NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse TUDomainResourceCoverageEligibilityResponse resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
EligibilityResponsePurpose (Required)
... patient 0..1Reference(Patient)The subject of the Products and Services
... serviced[x] 0..1Estimated date or dates for inquiry
.... servicedDatedate
.... servicedPeriodPeriod
... created 0..1dateTimeCreation date
... requestProvider 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible provider
... request 0..1Reference(CoverageEligibilityRequest)Eligibility reference
... outcome 0..1codequeued | complete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition Message
... insurer 0..1Reference(Organization)Insurer issuing the coverage
... insurance 0..*BackboneElementDetails by insurance coverage
.... coverage 0..1Reference(Coverage)Updated Coverage details
.... contract 0..1Reference(Contract)Contract details
.... inforce 0..1booleanCoverage inforce indicator
.... item I0..*BackboneElementBenefits 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.
..... category 0..1CodeableConceptType of service
Benefit Category Codes (Example)
..... billcode 0..1CodeableConceptBilling Code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptService/Product 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..1CodeableConceptDeductible, visits, benefit amount
Benefit Type Codes (Example)
...... allowed[x] 0..1Benefits allowed
....... allowedUnsignedIntunsignedInt
....... allowedStringstring
....... allowedMoneyMoney
...... used[x] 0..1Benefits used
....... usedUnsignedIntunsignedInt
....... usedMoneyMoney
..... authorizationRequired 0..1booleanAuthorization required flag
..... authorizationSupporting 0..*CodeableConceptCodes or text of materials to be submitted
..... authorizationUrl 0..1uriPre-authorization requirements
... preAuthRef 0..1stringPre-Authorization/Determination 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