This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
If the element is present, it must have either a @value, an @id, or extensions
A unique identifier assigned to this coverage eligiblity request.
The status of the resource instance.
Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.
The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
Information code for an event with a corresponding date or period.
The date or dates when the enclosed suite of services were performed or completed.
The date this resource was created.
The provider which is responsible for the request.
Reference to the original request resource.
The outcome of the request processing.
A human readable description of the status of the adjudication.
The Insurer who issued the coverage in question and is the author of the response.
Financial instruments for reimbursement for the health care products and services.
A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.
A code for the form to be used for printing the content.
Errors encountered during the processing of the request.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
A coded event such as when a service is expected or a card printed.
A date or period in the past or future indicating when the event occurred or is expectd to occur.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.
The term of the benefits documented in this response.
Benefits and optionally current balances, and authorization details by category or service.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
Code to identify the general type of benefits under which products and services are provided.
This contains the product, service, drug or other billing code for the item.
Item typification or modifiers codes to convey additional context for the product or service.
The practitioner who is eligible for the provision of the product or service.
True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
A short name or tag for the benefit.
A richer description of the benefit or services covered.
Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
Indicates if the benefits apply to an individual or to the family.
The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
Benefits used to date.
A boolean flag indicating whether a preauthorization is required prior to actual service delivery.
Codes or comments regarding information or actions associated with the preauthorization.
A web location for obtaining requirements or descriptive information regarding the preauthorization.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
Classification of benefit being provided.
The quantity of the benefit which is permitted under the coverage.
The quantity of the benefit which have been consumed to date.
This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
An error code,from a specified code system, which details why the eligibility check could not be performed.
A [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.
Queued
Processing Complete
Error
Partial Processing
If the element is present, it must have either a @value, an @id, or extensions
Coverage auth-requirements
Coverage benefits
Coverage Discovery
Coverage Validation
If the element is present, it must have either a @value, an @id, or extensions