Eligibility Response FHIR Resource Proposal
- 1 EligibilityResponse
- 1.1 Owning committee name
- 1.2 Contributing or Reviewing Work Groups
- 1.3 FHIR Resource Development Project Insight ID
- 1.4 Scope of coverage
- 1.5 RIM scope
- 1.6 Resource appropriateness
- 1.7 Expected implementations
- 1.8 Content sources
- 1.9 Example Scenarios
- 1.10 Resource Relationships
- 1.11 Timelines
- 1.12 gForge Users
Owning committee name
Contributing or Reviewing Work Groups
FHIR Resource Development Project Insight ID
Scope of coverage
Represents more or less granular information verifying whether or not a patient is enrolled in a public health program or private health insurance policy for which premiums are to be or have been paid, and for which types or specific healthcare services are covered. It includes verification of coverage for humans as well as animals.
Observation class with classCode of VERIF and moodCode of EVN.
Eligibility Response is a determination by a public health program or private health insurer, or a designate that a specific insurance policy is in effect on a specific date for a specific individual, which is used to verify a patient’s eligibility for health services. It does not imply that a particular service and/or product will be covered and/or paid if submitted to a public health program or private health insurer.
Referenced by CCDA in situations where coverage has is not yet effective, is effective, or has lapsed.
- v2 IN1, IN2, IN3 segments
- v3 Eligibility and Coverage models
- X12 270, 271, 834, 820
Payor verification of patient’s coverage in response to provider Eligibility query.
Eligibility Response is associated to Eligibility, Coverage, Patients as covered parties, and RelatedPersons or Organizations as policy holders. Eligibility Response is referenced by Claim.
Part of initial DSTU.