DSTU2 STU 3 Candidate
This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . For a full list of available versions, see the Directory of published versions . Page versions: . Page versions: R3 R2

7.5 Resource EligibilityResponse - Content Resource EligibilityResponse - Content This resource is marked as a draft

This resource is marked as a draft .

This resource provides eligibility and plan details from the processing of an Eligibility resource.
Financial Management Financial Management Work Group Work Group Maturity Level : 0 Maturity Level : 0 Compartments : Not linked to any defined compartments : Not linked to any defined compartments

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

7.5.1 Scope and Usage Scope and Usage

This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft. This resource has not yet undergone proper review by FM. At this time, it is to be considered as a draft. The EligibilityResponse resource provides eligibility and plan details from the processing of an Eligibility resource. It combines key information from a payor as to whether a Coverage is in-force, and optionally the nature of the Policy details. Todo

The EligibilityResponse resource provides eligibility and plan details from the processing of an Eligibility resource. It combines key information from a payor as to whether a Coverage is in-force, and optionally the nature of the Policy details.

Todo

7.5.2 Resource Content Resource Content

Structure

Claim reference Insurer
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EligibilityResponse Σ DomainResource EligibilityResponse resource EligibilityResponse resource
. . . identifier Σ 0..* Identifier Business Identifier Business Identifier
. . request . request[x] Σ 0..1 Claim reference
.... requestIdentifier Identifier
.... requestReference Reference ( EligibilityRequest )
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . organization . organization[x] Σ 0..1 Insurer
.... organizationIdentifier Identifier
.... organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] Σ 0..1 Responsible practitioner
.... requestProviderIdentifier Identifier
.... requestProviderReference Reference ( Practitioner )
. . . requestOrganization[x] Responsible practitioner Σ 0..1 Responsible organization
.... requestOrganizationIdentifier Identifier
. . . requestOrganization . requestOrganizationReference Reference ( Organization )
. . . inforce Σ 0..1 boolean Coverage inforce
... contract Σ 0..1 Reference ( Organization Contract ) Responsible organization Contract details
. . . form Σ 0..1 Coding Printed Form Identifier
Form Codes ( Required )
... benefitBalance Σ 0..* BackboneElement Benefits by Category
.... category Σ 1..1 Coding Benefit Category
Benefit Category Codes ( Example )
.... subCategory Σ 0..1 Coding Benefit SubCategory
Benefit SubCategory Codes ( Example )
.... network Σ 0..1 Coding In or out of network
Network Type Codes ( Example )
.... unit Σ 0..1 Coding Individual or family
Unit Type Codes ( Example )
.... term Σ 0..1 Coding Annual or lifetime
Benefit Term Codes ( Example )
.... financial Σ 0..* BackboneElement Benefit Summary
..... type Σ 1..1 Coding Deductable, visits, benefit amount
Benefit Type Codes ( Example )
..... benefit[x] Σ 0..1 Benefits allowed
...... benefitUnsignedInt unsignedInt
...... benefitQuantity Money
..... benefitUsed[x] Σ 0..1 Benefits used
...... benefitUsedUnsignedInt unsignedInt
...... benefitUsedQuantity Money
... error Σ 0..* BackboneElement Processing errors
.... code Σ 1..1 Coding Error code detailing processing issues
Adjudication Error Codes ( Required )

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

EligibilityResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference Original request resource reference request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( EligibilityRequest » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates inforce : boolean [0..1] The contract resource which may provide more detailed information contract : Reference [0..1] « Contract » The form to be used for printing the content form : Coding [0..1] « The forms codes. (Strength=Required) Form ! » Benefits Dental, Vision, Medical, Pharmacy, Rehab etc category : Coding [1..1] « Benefit categories such as: oral, medical, vision etc. (Strength=Example) Benefit Category ?? » Dental: basic, major, ortho; Vision exam, glasses, contacts; etc subCategory : Coding [0..1] « Benefit subcategories such as: oral-basic, major, glasses (Strength=Example) Benefit SubCategory ?? » Network designation network : Coding [0..1] « Code to classify in or out of network services (Strength=Example) Network Type ?? » Unit designation: individual or family unit : Coding [0..1] « Unit covered/serviced - individual or family (Strength=Example) Unit Type ?? » The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis' term : Coding [0..1] « Coverage unit - annual, lifetime (Strength=Example) Benefit Term ?? » Benefit Deductable, visits, benefit amount type : Coding [1..1] « Deductable, visits, co-pay, etc. (Strength=Example) Benefit Type ?? » Benefits allowed benefit[x] : Type [0..1] « unsignedInt | Quantity ( Money ) » Benefits used benefitUsed[x] : Type [0..1] « unsignedInt | Quantity ( Money ) » Errors An error code,from a specified code system, which details why the eligibility check could not be performed code : Coding [1..1] « The error codes for adjudication processing. (Strength=Required) Adjudication Error ! » Benefits Used to date financial [0..*] Benefits and optionally current balances by Category benefitBalance [0..*]

