This page is part of the FHIR Specification (v0.0.82: DSTU 1). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R3 R2 Content Examples Detailed Descriptions Mappings Profiles 7.5 Resource EligibilityResponse - Content This resource maintained by the Financial Management Work Group This resource provides eligibility and plan details from the processing of an Eligibility resource. 7.5.1 Scope and Usage 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 7.5.2 Resource Content Structure UML XML JSON All Structure Name Flags Card. Type Description & Constraints EligibilityResponse DomainResource EligibilityResponse resource identifier 0..* Identifier Business Identifier request 0..1 EligibilityRequest Claim reference outcome 0..1 code complete | error RemittanceOutcome ( Required ) disposition 0..1 string Disposition Message ruleset 0..1 Coding Resource version Ruleset ( Example ) originalRuleset 0..1 Coding Original version Ruleset ( Example ) created 0..1 dateTime Creation date organization 0..1 Organization Insurer requestProvider 0..1 Practitioner Responsible practitioner requestOrganization 0..1 Organization Responsible organization UML Diagram EligibilityResponse ( DomainResource ) The Response Business Identifier identifier : Identifier 0..* Original request resource reference request : Reference ( EligibilityRequest ) 0..1 Transaction status: error, complete outcome : code 0..1 « The outcome of the processing. RemittanceOutcome » A description of the status of the adjudication disposition : string 0..1 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 « ( The static and dynamic model to which contents conform, may be business version or standard and version. Ruleset ) » The style (standard) and version of the original material which was converted into this resource originalRuleset : Coding 0..1 « ( The static and dynamic model to which contents conform, may be business version or standard and version. Ruleset ) » The date when the enclosed suite of services were performed or completed created : dateTime 0..1 The Insurer who produced this adjudicated response organization : Reference ( Organization ) 0..1 The practitioner who is responsible for the services rendered to the patient requestProvider : Reference ( Practitioner ) 0..1 The organization which is responsible for the services rendered to the patient requestOrganization : Reference ( Organization ) 0..1 XML Template < <!-- from --> <!-- from --> <</identifier> <</request> < < <</ruleset> <</originalRuleset> < <</organization> <</requestProvider> <</requestOrganization> </EligibilityResponse> JSON Template { "resourceType" : "", // from // from " " " " " " " " " " } Structure Name Flags Card. Type Description & Constraints EligibilityResponse DomainResource EligibilityResponse resource identifier 0..* Identifier Business Identifier request 0..1 EligibilityRequest Claim reference outcome 0..1 code complete | error RemittanceOutcome ( Required ) disposition 0..1 string Disposition Message ruleset 0..1 Coding Resource version Ruleset ( Example ) originalRuleset 0..1 Coding Original version Ruleset ( Example ) created 0..1 dateTime Creation date organization 0..1 Organization Insurer requestProvider 0..1 Practitioner Responsible practitioner requestOrganization 0..1 Organization Responsible organization UML Diagram EligibilityResponse ( DomainResource ) The Response Business Identifier identifier : Identifier 0..* Original request resource reference request : Reference ( EligibilityRequest ) 0..1 Transaction status: error, complete outcome : code 0..1 « The outcome of the processing. RemittanceOutcome » A description of the status of the adjudication disposition : string 0..1 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 « ( The static and dynamic model to which contents conform, may be business version or standard and version. Ruleset ) » The style (standard) and version of the original material which was converted into this resource originalRuleset : Coding 0..1 « ( The static and dynamic model to which contents conform, may be business version or standard and version. Ruleset ) » The date when the enclosed suite of services were performed or completed created : dateTime 0..1 The Insurer who produced this adjudicated response organization : Reference ( Organization ) 0..1 The practitioner who is responsible for the services rendered to the patient requestProvider : Reference ( Practitioner ) 0..1 The organization which is responsible for the services rendered to the patient requestOrganization : Reference ( Organization ) 0..1 XML Template < <!-- from --> <!-- from --> <</identifier> <</request> < < <</ruleset> <</originalRuleset> < <</organization> <</requestProvider> <</requestOrganization> </EligibilityResponse> JSON Template { "resourceType" : "", // from // from " " " " " " " " " " }   Alternate definitions: Schema / Schematron , Resource Profile ( XML , JSON ), Questionnaire 7.5.2.1 Terminology Bindings Path Definition Type Reference EligibilityResponse.outcome The outcome of the processing. Required http://hl7.org/fhir/RS-link EligibilityResponse.ruleset EligibilityResponse.originalRuleset The static and dynamic model to which contents conform, may be business version or standard and version. Example http://hl7.org/fhir/vs/ruleset 7.5.3 Search Parameters Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services. Name Type Description Paths identifier token The business identifier of the Explanation of Benefit EligibilityResponse.identifier © HL7.org 2011+. FHIR DSTU (v0.4.0-4902) generated on Fri, Mar 27, 2015 00:19+1100. 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