This operation is used to submit an eligibility request to a destination (payer, employer, HMO) to determine: (a) whether that entity has a particular subscriber or dependent on file, and (b) the health care eligibility and/or benefit information about that subscriber and/or dependent. The response to the request will be a bundle based on CoverageEligibilityResponse.
Identifies the type of the resource
Indicates the purpose of this bundle - how it is intended to be used.
An array of FHIR resources. At a minimum, a CoverageEligibilityRequest should include the following entries:
itemAdditional resources such as RelatedPerson should be included in scenarios where the Patient is a dependent of the coverage holder.
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Identifies the type of the resource
The internal tracking identifier for this eligibility request. This id will be returned on the CoverageEligibilityResponse.
The status of the resource instance.
Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.
The Patient that you want to run eligibility checks for. This may be different than the policy holder
Must be a resource of type Patient.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
The date when this resource was created.
The payer that the request should be submitted to.
Must be a resource of type Organization.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
Financial instruments for reimbursement for the health care products and services.
The patient's coverage that should be used to make the eligiblity determination.
Must be a resource of type Coverage.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.
A business agreement number established between the provider and the insurer for special business processing purposes.
Identifies the type of the resource
Indicates the purpose of this bundle - how it is intended to be used.
Contains at least one CoverageEligibilityResponse and other resources relevant to the coverage check.
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Identifies the type of the resource
The internal tracking identifier for this eligibility request. This id will be returned on the CoverageEligibilityResponse.
The status of the resource instance.
Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.
The Patient that the elgibility results are being reported for. This may be different than the policy holder
Must be a resource of type Patient.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
The date this resource was created.
The initial CoverageEligibilityRequest.
Must be a resource of type CoverageEligibilityRequest.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
The outcome of the request processing.
The payer that the request should be submitted to.
Must be a resource of type Organization.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
Financial instruments for reimbursement for the health care products and services.
The coverage of the patient.
Must be a resource of type Coverage.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
Benefits and optionally current balances, and authorization details by category or service.