XML Template XML Template 

<EligibilityResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <</request>

 <request[x]><!-- 0..1 Identifier|Reference(EligibilityRequest) Claim reference --></request[x]>

 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <inforce value="[boolean]"/><!-- 0..1 Coverage inforce -->
 <contract><!-- 0..1 Reference(Contract) Contract details --></contract>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <benefitBalance>  <!-- 0..* Benefits by Category -->
  <category><!-- 1..1 Coding Benefit Category --></category>
  <subCategory><!-- 0..1 Coding Benefit SubCategory --></subCategory>
  <network><!-- 0..1 Coding In or out of network --></network>
  <unit><!-- 0..1 Coding Individual or family --></unit>
  <term><!-- 0..1 Coding Annual or lifetime --></term>
  <financial>  <!-- 0..* Benefit Summary -->
   <type><!-- 1..1 Coding Deductable, visits, benefit amount --></type>
   <benefit[x]><!-- 0..1 unsignedInt|Quantity(Money) Benefits allowed --></benefit[x]>
   <benefitUsed[x]><!-- 0..1 unsignedInt|Quantity(Money) Benefits used --></benefitUsed[x]>
  </financial>
 </benefitBalance>
 <error>  <!-- 0..* Processing errors -->
  <code><!-- 1..1 Coding Error code detailing processing issues --></code>
 </error>

</EligibilityResponse>

JSON Template JSON Template 

{doco
  "resourceType" : "EligibilityResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "

  // request[x]: Claim reference. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(EligibilityRequest) },

  "outcome" : "<code>", // complete | error
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "
  "
  "

  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "inforce" : <boolean>, // Coverage inforce
  "contract" : { Reference(Contract) }, // Contract details
  "form" : { Coding }, // Printed Form Identifier
  "benefitBalance" : [{ // Benefits by Category
    "category" : { Coding }, // R!  Benefit Category
    "subCategory" : { Coding }, // Benefit SubCategory
    "network" : { Coding }, // In or out of network
    "unit" : { Coding }, // Individual or family
    "term" : { Coding }, // Annual or lifetime
    "financial" : [{ // Benefit Summary
      "type" : { Coding }, // R!  Deductable, visits, benefit amount
      // benefit[x]: Benefits allowed. One of these 2:

      "benefitUnsignedInt" : "<unsignedInt>",
      "benefitQuantity" : { Quantity(Money) },
      // benefitUsed[x]: Benefits used. One of these 2:

      "benefitUsedUnsignedInt" : "<unsignedInt>"
      "benefitUsedQuantity" : { Quantity(Money) }
    }]
  }],
  "error" : [{ // Processing errors
    "code" : { Coding } // R!  Error code detailing processing issues
  }]

