This resource provides eligibility and plan details from the processing of an Eligibility resource.

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 response as not currently valid.

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

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

The organization which is responsible for the services rendered to the patient.

Original request resource reference.

Transaction status: error, complete.

A description of the status of the adjudication.

The Insurer who produced this adjudicated response.

Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.

The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer.

A suite of updated or additional Coverages from the Insurer.

The contract resource which may provide more detailed information.

Benefits and optionally current balances by Category.

Dental, Vision, Medical, Pharmacy, Rehab etc.

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

True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.

A short name or tag for the benefit, for example MED01, or DENT2.

A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.

Network designation.

Unit designation: individual or family.

The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.

Benefits Used to date.

Deductable, visits, benefit amount.

Benefits allowed.

Benefits used.

A reference from the Insurer to which these services pertain.

To provide any pre-determination or prior authorization reference.

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 boolean flag indicating whether a prior authorization or pre-authorization is required prior to actual service delivery.

Any comments regarding information or actions assciated with the pre-authorization.

The form to be used for printing the content.

Mutually exclusive with Services Provided (Item).

An error code,from a specified code system, which details why the eligibility check could not be performed.