| Name | Flags | Card. | Type | Description & Constraints![]() |
|---|---|---|---|---|
| DomainResource | EligibilityResponse resource | |||
| 0..* | Identifier | Business Identifier | ||
| ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error EligibilityResponseStatus (Required) | |
| 0..1 | Claim reference | |||
| Identifier | ||||
| Reference(EligibilityRequest) | ||||
| 0..1 | code | complete | error | partial RemittanceOutcome (Required) | ||
| 0..1 | string | Disposition Message | ||
| 0..1 | Coding | Resource version Ruleset Codes (Example) | ||
| 0..1 | Coding | Original version Ruleset Codes (Example) | ||
| 0..1 | dateTime | Creation date | ||
| 0..1 | Insurer | |||
| Identifier | ||||
| Reference(Organization) | ||||
| 0..1 | Responsible practitioner | |||
| Identifier | ||||
| Reference(Practitioner) | ||||
| 0..1 | Responsible organization | |||
| Identifier | ||||
| Reference(Organization) | ||||
| 0..1 | boolean | Coverage inforce | ||
| 0..1 | Reference(Contract) | Contract details | ||
| 0..1 | Coding | Printed Form Identifier Form Codes (Required) | ||
| 0..* | BackboneElement | Benefits by Category | ||
| 1..1 | Coding | Benefit Category Benefit Category Codes (Example) | ||
| 0..1 | Coding | Benefit SubCategory Benefit SubCategory Codes (Example) | ||
| 0..1 | string | Short name for the benefit | ||
| 0..1 | string | Description of the benefit | ||
| 0..1 | Coding | In or out of network Network Type Codes (Example) | ||
| 0..1 | Coding | Individual or family Unit Type Codes (Example) | ||
| 0..1 | Coding | Annual or lifetime Benefit Term Codes (Example) | ||
| 0..* | BackboneElement | Benefit Summary | ||
| 1..1 | Coding | Deductable, visits, benefit amount Benefit Type Codes (Example) | ||
| 0..1 | Benefits allowed | |||
| unsignedInt | ||||
| string | ||||
| Money | ||||
| 0..1 | Benefits used | |||
| unsignedInt | ||||
| Money | ||||
| 0..* | BackboneElement | Processing errors | ||
| 1..1 | Coding | Error code detailing processing issues Adjudication Error Codes (Required) | ||
Documentation for this format | ||||