}

Structure

Claim reference Insurer
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . EligibilityResponse Σ DomainResource EligibilityResponse resource EligibilityResponse resource
. . . identifier Σ 0..* Identifier Business Identifier Business Identifier
. . request . request[x] Σ 0..1 Claim reference
.... requestIdentifier Identifier
.... requestReference Reference ( EligibilityRequest )
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . organization . organization[x] Σ 0..1 Insurer
.... organizationIdentifier Identifier
.... organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] Σ 0..1 Responsible practitioner
.... requestProviderIdentifier Identifier
.... requestProviderReference Reference ( Practitioner )
. . . requestOrganization[x] Responsible practitioner Σ 0..1 Responsible organization
.... requestOrganizationIdentifier Identifier
. . . requestOrganization . requestOrganizationReference Reference ( Organization )
. . . inforce Σ 0..1 boolean Coverage inforce
... contract Σ 0..1 Reference ( Organization Contract ) Responsible organization Contract details
. . . form Σ 0..1 Coding Printed Form Identifier
Form Codes ( Required )
... benefitBalance Σ 0..* BackboneElement Benefits by Category
.... category Σ 1..1 Coding Benefit Category
Benefit Category Codes ( Example )
.... subCategory Σ 0..1 Coding Benefit SubCategory
Benefit SubCategory Codes ( Example )
.... network Σ 0..1 Coding In or out of network
Network Type Codes ( Example )
.... unit Σ 0..1 Coding Individual or family
Unit Type Codes ( Example )
.... term Σ 0..1 Coding Annual or lifetime
Benefit Term Codes ( Example )
.... financial Σ 0..* BackboneElement Benefit Summary
..... type Σ 1..1 Coding Deductable, visits, benefit amount
Benefit Type Codes ( Example )
..... benefit[x] Σ 0..1 Benefits allowed
...... benefitUnsignedInt unsignedInt
...... benefitQuantity Money
..... benefitUsed[x] Σ 0..1 Benefits used
...... benefitUsedUnsignedInt unsignedInt
...... benefitUsedQuantity Money
... error Σ 0..* BackboneElement Processing errors
.... code Σ 1..1 Coding Error code detailing processing issues
Adjudication Error Codes ( Required )

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

EligibilityResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference Original request resource reference request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( EligibilityRequest » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates inforce : boolean [0..1] The contract resource which may provide more detailed information contract : Reference [0..1] « Contract » The form to be used for printing the content form : Coding [0..1] « The forms codes. (Strength=Required) Form ! » Benefits Dental, Vision, Medical, Pharmacy, Rehab etc category : Coding [1..1] « Benefit categories such as: oral, medical, vision etc. (Strength=Example) Benefit Category ?? » Dental: basic, major, ortho; Vision exam, glasses, contacts; etc subCategory : Coding [0..1] « Benefit subcategories such as: oral-basic, major, glasses (Strength=Example) Benefit SubCategory ?? » Network designation network : Coding [0..1] « Code to classify in or out of network services (Strength=Example) Network Type ?? » Unit designation: individual or family unit : Coding [0..1] « Unit covered/serviced - individual or family (Strength=Example) Unit Type ?? » The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis' term : Coding [0..1] « Coverage unit - annual, lifetime (Strength=Example) Benefit Term ?? » Benefit Deductable, visits, benefit amount type : Coding [1..1] « Deductable, visits, co-pay, etc. (Strength=Example) Benefit Type ?? » Benefits allowed benefit[x] : Type [0..1] « unsignedInt | Quantity ( Money ) » Benefits used benefitUsed[x] : Type [0..1] « unsignedInt | Quantity ( Money ) » Errors An error code,from a specified code system, which details why the eligibility check could not be performed code : Coding [1..1] « The error codes for adjudication processing. (Strength=Required) Adjudication Error ! » Benefits Used to date financial [0..*] Benefits and optionally current balances by Category benefitBalance [0..*]

XML Template XML Template 

<EligibilityResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <</request>

 <request[x]><!-- 0..1 Identifier|Reference(EligibilityRequest) Claim reference --></request[x]>

 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <inforce value="[boolean]"/><!-- 0..1 Coverage inforce -->
 <contract><!-- 0..1 Reference(Contract) Contract details --></contract>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <benefitBalance>  <!-- 0..* Benefits by Category -->
  <category><!-- 1..1 Coding Benefit Category --></category>
  <subCategory><!-- 0..1 Coding Benefit SubCategory --></subCategory>
  <network><!-- 0..1 Coding In or out of network --></network>
  <unit><!-- 0..1 Coding Individual or family --></unit>
  <term><!-- 0..1 Coding Annual or lifetime --></term>
  <financial>  <!-- 0..* Benefit Summary -->
   <type><!-- 1..1 Coding Deductable, visits, benefit amount --></type>
   <benefit[x]><!-- 0..1 unsignedInt|Quantity(Money) Benefits allowed --></benefit[x]>
   <benefitUsed[x]><!-- 0..1 unsignedInt|Quantity(Money) Benefits used --></benefitUsed[x]>
  </financial>
 </benefitBalance>
 <error>  <!-- 0..* Processing errors -->
  <code><!-- 1..1 Coding Error code detailing processing issues --></code>
 </error>

</EligibilityResponse>

JSON Template JSON Template 

{doco
  "resourceType" : "EligibilityResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "

  // request[x]: Claim reference. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(EligibilityRequest) },

  "outcome" : "<code>", // complete | error
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "
  "
  "

