Release 5

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13.3.8 Resource CoverageEligibilityResponse - Mappings

Financial Management icon Work GroupMaturity Level: N/AStandards Status: InformativeSecurity Category: Patient Compartments: Patient, Practitioner

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

RIM Mapping

Canadian Dental Association eclaims standard

Mappings for the coverageeligibilityresponse resource (see Mappings to Other Standards for further information & status).

13.3.8.1 FiveWs Pattern Mapping (http://hl7.org/fhir/fivews icon)

CoverageEligibilityResponsefinancial.support
    identifierFiveWs.identifier
    statusFiveWs.status
    purposeFiveWs.class
    patientFiveWs.subject[x]
    serviced[x]FiveWs.done[x]
    createdFiveWs.recorded
    requestorFiveWs.source
    requestFiveWs.why[x]
            providerFiveWs.source

13.3.8.2 Workflow Pattern (http://hl7.org/fhir/workflow icon)

CoverageEligibilityResponseEvent
    identifierEvent.identifier
    statusEvent.status
    patientEvent.subject
    requestEvent.basedOn
    dispositionEvent.note

13.3.8.3 RIM Mapping (http://hl7.org/v3 icon)

CoverageEligibilityResponse
    preAuthRef23

13.3.8.4 Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/ icon)

CoverageEligibilityResponse
    identifier
    status
    purpose
    patientC06,C07,C08, C05, C04
    event
        type
        when[x]
    serviced[x]F09
    created
    requestorB01
    requestA02|G01
    outcome
    disposition
    insurer
    insurance
        coverage
        inforce
        benefitPeriod
        item
            category
            productOrService
            modifier
            providerB01
            excluded
            name
            description
            network
            unit
            term
            benefit
                type
                allowed[x]
                used[x]
            authorizationRequired
            authorizationSupporting
            authorizationUrl
    preAuthRefF03
    formG42
    error
        code
        expression