]	0..1	date | Period	Estimated date or dates of service
createdRequiredΣ	1..1	dateTime	Response creation date
requestor	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
requestRequiredΣ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
outcomeRequiredΣ	1..1	code	queued | complete | error | partialBinding (required): remittance-outcome
disposition	0..1	string	Disposition Message
insurerRequiredΣ	1..1	Reference(Organization)	Coverage issuer
insurance	0..*	BackboneElement	Patient insurance information
coverageRequiredΣ	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
category	0..1	CodeableConcept	Benefit classificationBinding (example): ex-benefitcategory
productOrService	0..1	CodeableConcept	Billing, service, product, or drug codeBinding (example): service-uscls
modifier	0..*	CodeableConcept	Product or service billing modifiersBinding (example): claim-modifiers
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 networkBinding (example): benefit-network
unit	0..1	CodeableConcept	Individual or familyBinding (example): benefit-unit
term	0..1	CodeableConcept	Annual or lifetimeBinding (example): benefit-term
benefit	0..*	BackboneElement	Benefit Summary
typeRequired	1..1	CodeableConcept	Benefit classificationBinding (example): benefit-type
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 materialsBinding (example): coverageeligibilityresponse-ex-auth-support
authorizationUrl	0..1	uri	Preauthorization requirements endpoint
preAuthRef	0..1	string	Preauthorization reference
form	0..1	CodeableConcept	Printed form identifierBinding (example): forms
error	0..*	BackboneElement	Processing errors
codeRequired	1..1	CodeableConcept	Error code detailing processing issuesBinding (example): adjudication-error

Σ in _summary results · ?! modifier element · 1.. required · inherited elements in grey

Search parameters

Query with GET [base]/CoverageEligibilityResponse?[parameter]=[value]. Type decides which modifiers and prefixes apply, see search features.

Parameter	Type	Description	PG	ES
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

PG: PostgreSQL, ES: Elasticsearch. passes its TestScript checks, fails, not tested yet.

Common parameters on every resource (8)

_haste-health-author	reference	The author of the resource
_id	token	Logical id of this artifact
_lastUpdated	date	When the resource version last changed
_profile	uri	Profiles this resource claims to conform to
_security	token	Security Labels applied to this resource
_source	uri	Identifies where the resource comes from
_tag	token	Tags applied to this resource
_type	token	Derived from the R4B Definition