  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "inforce" : <boolean>, // Coverage inforce
  "contract" : { Reference(Contract) }, // Contract details
  "form" : { Coding }, // Printed Form Identifier
  "benefitBalance" : [{ // Benefits by Category
    "category" : { Coding }, // R!  Benefit Category
    "subCategory" : { Coding }, // Benefit SubCategory
    "network" : { Coding }, // In or out of network
    "unit" : { Coding }, // Individual or family
    "term" : { Coding }, // Annual or lifetime
    "financial" : [{ // Benefit Summary
      "type" : { Coding }, // R!  Deductable, visits, benefit amount
      // benefit[x]: Benefits allowed. One of these 2:

      "benefitUnsignedInt" : "<unsignedInt>",
      "benefitQuantity" : { Quantity(Money) },
      // benefitUsed[x]: Benefits used. One of these 2:

      "benefitUsedUnsignedInt" : "<unsignedInt>"
      "benefitUsedQuantity" : { Quantity(Money) }
    }]
  }],
  "error" : [{ // Processing errors
    "code" : { Coding } // R!  Error code detailing processing issues
  }]

}

  Alternate definitions:

Alternate definitions: Schema / Schematron , Resource Profile ( , Resource Profile ( XML , , JSON ), ), Questionnaire

7.5.2.1 Terminology Bindings Terminology Bindings

Path Definition Type Reference
EligibilityResponse.outcome EligibilityResponse.outcome The outcome of the processing. The outcome of the processing. Required RemittanceOutcome
EligibilityResponse.ruleset
EligibilityResponse.originalRuleset EligibilityResponse.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard/version. The static and dynamic model to which contents conform, which may be business version or standard/version. Example Ruleset Codes Ruleset Codes
EligibilityResponse.form The forms codes. Required Form Codes
EligibilityResponse.benefitBalance.category Benefit categories such as: oral, medical, vision etc. Example Benefit Category Codes
EligibilityResponse.benefitBalance.subCategory Benefit subcategories such as: oral-basic, major, glasses Example Benefit SubCategory Codes
EligibilityResponse.benefitBalance.network Code to classify in or out of network services Example Network Type Codes
EligibilityResponse.benefitBalance.unit Unit covered/serviced - individual or family Example Unit Type Codes
EligibilityResponse.benefitBalance.term Coverage unit - annual, lifetime Example Benefit Term Codes
EligibilityResponse.benefitBalance.financial.type Deductable, visits, co-pay, etc. Example Benefit Type Codes
EligibilityResponse.error.code The error codes for adjudication processing. Required Adjudication Error Codes

7.5.3 Search Parameters Search Parameters Search parameters for this resource. The common parameters also apply. See

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services. for more information about searching in REST, messaging, and services.

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100.
Name Type Description Paths
created date The creation date EligibilityResponse.created
disposition string The contents of the disposition message EligibilityResponse.disposition
identifier token The business identifier of the Explanation of Benefit The business identifier EligibilityResponse.identifier
organizationidentifier token The organization which generated this resource EligibilityResponse.organizationIdentifier
organizationreference reference The organization which generated this resource EligibilityResponse.organizationReference
Links: Search ( Organization )
outcome token | Version History The processing outcome EligibilityResponse.outcome
requestidentifier token | Table of Contents The EligibilityRequest reference EligibilityResponse.requestIdentifier
requestorganizationidentifier token | Compare to DSTU1 The EligibilityRequest organization EligibilityResponse.requestOrganizationIdentifier
requestorganizationreference reference | The EligibilityRequest organization EligibilityResponse.requestOrganizationReference
( Organization | Propose a change )
requestprovideridentifier token The EligibilityRequest provider EligibilityResponse.requestProviderIdentifier
requestproviderreference reference The EligibilityRequest provider EligibilityResponse.requestProviderReference
( Practitioner try { var currentTabIndex = sessionStorage.getItem('fhir-resource-tab-index'); } catch(exception){ } if (!currentTabIndex) currentTabIndex = '0'; $( '#tabs' ).tabs({ active: currentTabIndex, activate: function( event, ui ) { var active = $('.selector').tabs('option', 'active'); currentTabIndex = ui.newTab.index(); document.activeElement.blur(); try { sessionStorage.setItem('fhir-resource-tab-index', currentTabIndex); } catch(exception){ } } });
requestreference reference The EligibilityRequest reference EligibilityResponse.requestReference
( EligibilityRequest )