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CoverageEligibilityResponse

PropertyValue
Publisher
NameCoverageEligibilityResponse
URLhttp://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
Statusdraft
Description
Abstractfalse

Structure

PathCardinalityTypeDescription
CoverageEligibilityResponse0..*CoverageEligibilityResponseThis resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
CoverageEligibilityResponse.id0..1http://hl7.org/fhirpath/System.StringThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
CoverageEligibilityResponse.meta0..1MetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
CoverageEligibilityResponse.implicitRules0..1uriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
CoverageEligibilityResponse.language0..1codeThe base language in which the resource is written.
CoverageEligibilityResponse.text0..1NarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
CoverageEligibilityResponse.contained0..*ResourceThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
CoverageEligibilityResponse.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
CoverageEligibilityResponse.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
CoverageEligibilityResponse.identifier0..*IdentifierA unique identifier assigned to this coverage eligiblity request.
CoverageEligibilityResponse.status1..1codeThe status of the resource instance.
CoverageEligibilityResponse.purpose1..*codeCode 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.
CoverageEligibilityResponse.patient1..1ReferenceThe party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
CoverageEligibilityResponse.serviced[x]0..1dateThe date or dates when the enclosed suite of services were performed or completed.
CoverageEligibilityResponse.created1..1dateTimeThe date this resource was created.
CoverageEligibilityResponse.requestor0..1ReferenceThe provider which is responsible for the request.
CoverageEligibilityResponse.request1..1ReferenceReference to the original request resource.
CoverageEligibilityResponse.outcome1..1codeThe outcome of the request processing.
CoverageEligibilityResponse.disposition0..1stringA human readable description of the status of the adjudication.
CoverageEligibilityResponse.insurer1..1ReferenceThe Insurer who issued the coverage in question and is the author of the response.
CoverageEligibilityResponse.insurance0..*BackboneElementFinancial instruments for reimbursement for the health care products and services.
CoverageEligibilityResponse.insurance.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
CoverageEligibilityResponse.insurance.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
CoverageEligibilityResponse.insurance.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
CoverageEligibilityResponse.insurance.coverage1..1ReferenceReference 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.
CoverageEligibilityResponse.insurance.inforce0..1booleanFlag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.
CoverageEligibilityResponse.insurance.benefitPeriod0..1PeriodThe term of the benefits documented in this response.
CoverageEligibilityResponse.insurance.item0..*BackboneElementBenefits and optionally current balances, and authorization details by category or service.
CoverageEligibilityResponse.insurance.item.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
CoverageEligibilityResponse.insurance.item.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
CoverageEligibilityResponse.insurance.item.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
CoverageEligibilityResponse.insurance.item.category0..1CodeableConceptCode to identify the general type of benefits under which products and services are provided.
CoverageEligibilityResponse.insurance.item.productOrService0..1CodeableConceptThis contains the product, service, drug or other billing code for the item.
CoverageEligibilityResponse.insurance.item.modifier0..*CodeableConceptItem typification or modifiers codes to convey additional context for the product or service.
CoverageEligibilityResponse.insurance.item.provider0..1ReferenceThe practitioner who is eligible for the provision of the product or service.
CoverageEligibilityResponse.insurance.item.excluded0..1booleanTrue if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
CoverageEligibilityResponse.insurance.item.name0..1stringA short name or tag for the benefit.
CoverageEligibilityResponse.insurance.item.description0..1stringA richer description of the benefit or services covered.
CoverageEligibilityResponse.insurance.item.network0..1CodeableConceptIs a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
CoverageEligibilityResponse.insurance.item.unit0..1CodeableConceptIndicates if the benefits apply to an individual or to the family.
CoverageEligibilityResponse.insurance.item.term0..1CodeableConceptThe term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
CoverageEligibilityResponse.insurance.item.benefit0..*BackboneElementBenefits used to date.
CoverageEligibilityResponse.insurance.item.benefit.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
CoverageEligibilityResponse.insurance.item.benefit.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
CoverageEligibilityResponse.insurance.item.benefit.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
CoverageEligibilityResponse.insurance.item.benefit.type1..1CodeableConceptClassification of benefit being provided.
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]0..1unsignedIntThe quantity of the benefit which is permitted under the coverage.
CoverageEligibilityResponse.insurance.item.benefit.used[x]0..1unsignedIntThe quantity of the benefit which have been consumed to date.
CoverageEligibilityResponse.insurance.item.authorizationRequired0..1booleanA boolean flag indicating whether a preauthorization is required prior to actual service delivery.
CoverageEligibilityResponse.insurance.item.authorizationSupporting0..*CodeableConceptCodes or comments regarding information or actions associated with the preauthorization.
CoverageEligibilityResponse.insurance.item.authorizationUrl0..1uriA web location for obtaining requirements or descriptive information regarding the preauthorization.
CoverageEligibilityResponse.preAuthRef0..1stringA reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.
CoverageEligibilityResponse.form0..1CodeableConceptA code for the form to be used for printing the content.
CoverageEligibilityResponse.error0..*BackboneElementErrors encountered during the processing of the request.
CoverageEligibilityResponse.error.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
CoverageEligibilityResponse.error.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
CoverageEligibilityResponse.error.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
CoverageEligibilityResponse.error.code1..1CodeableConceptAn error code,from a specified code system, which details why the eligibility check could not be performed.

Search Parameters

NameTypeDescriptionExpression
_textstringSearch on the narrative of the resource
_contentstringSearch on the entire content of the resource
_idtokenLogical id of this artifactResource.id
_lastUpdateddateWhen the resource version last changedResource.meta.lastUpdated
_profileuriProfiles this resource claims to conform toResource.meta.profile
_querytokenA custom search profile that describes a specific defined query operation
_securitytokenSecurity Labels applied to this resourceResource.meta.security
_sourceuriIdentifies where the resource comes fromResource.meta.source
_tagtokenTags applied to this resourceResource.meta.tag
createddateThe creation dateCoverageEligibilityResponse.created
dispositionstringThe contents of the disposition messageCoverageEligibilityResponse.disposition
identifiertokenThe business identifierCoverageEligibilityResponse.identifier
insurerreferenceThe organization which generated this resourceCoverageEligibilityResponse.insurer
outcometokenThe processing outcomeCoverageEligibilityResponse.outcome
patientreferenceThe reference to the patientCoverageEligibilityResponse.patient
requestreferenceThe EligibilityRequest referenceCoverageEligibilityResponse.request
requestorreferenceThe EligibilityRequest providerCoverageEligibilityResponse.requestor
statustokenThe EligibilityRequest statusCoverageEligibilityResponse.status
_iguhealth-version-seqnumberThe version sequence of the resourceResource.meta.extension.where(url='https://iguhealth.app/version-sequence').value
_iguhealth-authorreferenceThe author of the resourceResource.meta.extension.where(url='https://iguhealth.app/author').value