NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse TUDomainResourceCoverageEligibilityResponse resource

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for coverage eligiblity request

... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (Required)
... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
Binding: Eligibility Response Purpose (Required)

... patient Σ1..1Reference(Patient)Intended recipient of products and services
... event 0..*BackboneElementEvent information

.... type 1..1CodeableConceptSpecific event
Binding: Dates Type Codes (Example)
.... when[x] 1..1Occurance date or period
..... whenDateTimedateTime
..... whenPeriodPeriod
... serviced[x] 0..1Estimated date or dates of service
.... servicedDatedate
.... servicedPeriodPeriod
... created Σ1..1dateTimeResponse creation date
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the request
... request Σ1..1Reference(CoverageEligibilityRequest)Eligibility request reference
... outcome Σ1..1codequeued | complete | error | partial
Binding: Eligibility Outcome (Required)
... disposition 0..1stringDisposition Message
... insurer Σ1..1Reference(Organization)Coverage issuer
... insurance 0..*BackboneElementPatient insurance information

.... coverage Σ1..1Reference(Coverage)Insurance information
.... inforce 0..1booleanCoverage inforce indicator
.... benefitPeriod 0..1PeriodWhen the benefits are applicable
.... item C0..*BackboneElementBenefits and authorization details
+ Rule: SHALL contain a category or a billcode but not both.

..... category C0..1CodeableConceptBenefit classification
Binding: Benefit Category Codes (Example)
..... productOrService C0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLS Codes (Example)
..... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: 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
Binding: Network Type Codes (Example)
..... unit 0..1CodeableConceptIndividual or family
Binding: Unit Type Codes (Example)
..... term 0..1CodeableConceptAnnual or lifetime
Binding: Benefit Term Codes (Example)
..... benefit 0..*BackboneElementBenefit Summary

...... type 1..1CodeableConceptBenefit classification
Binding: Benefit Type Codes (Example)
...... allowed[x] 0..1Benefits allowed
....... allowedUnsignedIntunsignedInt
....... allowedStringstring
....... allowedMoneyMoney
...... used[x] 0..1Benefits used
....... usedUnsignedIntunsignedInt
....... usedStringstring
....... usedMoneyMoney
..... authorizationRequired 0..1booleanAuthorization required flag
..... authorizationSupporting 0..*CodeableConceptType of required supporting materials
Binding: CoverageEligibilityResponse Auth Support Codes (Example)

..... authorizationUrl 0..1uriPreauthorization requirements endpoint
... preAuthRef 0..1stringPreauthorization reference
... form 0..1CodeableConceptPrinted form identifier
Binding: Form Codes (Example)
... error 0..*BackboneElementProcessing errors

.... code Σ1..1CodeableConceptError code detailing processing issues
Binding: Adjudication Error Codes (Example)
.... expression Σ0..*stringFHIRPath of element(s) related to issue


doco Documentation for this format