Name Flags Card. Type Description & Constraints doco
. . EligibilityResponse Σ DomainResource EligibilityResponse resource
. . . identifier Σ 0..* Identifier Business Identifier
. . . request[x] Σ 0..1 Claim reference
. . . . requestIdentifier Identifier
. . . . requestReference Reference( EligibilityRequest)
. . . outcome Σ 0..1 code complete | error
RemittanceOutcome ( Required)
. . . disposition Σ 0..1 string Disposition Message
. . . ruleset Σ 0..1 Coding Resource version
Ruleset Codes ( Example)
. . . originalRuleset Σ 0..1 Coding Original version
Ruleset Codes ( Example)
. . . created Σ 0..1 dateTime Creation date
. . . organization[x] Σ 0..1 Insurer
. . . . organizationIdentifier Identifier
. . . . organizationReference Reference( Organization)
. . . requestProvider[x] Σ 0..1 Responsible practitioner
. . . . requestProviderIdentifier Identifier
. . . . requestProviderReference Reference( Practitioner)
. . . requestOrganization[x] Σ 0..1 Responsible organization
. . . . requestOrganizationIdentifier Identifier
. . . . requestOrganizationReference Reference( Organization)
. . . inforce Σ 0..1 boolean Coverage inforce
. . . contract Σ 0..1 Reference( Contract) Contract details
. . . form Σ 0..1 Coding Printed Form Identifier
Form Codes ( Required)
. . . benefitBalance Σ 0..* BackboneElement Benefits by Category
. . . . category Σ 1..1 Coding Benefit Category
Benefit Category Codes ( Example)
. . . . subCategory Σ 0..1 Coding Benefit SubCategory
Benefit SubCategory Codes ( Example)
. . . . network Σ 0..1 Coding In or out of network
Network Type Codes ( Example)
. . . . unit Σ 0..1 Coding Individual or family
Unit Type Codes ( Example)
. . . . term Σ 0..1 Coding Annual or lifetime
Benefit Term Codes ( Example)
. . . . financial Σ 0..* BackboneElement Benefit Summary
. . . . . type Σ 1..1 Coding Deductable, visits, benefit amount
Benefit Type Codes ( Example)
. . . . . benefit[x] Σ 0..1 Benefits allowed
. . . . . . benefitUnsignedInt unsignedInt
. . . . . . benefitQuantity Money
. . . . . benefitUsed[x] Σ 0..1 Benefits used
. . . . . . benefitUsedUnsignedInt unsignedInt
. . . . . . benefitUsedQuantity Money
. . . error Σ 0..* BackboneElement Processing errors
. . . . code Σ 1..1 Coding Error code detailing processing issues
Adjudication Error Codes ( Required)

doco Documentation for this format