CoverageEligibilityResponse - FHIR Resource (r4)


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

Validate an CoverageEligibilityResponse FHIR Resource (r4)



Resource Attributes

AttributeField is listTypeDescription
createdfalsedateTime# Response creation date
dispositionfalsestring# Disposition Message
errortrueData Type# Processing errors
formfalseCodeableConcept# Printed form identifier
identifiertrueIdentifier# Business Identifier for coverage eligiblity request
insurancetrueData Type# Patient insurance information
insurerfalseReference# Coverage issuer
outcomefalsecode# queued | complete | error | partial
patientfalseReference# Intended recipient of products and services
preAuthReffalsestring# Preauthorization reference
purposetruecode# auth-requirements | benefits | discovery | validation
requestfalseReference# Eligibility request reference
requestorfalseReference# Party responsible for the request
serviced[x]falsedate|Period#undefined
statusfalsecode# active | cancelled | draft | entered-in-error

CoverageEligibilityResponse Example

{
  "resourceType": "CoverageEligibilityResponse",
  "id": "E2500",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value": "881234"
    }
  ],
  "status": "active",
  "purpose": [
    "validation"
  ],
  "patient": {
    "reference": "Patient/pat1"
  },
  "created": "2014-08-16",
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332402"
  },
  "outcome": "complete",
  "disposition": "Policy is currently in-force.",
  "insurer": {
    "reference": "Organization/2"
  },
  "insurance": [
    {
      "coverage": {
        "reference": "Coverage/9876B1"
      },
      "inforce": true
    }
  ]
}

CoverageEligibilityResponse Structure

{
  "resourceType" : "CoverageEligibilityResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for coverage eligiblity request
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "purpose" : ["<code>"], // R!  auth-requirements | benefits | discovery | validation
  "patient" : { Reference(Patient) }, // R!  Intended recipient of products and services
  // serviced[x]: Estimated date or dates of service. One of these 2:
  "servicedDate" : "<date>",
  "servicedPeriod" : { Period },
  "created" : "<dateTime>", // R!  Response creation date
  "requestor" : { Reference(Practitioner|PractitionerRole|Organization) }, // Party responsible for the request
  "request" : { Reference(CoverageEligibilityRequest) }, // R!  Eligibility request reference
  "outcome" : "<code>", // R!  queued | complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "insurer" : { Reference(Organization) }, // R!  Coverage issuer
  "insurance" : [{ // Patient insurance information
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "inforce" : <boolean>, // Coverage inforce indicator
    "benefitPeriod" : { Period }, // When the benefits are applicable
    "item" : [{ // Benefits and authorization details
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
      "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
      "provider" : { Reference(Practitioner|PractitionerRole) }, // Performing practitioner
      "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
      "benefit" : [{ // Benefit Summary
        "type" : { CodeableConcept }, // R!  Benefit classification
        // allowed[x]: Benefits allowed. One of these 3:
        "allowedUnsignedInt" : "<unsignedInt>",
        "allowedString" : "<string>",
        "allowedMoney" : { Money },
        // used[x]: Benefits used. One of these 3:
        "usedUnsignedInt" : "<unsignedInt>"
        "usedString" : "<string>"
        "usedMoney" : { Money }
      }],
      "authorizationRequired" : <boolean>, // Authorization required flag
      "authorizationSupporting" : [{ CodeableConcept }], // Type of required supporting materials
      "authorizationUrl" : "<uri>" // Preauthorization requirements endpoint
    }]
  }],
  "preAuthRef" : "<string>", // Preauthorization reference
  "form" : { CodeableConcept }, // Printed form identifier
  "error" : [{ // Processing errors
    "code" : { CodeableConcept } // R!  Error code detailing processing issues
  }]
}

CoverageEligibilityResponse Search Parameters

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

https://api.1up.health/fhir/r4/CoverageEligibilityResponse?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
createddatecreated
dispositiontextdisposition
identifiertextidentifier
insurerreferenceinsurer
outcometextoutcome
patientreferencepatient
requestreferencerequest
requestorreferencerequestor
statustextstatus