Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
TU | DomainResource | CoverageEligibilityResponse resource Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | ||
0..* | Identifier | Business Identifier | ||
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Financial Resource Status Codes (Required) | |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation EligibilityResponsePurpose (Required) | |
0..1 | Reference(Patient) | The subject of the Products and Services | ||
0..1 | Estimated date or dates for inquiry | |||
date | ||||
Period | ||||
0..1 | dateTime | Creation date | ||
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible provider | ||
0..1 | Reference(CoverageEligibilityRequest) | Eligibility reference | ||
0..1 | code | queued | complete | error | partial RemittanceOutcome (Required) | ||
0..1 | string | Disposition Message | ||
0..1 | Reference(Organization) | Insurer issuing the coverage | ||
0..* | BackboneElement | Details by insurance coverage | ||
0..1 | Reference(Coverage) | Updated Coverage details | ||
0..1 | Reference(Contract) | Contract details | ||
0..1 | boolean | Coverage inforce indicator | ||
I | 0..* | BackboneElement | Benefits and Authorization requirements by Category or Service + Rule: SHALL contain a category or a billcode but not both. + Rule: SHALL contain a billcode for modifier to be present. | |
0..1 | CodeableConcept | Type of service Benefit Category Codes (Example) | ||
0..1 | CodeableConcept | Billing Code USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | ||
0..1 | boolean | Excluded from the plan | ||
0..1 | string | Short name for the benefit | ||
0..1 | string | Description of the benefit or services covered | ||
0..1 | CodeableConcept | In or out of network Network Type Codes (Example) | ||
0..1 | CodeableConcept | Individual or family Unit Type Codes (Example) | ||
0..1 | CodeableConcept | Annual or lifetime Benefit Term Codes (Example) | ||
0..* | BackboneElement | Benefit Summary | ||
1..1 | CodeableConcept | Deductible, visits, benefit amount Benefit Type Codes (Example) | ||
0..1 | Benefits allowed | |||
unsignedInt | ||||
string | ||||
Money | ||||
0..1 | Benefits used | |||
unsignedInt | ||||
Money | ||||
0..1 | boolean | Authorization required flag | ||
0..* | CodeableConcept | Codes or text of materials to be submitted | ||
0..1 | uri | Pre-authorization requirements | ||
0..1 | string | Pre-Authorization/Determination Reference | ||
0..1 | CodeableConcept | Printed Form Identifier Forms (Example) | ||
0..* | BackboneElement | Processing errors | ||
1..1 | CodeableConcept | Error code detailing processing issues AdjudicationError (Example) | ||
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