EligibilityResponse - FHIR Resource (stu3)


This EligibilityResponse Resource uses the FHIR API standard for access and structure.

Validate an EligibilityResponse FHIR Resource (stu3)



Resource Attributes

AttributeField is listTypeDescription
createdfalsedateTime# Creation date
dispositionfalsestring# Disposition Message
errortrueData Type# Processing errors
formfalseCodeableConcept# Printed Form Identifier
identifiertrueIdentifier# Business Identifier
inforcefalseboolean# Coverage inforce indicator
insurancetrueData Type# Details by insurance coverage
insurerfalseReference# Insurer issuing the coverage
outcomefalseCodeableConcept# complete | error | partial
requestfalseReference# Eligibility reference
requestOrganizationfalseReference# Responsible organization
requestProviderfalseReference# Responsible practitioner
statusfalsecode# active | cancelled | draft | entered-in-error

EligibilityResponse Example

{
  "status": "active",
  "outcome": {
    "coding": [
      {
        "code": "complete",
        "system": "http://hl7.org/fhir/remittance-outcome"
      }
    ]
  },
  "created": "2014-08-16",
  "resourceType": "EligibilityResponse",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/eligibility/225476332402"
  },
  "disposition": "Policy is currently in-force.",
  "inforce": true,
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/eligibilityresponse",
      "value": "881234"
    }
  ],
  "id": "E2500"
}

EligibilityResponse Structure


  
{
  "resourceType" : "EligibilityResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "created" : "<dateTime>", // Creation date
  "requestProvider" : { Reference(Practitioner) }, // Responsible practitioner
  "requestOrganization" : { Reference(Organization) }, // Responsible organization
  "request" : { Reference(EligibilityRequest) }, // Eligibility reference
  "outcome" : { CodeableConcept }, // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "insurer" : { Reference(Organization) }, // Insurer issuing the coverage
  "inforce" : <boolean>, // Coverage inforce indicator
  "insurance" : [{ // Details by insurance coverage
    "coverage" : { Reference(Coverage) }, // Updated Coverage details
    "contract" : { Reference(Contract) }, // Contract details
    "benefitBalance" : [{ // Benefits by Category
      "category" : { CodeableConcept }, // R!  Type of services covered
      "subCategory" : { CodeableConcept }, // Detailed services covered within the type
      "excluded" : <boolean>, // Excluded from the plan
      "name" : "<string>", // Short name for the benefit
      "description" : "<string>", // Description of the benefit or services covered
      "network" : { CodeableConcept }, // In or out of network
      "unit" : { CodeableConcept }, // Individual or family
      "term" : { CodeableConcept }, // Annual or lifetime
      "financial" : [{ // Benefit Summary
        "type" : { CodeableConcept }, // R!  Deductable, visits, benefit amount
        // allowed[x]: Benefits allowed. One of these 3:
        "allowedUnsignedInt" : "<unsignedInt>",
        "allowedString" : "<string>",
        "allowedMoney" : { Money },
        // used[x]: Benefits used. One of these 2:
        "usedUnsignedInt" : "<unsignedInt>"
        "usedMoney" : { Money }
      }]
    }]
  }],
  "form" : { CodeableConcept }, // Printed Form Identifier
  "error" : [{ // Processing errors
    "code" : { CodeableConcept } // R!  Error code detailing processing issues
  }]
}


 

EligibilityResponse Search Parameters

The following search parameters can be used to query EligibilityResponse resources. Just submit the like so:

https://api.1up.health/fhir/stu3/EligibilityResponse?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
createddatecreated
dispositiontextdisposition
identifiertextidentifier
insurerreferenceinsurer
outcometextoutcome
requestreferencerequest
request-organizationreferencerequestOrganization
request-providerreferencerequestProvider