This page is part of the FHIR Specification (v1.6.0:
STU
3 Ballot 4). 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
Detailed Descriptions for the elements in the EligibilityResponse resource.
| EligibilityResponse | |
| Definition |
|
| Control | 1..1 |
| EligibilityResponse.identifier | |
| Definition |
|
| Note |
|
| Control | 0..* |
| Type | Identifier |
| EligibilityResponse.status | |
| Definition | The status of the resource instance. |
| Control | 1..1 |
| Binding | EligibilityResponseStatus: A code specifying the state of the resource instance. ( Required ) |
| Type | code |
| Is Modifier | true |
| Summary | true |
|
|
|
| Definition |
|
| Control | 0..1 |
| Type | Identifier | Reference ( EligibilityRequest ) |
|
|
|
| EligibilityResponse.outcome | |
| Definition |
|
| Control | 0..1 |
| Binding |
|
| Type | code |
| EligibilityResponse.disposition | |
| Definition |
A description of the status of the adjudication. |
| Control |
|
| Type | string |
| EligibilityResponse.ruleset | |
| Definition | The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources. |
| Control | 0..1 |
| Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Example ) |
| Type | Coding |
|
|
|
| Definition |
|
| Control | 0..1 |
| Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. ( Example ) |
| Type | Coding |
| Requirements | Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. |
| EligibilityResponse.created | |
| Definition | The date when the enclosed suite of services were performed or completed. |
| Control | 0..1 |
| Type |
|
| EligibilityResponse.organization[x] | |
| Definition |
The Insurer who produced this adjudicated response. |
| Control |
|
| Type | Identifier | Reference ( Organization ) |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.requestProvider[x] | |
| Definition | The practitioner who is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Identifier | Reference ( Practitioner ) |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
|
|
|
| Definition |
|
| Control | 0..1 |
| Type | Identifier | Reference ( Organization ) |
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.inforce | |
| Definition | Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates. |
| Control | 0..1 |
|
|
|
| EligibilityResponse.contract | |
| Definition | The contract resource which may provide more detailed information. |
| Control | 0..1 |
| Type |
Reference
(
|
| EligibilityResponse.form | |
| Definition | The form to be used for printing the content. |
| Control | 0..1 |
| Binding | Form Codes: The forms codes. ( Required ) |
| Type | Coding |
| EligibilityResponse.benefitBalance | |
| Definition |
Benefits and optionally current balances by Category. |
| Control |
|
|
|
|
| Definition |
|
| Control |
|
| Binding |
|
| Type | Coding |
| EligibilityResponse.benefitBalance.subCategory | |
|
|
|
| Control | 0..1 |
|
|
|
| Type | Coding |
|
|
|
| Definition |
|
| Control | 0..1 |
| Type |
|
| EligibilityResponse.benefitBalance.description | |
| Definition |
A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'. |
| Control |
|
| Type | string |
|
|
|
| Definition |
|
| Control | 0..1 |
| Binding | Network Type Codes: Code to classify in or out of network services ( Example ) |
| Type |
|
| EligibilityResponse.benefitBalance.unit | |
| Definition | Unit designation: individual or family. |
| Control | 0..1 |
| Binding | Unit Type Codes: Unit covered/serviced - individual or family ( Example ) |
|
|
|
|
|
|
| Definition |
|
| Control | 0..1 |
| Binding | Benefit Term Codes: Coverage unit - annual, lifetime ( Example ) |
| Type |
|
| EligibilityResponse.benefitBalance.financial | |
| Definition | Benefits Used to date. |
| Control | 0..* |
| EligibilityResponse.benefitBalance.financial.type | |
| Definition | Deductable, visits, benefit amount. |
| Control | 1..1 |
| Binding | Benefit Type Codes: Deductable, visits, co-pay, etc. ( Example ) |
|
|
|
|
|
|
| Definition |
|
| Control | 0..1 |
| Type |
|
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.benefitBalance.financial.benefitUsed[x] | |
|
|
|
|
Control
|
0..1 |
|
Type
|
unsignedInt
|
|
| [x] Note | See Choice of Data Types for further information about how to use [x] |
| EligibilityResponse.error | |
| Definition | Mutually exclusive with Services Provided (Item). |
|
Control
|
0..* |
| EligibilityResponse.error.code | |
| Definition | An error code,from a specified code system, which details why the eligibility check could not be performed. |
|
Control
|
1..1 |
| Binding | Adjudication Error Codes: The error codes for adjudication processing. ( Required ) |
| Type | Coding |