CoverageEligibilityResponse $respond

Response to the CoverageEligiblityRequest/$submit operation. Contains information about whether the Patient is eligible for the requested services, and additional information about their benefits.

Request Fields and Example
resourceType
required, string

Identifies the type of the resource

Value: Bundle
type
required, string

Indicates the purpose of this bundle - how it is intended to be used.

Value: collection
entry
required, [CoverageEligibilityResponse, Patient, Coverage, Location, Practitioner, RelatedPerson, Other]

Contains at least one CoverageEligibilityResponse and other resources relevant to the coverage check.

Any of:
resource
required, object

The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.

resourceType
required, string

Identifies the type of the resource

Value: CoverageEligibilityResponse
id
required, string

The internal tracking identifier for this eligibility request. This id will be returned on the CoverageEligibilityResponse.

status
required, string

The status of the resource instance.

Possible Values: active, cancelled, draft, entered-in-error
purpose
required, [string]

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.

Possible Values: auth-requirements, benefits, discovery, validation
patient
required, object

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.

reference
string

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.

created
required, string

The date this resource was created.

request
required, object

The initial CoverageEligibilityRequest.

Must be a resource of type CoverageEligibilityRequest.

reference
string

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.

outcome
required, string

The outcome of the request processing.

Possible Values: queued, complete, error, partial
insurer
required, object

The payer that the request should be submitted to.

Must be a resource of type Organization.

reference
string

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.

insurance
required, [object]

Financial instruments for reimbursement for the health care products and services.

coverage
required, object

The coverage of the patient.

Must be a resource of type Coverage.

reference
string

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.

item
[object]

Benefits and optionally current balances, and authorization details by category or service.

post/CoverageEligibilityResponse/$respond
Example Eligibility Response
Response Fields and Example
resourceType
required, string

Identifies the type of the resource

Value: Bundle
type
required, string

Indicates the purpose of this bundle - how it is intended to be used.

Value: collection
entry
required, [CoverageEligibilityResponse, Patient, Coverage, Location, Practitioner, RelatedPerson, Other]

Contains at least one CoverageEligibilityResponse and other resources relevant to the coverage check.

Any of:
resource
required, object

The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.

resourceType
required, string

Identifies the type of the resource

Value: CoverageEligibilityResponse
id
required, string

The internal tracking identifier for this eligibility request. This id will be returned on the CoverageEligibilityResponse.

status
required, string

The status of the resource instance.

Possible Values: active, cancelled, draft, entered-in-error
purpose
required, [string]

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.

Possible Values: auth-requirements, benefits, discovery, validation
patient
required, object

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.

reference
string

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.

created
required, string

The date this resource was created.

request
required, object

The initial CoverageEligibilityRequest.

Must be a resource of type CoverageEligibilityRequest.

reference
string

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.

outcome
required, string

The outcome of the request processing.

Possible Values: queued, complete, error, partial
insurer
required, object

The payer that the request should be submitted to.

Must be a resource of type Organization.

reference
string

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.

insurance
required, [object]

Financial instruments for reimbursement for the health care products and services.

coverage
required, object

The coverage of the patient.

Must be a resource of type Coverage.

reference
string

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.

item
[object]

Benefits and optionally current balances, and authorization details by category or service.

Example Eligibility Response