NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse TUDomainResourceCoverageEligibilityResponse resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for coverage eligiblity request
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
EligibilityResponsePurpose (Required)
... patient Σ1..1Reference(Patient)Intended recipient of products and services
... serviced[x] 0..1Estimated date or dates of service
.... servicedDatedate
.... servicedPeriodPeriod
... created Σ1..1dateTimeResponse creation date
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the request
... request Σ1..1Reference(CoverageEligibilityRequest)Eligibility request reference
... outcome Σ1..1codequeued | complete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition Message
... insurer Σ1..1Reference(Organization)Coverage issuer
... insurance 0..*BackboneElementPatient insurance information
.... coverage Σ1..1Reference(Coverage)Insurance information
.... inforce 0..1booleanCoverage inforce indicator
.... benefitPeriod 0..1PeriodWhen the benefits are applicable
.... item I0..*BackboneElementBenefits and authorization details
+ Rule: SHALL contain a category or a billcode but not both.
..... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptProduct or service billing modifiers
Modifier type Codes (Example)
..... provider 0..1Reference(Practitioner | PractitionerRole)Performing practitioner
..... excluded 0..1booleanExcluded from the plan
..... name 0..1stringShort name for the benefit
..... description 0..1stringDescription of the benefit or services covered
..... network 0..1CodeableConceptIn or out of network
Network Type Codes (Example)
..... unit 0..1CodeableConceptIndividual or family
Unit Type Codes (Example)
..... term 0..1CodeableConceptAnnual or lifetime
Benefit Term Codes (Example)
..... benefit 0..*BackboneElementBenefit Summary
...... type 1..1CodeableConceptBenefit classification
Benefit Type Codes (Example)
...... allowed[x] 0..1Benefits allowed
....... allowedUnsignedIntunsignedInt
....... allowedStringstring
....... allowedMoneyMoney
...... used[x] 0..1Benefits used
....... usedUnsignedIntunsignedInt
....... usedStringstring
....... usedMoneyMoney
..... authorizationRequired 0..1booleanAuthorization required flag
..... authorizationSupporting 0..*CodeableConceptType of required supporting materials
CoverageEligibilityResponse Auth Support Codes (Example)
..... authorizationUrl 0..1uriPreauthorization requirements endpoint
... preAuthRef 0..1stringPreauthorization reference
... form 0..1CodeableConceptPrinted form identifier
Forms (Example)
... error 0..*BackboneElementProcessing errors
.... code 1..1CodeableConceptError code detailing processing issues
AdjudicationError (Example)

doco Documentation for this format