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