"This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource." - HL7 FHIR, CoverageEligibilityResponse

Attributes
«TS» PointInTime	dateCreated	"The date this resource was created." - HL7 FHIR, CoverageEligibilityResponse.created
«IVL_TS» Period	datesOfService	"The date or dates when the enclosed suite of services were performed or completed." - HL7 FHIR, CoverageEligibilityResponse.serviced[x] Note that in FHIR, the data type of this property can be either a DateTime or a Period. In the FHIM, this is modeled as a Period. If a only a date/time is needed, use Period.start and leave Period.end empty.
String	disposition	"A human readable description of the status of the adjudication." - HL7 FHIR, CoverageEligibilityResponse.disposition
Error	error	"Errors encountered during the processing of the request." - HL7 FHIR, CoverageEligibilityResponse.error
«CS» Code	form	"A code for the form to be used for printing the content." - HL7 FHIR, CoverageEligibilityResponse.form
«II» Id	identifier	"A unique identifier assigned to this coverage eligiblity request." - HL7 FHIR, CoverageEligibilityResponse.identifier
ResponseInsurance	insurance	"Financial instruments for reimbursement for the health care products and services." - HL7 FHIR, CoverageEligibilityResponse.insurance
Organization	insurer	"The Insurer who issued the coverage in question and is the author of the response." - HL7 FHIR, CoverageEligibilityResponse.insurer
«CS» Code	outcome	"The outcome of the request processing." Possible values are: Queued; Processing Complete; Error; Partial Processing. - HL7 FHIR, CoverageEligibilityResponse.outcome
CoveredPatient	patient	"The party who is the beneficiary of the supplied coverage and for whom eligibility is sought." - HL7 FHIR, CoverageEligibilityResponse.patient
String	preAuthRef	"A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred." - HL7 FHIR, CoverageEligibilityResponse.preAuthRef
«CS» Code	purpose	"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 are: Coverage auth-requirements; Coverage benefits; Coverage Discovery; Coverage Validation. - HL7 FHIR, CoverageEligibilityResponse.purpose
CoverageEligibilityRequest	request	"Reference to the original request resource." - HL7 FHIR, CoverageEligibilityResponse.request
HealthcareProvider	requestor	"The provider which is responsible for the request." - HL7 FHIR, CoverageEligibilityResponse.requestor
«CS» Code	status	"The status of the resource instance." Possible values are: Active; Cancelled; Draft; Entered in Error. - HL7 FHIR, CoverageEligibilityResponse.status

 dateCreated

Public «TS» PointInTime dateCreated

"The date this resource was created." - HL7 FHIR, CoverageEligibilityResponse.created

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	dateCreated
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::dateCreated
Stereotype
Template Parameter
Type	«TS» PointInTime
Upper	1
Upper Value	(1)
Visibility	Public

 datesOfService

Public «IVL_TS» Period datesOfService

"The date or dates when the enclosed suite of services were performed or completed." - HL7 FHIR, CoverageEligibilityResponse.serviced[x]
Note that in FHIR, the data type of this property can be either a DateTime or a Period. In the FHIM, this is modeled as a Period. If a only a date/time is needed, use Period.start and leave Period.end empty.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	datesOfService
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::datesOfService
Stereotype
Template Parameter
Type	«IVL_TS» Period
Upper	1
Upper Value	(1)
Visibility	Public

 disposition

Public String disposition

"A human readable description of the status of the adjudication." - HL7 FHIR, CoverageEligibilityResponse.disposition

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	disposition
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::disposition
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 error

Public Error error

"Errors encountered during the processing of the request." - HL7 FHIR, CoverageEligibilityResponse.error

Constraints:

Properties:

Aggregation	None
Alias
Association	coverageEligibilityResponse__error
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	error
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::error
Stereotype
Template Parameter
Type	Error
Upper	*
Upper Value	(*)
Visibility	Public

 form

Public «CS» Code form

"A code for the form to be used for printing the content." - HL7 FHIR, CoverageEligibilityResponse.form

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Terminologies	[ HL7_FHIR_R4 Forms http://hl7.org/fhir/ValueSet/forms ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	form
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::form
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 identifier

Public «II» Id identifier

"A unique identifier assigned to this coverage eligiblity request." - HL7 FHIR, CoverageEligibilityResponse.identifier

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	identifier
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::identifier
Stereotype
Template Parameter
Type	«II» Id
Upper	*
Upper Value	(*)
Visibility	Public

 insurance

Public ResponseInsurance insurance

"Financial instruments for reimbursement for the health care products and services." - HL7 FHIR, CoverageEligibilityResponse.insurance

Constraints:

Properties:

Aggregation	None
Alias
Association	coverageEligibilityResponse_insurance
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	insurance
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::insurance
Stereotype
Template Parameter
Type	ResponseInsurance
Upper	*
Upper Value	(*)
Visibility	Public

 insurer

Public Organization insurer

"The Insurer who issued the coverage in question and is the author of the response." - HL7 FHIR, CoverageEligibilityResponse.insurer

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	insurer
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::insurer
Stereotype
Template Parameter
Type	Organization
Upper	1
Upper Value	(1)
Visibility	Public

 outcome

Public «CS» Code outcome

"The outcome of the request processing." Possible values are: Queued; Processing Complete; Error; Partial Processing. - HL7 FHIR, CoverageEligibilityResponse.outcome

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Terminologies	[ HL7_FHIR_R4 Claim Processing Codes http://hl7.org/fhir/ValueSet/remittance-outcome ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	outcome
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::outcome
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 patient

Public CoveredPatient patient

"The party who is the beneficiary of the supplied coverage and for whom eligibility is sought." - HL7 FHIR, CoverageEligibilityResponse.patient

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	patient
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::patient
Stereotype
Template Parameter
Type	CoveredPatient
Upper	1
Upper Value	(1)
Visibility	Public

 preAuthRef

Public String preAuthRef

"A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred." - HL7 FHIR, CoverageEligibilityResponse.preAuthRef

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	preAuthRef
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::preAuthRef
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 purpose

Public «CS» Code purpose

"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 are: Coverage auth-requirements; Coverage benefits; Coverage Discovery; Coverage Validation. - HL7 FHIR, CoverageEligibilityResponse.purpose

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1..*
Name	purpose
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::purpose
Stereotype
Template Parameter
Type	«CS» Code
Upper	*
Upper Value	(*)
Visibility	Public

 request

Public CoverageEligibilityRequest request

"Reference to the original request resource." - HL7 FHIR, CoverageEligibilityResponse.request

Constraints:

Properties:

Aggregation	None
Alias
Association	coverageEligibilityResponse__request
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	request
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::request
Stereotype
Template Parameter
Type	CoverageEligibilityRequest
Upper	1
Upper Value	(1)
Visibility	Public

 requestor

Public HealthcareProvider requestor

"The provider which is responsible for the request." - HL7 FHIR, CoverageEligibilityResponse.requestor

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	requestor
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::requestor
Stereotype
Template Parameter
Type	HealthcareProvider
Upper	1
Upper Value	(1)
Visibility	Public

 status

Public «CS» Code status

"The status of the resource instance." Possible values are: Active; Cancelled; Draft; Entered in Error. - HL7 FHIR, CoverageEligibilityResponse.status

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CoverageEligibilityResponse
Terminologies	[ HL7_FHIR_R4 Financial Resource Status Codes http://hl7.org/fhir/ValueSet/fm-status ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	status
Name Expression
Namespace	CoverageEligibilityResponse
Opposite
Owner	CoverageEligibilityResponse
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CoverageEligibilityResponse::status
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public