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

CoverageEligibilityResponse
identifier
Business Identifier for coverage eligiblity request
status
active | cancelled | draft | entered-in-error
purpose
auth-requirements | benefits | discovery | validation
patient
Intended recipient of products and services
serviced[x]
Estimated date or dates of service
created
Response creation date
requestor
Party responsible for the request
request
Eligibility request reference
outcome
queued | complete | error | partial
disposition
Disposition Message
insurer
Coverage issuer
insurance
Patient insurance information
coverage
Insurance information
inforce
Coverage inforce indicator
benefitPeriod
When the benefits are applicable
item
Benefits and authorization details
category
Benefit classification
productOrService
Billing, service, product, or drug code
modifier
Product or service billing modifiers
provider
Performing practitioner
excluded
Excluded from the plan
name
Short name for the benefit
description
Description of the benefit or services covered
network
In or out of network
unit
Individual or family
term
Annual or lifetime
benefit
Benefit Summary
type
Benefit classification
allowed[x]
Benefits allowed
used[x]
Benefits used
authorizationRequired
Authorization required flag
authorizationSupporting
Type of required supporting materials
authorizationUrl
Preauthorization requirements endpoint
preAuthRef
Preauthorization reference
form
Printed form identifier
error
Processing errors
code
Error code detailing processing issues