Release 5 R6 Ballot (3rd Draft)
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Example CoverageEligibilityResponse/E2503 (XML)

Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Patient , Practitioner

Raw XML ( canonical form + also see XML Format Specification )

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General Person Primary Coverage with error (id = "E2503") 

<?xml version="1.0" encoding="UTF-8"?>

<CoverageEligibilityResponse xmlns="http://hl7.org/fhir">
  <id value="E2503"/> 
  <text> 
    
    

    <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityResponse.</div> 
  </text> 
  <identifier> 
    <system value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"/> 
    <value value="8812343"/> 
  </identifier> 
  <status value="active"/> 
  <purpose value="validation"/> 
  <patient> 
    <reference value="Patient/f201"/> 
  </patient> 
  <created value="2014-09-16"/> 
  <requestor> 
    <identifier> 
      <system value="http://national.org/clinic"/> 
      <value value="OR1234"/> 
       

    </identifier> 
  </requestor> 
  <request> 
    <reference value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332406"/> 
  </request> 
  <outcome value="error"/> 
  

  <disposition value="Eligibiliy request could not be processed, please address errors before submitting."/> 
  <insurer> 
    <reference value="Organization/2"/> 
  </insurer> 
  <form> 
    <coding> 
      <system value="http://national.org/form"/> 
      <code value="ELRSP/2017/01"/> 
    </coding> 
  </form> 
  <error> 
    <code> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/> 
        <code value="a001"/> 
      </coding> 
    </code> 
  </error> 


</

CoverageEligibilityResponse

>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.