This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). 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
Detailed Descriptions for the elements in the EligibilityResponse resource.
| EligibilityResponse | |
| Definition | This resource provides eligibility and plan details from the processing of an Eligibility resource. |
| Control | 1..1 |
| EligibilityResponse.identifier | |
| Definition | The Response business identifier. |
| Note | This is a business identifer, not a resource identifier (see discussion) |
| Control | 0..* |
| Type | Identifier |
| EligibilityResponse.status | |
| Definition | The status of the resource instance. |
| Control | 0..1 |
| Terminology Binding | Financial Resource Status Codes (Required) |
| Type | code |
| Is Modifier | true |
| Summary | true |
| EligibilityResponse.created | |
| Definition | The date when the enclosed suite of services were performed or completed. |
| Control | 0..1 |
| Type | dateTime |
| EligibilityResponse.requestProvider | |
| Definition | The practitioner who is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Reference(Practitioner) |
| EligibilityResponse.requestOrganization | |
| Definition | The organization which is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Reference(Organization) |
| EligibilityResponse.request | |
| Definition | Original request resource reference. |
| Control | 0..1 |
| Type | Reference(EligibilityRequest) |
| EligibilityResponse.outcome | |
| Definition | Transaction status: error, complete. |
| Control | 0..1 |
| Terminology Binding | RemittanceOutcome (Required) |
| Type | CodeableConcept |
| EligibilityResponse.disposition | |
| Definition | A description of the status of the adjudication. |
| Control | 0..1 |
| Type | string |
| EligibilityResponse.insurer | |
| Definition | The Insurer who produced this adjudicated response. |
| Control | 0..1 |
| Type | Reference(Organization) |
| EligibilityResponse.inforce | |
| Definition | Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates. |
| Control | 0..1 |
| Type | boolean |
| EligibilityResponse.insurance | |
| Definition | The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer. |
| Control | 0..* |
| EligibilityResponse.insurance.coverage | |
| Definition | A suite of updated or additional Coverages from the Insurer. |
| Control | 0..1 |
| Type | Reference(Coverage) |
| EligibilityResponse.insurance.contract | |
| Definition | The contract resource which may provide more detailed information. |
| Control | 0..1 |
| Type | Reference(Contract) |
| EligibilityResponse.insurance.benefitBalance | |
| Definition | Benefits and optionally current balances by Category. |
| Control | 0..* |
| EligibilityResponse.insurance.benefitBalance.category | |
| Definition | Dental, Vision, Medical, Pharmacy, Rehab etc. |
| Control | 1..1 |
| Terminology Binding | Benefit Category Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.subCategory | |
| Definition | Dental: basic, major, ortho; Vision exam, glasses, contacts; etc. |
| Control | 0..1 |
| Terminology Binding | Benefit SubCategory Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.excluded | |
| Definition | True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage. |
| Control | 0..1 |
| Type | boolean |
| EligibilityResponse.insurance.benefitBalance.name | |
| Definition | A short name or tag for the benefit, for example MED01, or DENT2. |
| Control | 0..1 |
| Type | string |
| EligibilityResponse.insurance.benefitBalance.description | |
| Definition | A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'. |
| Control | 0..1 |
| Type | string |
| EligibilityResponse.insurance.benefitBalance.network | |
| Definition | Network designation. |
| Control | 0..1 |
| Terminology Binding | Network Type Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.unit | |
| Definition | Unit designation: individual or family. |
| Control | 0..1 |
| Terminology Binding | Unit Type Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.term | |
| Definition | The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'. |
| Control | 0..1 |
| Terminology Binding | Benefit Term Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.financial | |
| Definition | Benefits Used to date. |
| Control | 0..* |
| EligibilityResponse.insurance.benefitBalance.financial.type | |
| Definition | Deductable, visits, benefit amount. |
| Control | 1..1 |
| Terminology Binding | Benefit Type Codes (Example) |
| Type | CodeableConcept |
| EligibilityResponse.insurance.benefitBalance.financial.benefit[x] | |
| Definition | Benefits allowed. |
| Control | 0..1 |
| Type | unsignedInt|string|Money |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.insurance.benefitBalance.financial.benefitUsed[x] | |
| Definition | Benefits used. |
| Control | 0..1 |
| Type | unsignedInt|Money |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.form | |
| Definition | The form to be used for printing the content. |
| Control | 0..1 |
| Terminology Binding | Form Codes (Required) |
| Type | CodeableConcept |
| EligibilityResponse.error | |
| Definition | Mutually exclusive with Services Provided (Item). |
| Control | 0..* |
| EligibilityResponse.error.code | |
| Definition | An error code,from a specified code system, which details why the eligibility check could not be performed. |
| Control | 1..1 |
| Terminology Binding | Adjudication Error Codes (Required) |
| Type | CodeableConcept |