CoverageEligibilityResponse | Medplum

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

Elements

Name Required Type Description
identifier Identifier[] Business Identifier for coverage eligibility request. A unique identifier assigned to this coverage eligibility request.
status ✓ code active
purpose ✓ code[] auth-requirements
patient ✓ Reference< Patient > Intended recipient of products and services. The party who is the beneficiary of the supplied coverage for whom eligibility is sought.
serviced[x] date, Period Estimated date or dates of service. The date when the enclosed services were performed or completed.
created ✓ dateTime Response creation date. The date this resource was created.
requestor Reference< Practitioner PractitionerRole
request ✓ Reference< CoverageEligibilityRequest > Eligibility request reference. Reference to the original request resource.
outcome ✓ code queued
disposition string Disposition Message. Human-readable description of the status of the adjudication.
insurer ✓ Reference< Organization > Coverage issuer. The Insurer who issued the coverage and is the author of the response.
insurance CoverageEligibilityResponseInsurance[] Patient insurance information. Financial instruments for reimbursement for the health care products and services.
id string Unique id for inter-element referencing. This may be any string value that does not contain spaces.
extension Extension[] Additional content defined by implementations. May be used to represent additional information that is not part of the basic definition.
modifierExtension Extension[] Extensions that cannot be ignored. May represent additional information modifying understanding of the element.
coverage ✓ Reference< Coverage > Insurance information. Reference to the insurance card level information.
inforce boolean Coverage inforce indicator. Flag indicating if the coverage is in-force.
benefitPeriod Period When the benefits are applicable. The term of the benefits documented in this response.
item CoverageEligibilityResponseInsuranceItem[] Benefits and authorization details. Benefits, balances, and authorization details by category or service.

Search Parameters

Name Type Description Expression
created date The creation date CoverageEligibilityResponse.created
disposition string The contents of the disposition message CoverageEligibilityResponse.disposition
identifier token The business identifier CoverageEligibilityResponse.identifier
insurer reference The organization which generated this resource CoverageEligibilityResponse.insurer
outcome token The processing outcome CoverageEligibilityResponse.outcome
patient reference The reference to the patient CoverageEligibilityResponse.patient
request reference The EligibilityRequest reference CoverageEligibilityResponse.request
requestor reference The EligibilityRequest provider CoverageEligibilityResponse.requestor
status token The EligibilityRequest status CoverageEligibilityResponse.status

Inherited Elements

Name Required Type Description
id string Logical id of this artifact. The logical id of the resource.
meta Meta Metadata about the resource. Content that is maintained by the infrastructure.
implicitRules uri A set of rules under which this content was created. Reference to rules that must be understood when processing the content.
language code Language of the resource content. Base language for resource written content.
text Narrative Text summary of the resource. A human-readable narrative summarizing the resource.
contained Resource[] Contained, inline Resources. Resources that do not have an independent existence apart from the resource containing them.
extension Extension[] Additional content defined by implementations. May represent additional information.
modifierExtension Extension[] Extensions that cannot be ignored. May represent additional information that modifies understanding of the element that contains it.