CoverageEligibilityResponse - FHIR Resource (r4)
This CoverageEligibilityResponse Resource uses the FHIR API standard for access and structure.
Validate an CoverageEligibilityResponse FHIR Resource (r4)
CoverageEligibilityResponse Attributes
AttributeField is listTypeDescription
Description: Business Identifier for coverage eligiblity request
FHIR Version: r4
Attribute Type : Identifier
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value": "881234"
}
]Learn more about the (CoverageEligibilityResponse) identifier FHIR attribute
Description: active | cancelled | draft | entered-in-error
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"status": "active"Learn more about the (CoverageEligibilityResponse) status FHIR attribute
Description: auth-requirements | benefits | discovery | validation
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"purpose": [
"validation"
]Learn more about the (CoverageEligibilityResponse) purpose FHIR attribute
Description: Intended recipient of products and services
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"patient": {
"reference": "Patient/pat1"
}Learn more about the (CoverageEligibilityResponse) patient FHIR attribute
Description:
FHIR Version: r4
Attribute Type : date|Period
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"serviced[x]": Learn more about the (CoverageEligibilityResponse) serviced[x] FHIR attribute
Description: Response creation date
FHIR Version: r4
Attribute Type : dateTime
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"created": "2014-08-16"Learn more about the (CoverageEligibilityResponse) created FHIR attribute
Description: Party responsible for the request
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"requestor": Learn more about the (CoverageEligibilityResponse) requestor FHIR attribute
Description: Eligibility request reference
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"request": {
"reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332402"
}Learn more about the (CoverageEligibilityResponse) request FHIR attribute
Description: queued | complete | error | partial
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"outcome": "complete"Learn more about the (CoverageEligibilityResponse) outcome FHIR attribute
Description: Disposition Message
FHIR Version: r4
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"disposition": "Policy is currently in-force."Learn more about the (CoverageEligibilityResponse) disposition FHIR attribute
Description: Coverage issuer
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurer": {
"reference": "Organization/2"
}Learn more about the (CoverageEligibilityResponse) insurer FHIR attribute
Description: Patient insurance information
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurance": [
{
"coverage": {
"reference": "Coverage/9876B1"
},
"inforce": true
}
]Learn more about the (CoverageEligibilityResponse) insurance FHIR attribute
Description: Preauthorization reference
FHIR Version: r4
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"preAuthRef": Learn more about the (CoverageEligibilityResponse) preAuthRef FHIR attribute
Description: Printed form identifier
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"form": Learn more about the (CoverageEligibilityResponse) form FHIR attribute
Description: Processing errors
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"error": Learn more about the (CoverageEligibilityResponse) error FHIR attribute
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 Parameter | Field Type | Resource Fields Searched |
|---|---|---|
created | date | created |
disposition | text | disposition |
identifier | text | identifier |
insurer | reference | insurer |
outcome | text | outcome |
patient | reference | patient |
request | reference | request |
requestor | reference | requestor |
status | text | status |
