DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R3 R2

7.5 Resource EligibilityResponse - Content

This resource is marked as a draft.

Financial Management Work GroupMaturity Level: 0Compartments: Not linked to any defined compartments

This resource provides eligibility and plan details from the processing of an Eligibility resource.

7.5.1 Scope and Usage

This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft.

The EligibilityResponse resource provides eligibility and plan details from the processing of an Eligibility resource. It combines key information from a payor as to whether a Coverage is in-force, and optionally the nature of the Policy details.

Todo

7.5.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EligibilityResponse ΣDomainResourceEligibilityResponse resource
... identifier Σ0..*IdentifierBusiness Identifier
... request Σ0..1Reference(EligibilityRequest)Claim reference
... outcome Σ0..1codecomplete | error
RemittanceOutcome (Required)
... disposition Σ0..1stringDisposition Message
... ruleset Σ0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset Σ0..1CodingOriginal version
Ruleset Codes (Example)
... created Σ0..1dateTimeCreation date
... organization Σ0..1Reference(Organization)Insurer
... requestProvider Σ0..1Reference(Practitioner)Responsible practitioner
... requestOrganization Σ0..1Reference(Organization)Responsible organization

doco Documentation for this format

XML Template

<EligibilityResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <request><!-- 0..1 Reference(EligibilityRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>
</EligibilityResponse>

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EligibilityResponse ΣDomainResourceEligibilityResponse resource
... identifier Σ0..*IdentifierBusiness Identifier
... request Σ0..1Reference(EligibilityRequest)Claim reference
... outcome Σ0..1codecomplete | error
RemittanceOutcome (Required)
... disposition Σ0..1stringDisposition Message
... ruleset Σ0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset Σ0..1CodingOriginal version
Ruleset Codes (Example)
... created Σ0..1dateTimeCreation date
... organization Σ0..1Reference(Organization)Insurer
... requestProvider Σ0..1Reference(Practitioner)Responsible practitioner
... requestOrganization Σ0..1Reference(Organization)Responsible organization

doco Documentation for this format

XML Template

<EligibilityResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <request><!-- 0..1 Reference(EligibilityRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>
</EligibilityResponse>

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

7.5.2.1 Terminology Bindings

PathDefinitionTypeReference
EligibilityResponse.outcome The outcome of the processing.RequiredRemittanceOutcome
EligibilityResponse.ruleset
EligibilityResponse.originalRuleset
The static and dynamic model to which contents conform, which may be business version or standard/version.ExampleRuleset Codes

7.5.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
identifiertokenThe business identifier of the Explanation of BenefitEligibilityResponse.identifier