The EligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an EligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.

The Response business identifier.

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the request as not currently valid.

Immediate (STAT), best effort (NORMAL), deferred (DEFER).

Patient Resource.

1..1.

The date or dates when the enclosed suite of services were performed or completed.

The date when this resource was created.

Person who created the invoice/claim/pre-determination or pre-authorization.

The practitioner who is responsible for the services rendered to the patient.

The Insurer who is target of the request.

Facility where the services were provided.

Financial instrument by which payment information for health care.

Need to identify the issuer to target for processing and for coordination of benefit processing.

1..1.

The contract number of a business agreement which describes the terms and conditions.

Dental, Vision, Medical, Pharmacy, Rehab etc.

Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.

A list of billable services for which an authorization prior to service delivery may be required by the payor.

Sequence of procedures which serves to order and provide a link.

A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).

Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.

The number of repetitions of a service or product.

The fee for an addittional service or product or charge.

Facility where the services were provided.

List of patient diagnosis for which care is sought.

The diagnosis.

Required to adjudicate services rendered to condition presented.