EligibilityResponse - FHIR Resource (stu3)

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

Validate an EligibilityResponse FHIR Resource (stu3)

EligibilityResponse Attributes

AttributeField is listTypeDescription

Description: active | cancelled | draft | entered-in-error

FHIR Version: stu3

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 (EligibilityResponse) status FHIR attribute

Description: Responsible organization

FHIR Version: stu3

Attribute Type : Reference

Required: N/A

Countability: Singleton

Flags: N/A

Terminology bindings: N/A

Requirements: N/A

Comments: N/A

Example:

"requestOrganization":

Learn more about the (EligibilityResponse) requestOrganization FHIR attribute

Description: Business Identifier

FHIR Version: stu3

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/eligibilityresponse",
    "value": "881234"
  }
]

Learn more about the (EligibilityResponse) identifier FHIR attribute

Description: Printed Form Identifier

FHIR Version: stu3

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 (EligibilityResponse) form FHIR attribute

Description: Creation date

FHIR Version: stu3

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 (EligibilityResponse) created FHIR attribute

Description: Coverage inforce indicator

FHIR Version: stu3

Attribute Type : boolean

Required: N/A

Countability: Singleton

Flags: N/A

Terminology bindings: N/A

Requirements: N/A

Comments: N/A

Example:

"inforce": true

Learn more about the (EligibilityResponse) inforce FHIR attribute

Description: Insurer issuing the coverage

FHIR Version: stu3

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 (EligibilityResponse) insurer FHIR attribute

Description: Eligibility reference

FHIR Version: stu3

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/eligibility/225476332402"
}

Learn more about the (EligibilityResponse) request FHIR attribute

Description: Responsible practitioner

FHIR Version: stu3

Attribute Type : Reference

Required: N/A

Countability: Singleton

Flags: N/A

Terminology bindings: N/A

Requirements: N/A

Comments: N/A

Example:

"requestProvider":

Learn more about the (EligibilityResponse) requestProvider FHIR attribute

Description: Disposition Message

FHIR Version: stu3

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 (EligibilityResponse) disposition FHIR attribute

Description: Processing errors

FHIR Version: stu3

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 (EligibilityResponse) error FHIR attribute

Description: complete | error | partial

FHIR Version: stu3

Attribute Type : CodeableConcept

Required: N/A

Countability: Singleton

Flags: N/A

Terminology bindings: N/A

Requirements: N/A

Comments: N/A

Example:

"outcome": {
  "coding": [
    {
      "code": "complete",
      "system": "http://hl7.org/fhir/remittance-outcome"
    }
  ]
}

Learn more about the (EligibilityResponse) outcome FHIR attribute

Description: Details by insurance coverage

FHIR Version: stu3

Attribute Type : Data Type

Required: N/A

Countability: Array

Flags: N/A

Terminology bindings: N/A

Requirements: N/A

Comments: N/A

Example:

"insurance":

Learn more about the (EligibilityResponse) insurance FHIR attribute

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 them like so:

https://api.1up.health/fhir/stu3/EligibilityResponse?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`
`request`	`reference`	`request`
`request-organization`	`reference`	`requestOrganization`
`request-provider`	`reference`	`requestProvider`