Data Model Libraries
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    CoverageEligibilityResponse Class

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

    FHIR Specification

    • Short: CoverageEligibilityResponse resource
    • Definition: This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
    • FHIR Version: 5.0.0

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    Methods

    parse getIdentifier setIdentifier addIdentifier hasIdentifier getStatusEnumType setStatusEnumType hasStatusEnumType getStatusElement setStatusElement hasStatusElement getStatus setStatus hasStatus getPurposeEnumType setPurposeEnumType addPurposeEnumType hasPurposeEnumType getPurposeElement setPurposeElement addPurposeElement hasPurposeElement getPurpose setPurpose addPurpose hasPurpose getPatient setPatient hasPatient getEvent setEvent addEvent hasEvent getServiced setServiced hasServiced getServicedDateType hasServicedDateType getServicedPeriod hasServicedPeriod getCreatedElement setCreatedElement hasCreatedElement getCreated setCreated hasCreated getRequestor setRequestor hasRequestor getRequest setRequest hasRequest getOutcomeEnumType setOutcomeEnumType hasOutcomeEnumType getOutcomeElement setOutcomeElement hasOutcomeElement getOutcome setOutcome hasOutcome getDispositionElement setDispositionElement hasDispositionElement getDisposition setDisposition hasDisposition getInsurer setInsurer hasInsurer getInsurance setInsurance addInsurance hasInsurance getPreAuthRefElement setPreAuthRefElement hasPreAuthRefElement getPreAuthRef setPreAuthRef hasPreAuthRef getForm setForm hasForm getError setError addError hasError fhirType isEmpty isRequiredFieldsEmpty copy toJSON getText setText hasText getContained setContained addContained hasContained getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension resourceType getIdElement setIdElement hasIdElement getId setId hasId getMeta setMeta hasMeta getImplicitRulesElement setImplicitRulesElement hasImplicitRulesElement getImplicitRules setImplicitRules hasImplicitRules getLanguageElement setLanguageElement hasLanguageElement getLanguage setLanguage hasLanguage isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initIdentifier initPurpose initEvent initInsurance initError

    Constructors

    Properties

    identifier?: Identifier[]

    CoverageEligibilityResponse.identifier Element

    FHIR Specification

    • Short: Business Identifier for coverage eligiblity request
    • Definition: A unique identifier assigned to this coverage eligiblity request.
    • Requirements: Allows coverage eligibility requests to be distinguished and referenced.
    • FHIR Type: Identifier
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    fmStatusEnum: FmStatusEnum

    FHIR CodeSystem: FmStatus

    status: null | EnumCodeType

    CoverageEligibilityResponse.status Element

    FHIR Specification

    • Short: active | cancelled | draft | entered-in-error
    • Definition: The status of the resource instance.
    • Comment: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
    • Requirements: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: true
    • isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    • isSummary: true

    CodeSystem Enumeration: FmStatusEnum

    eligibilityresponsePurposeEnum: EligibilityresponsePurposeEnum

    FHIR CodeSystem: EligibilityresponsePurpose

    purpose: null | EnumCodeType[]

    CoverageEligibilityResponse.purpose Element

    FHIR Specification

    • Short: auth-requirements | benefits | discovery | validation
    • Definition: 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.
    • Requirements: To indicate the processing actions requested.
    • FHIR Type: code
    • Cardinality: 1..*
    • isModifier: false
    • isSummary: true

    CodeSystem Enumeration: EligibilityresponsePurposeEnum

    patient: null | Reference

    CoverageEligibilityResponse.patient Element

    FHIR Specification

    • Short: Intended recipient of products and services
    • Definition: The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
    • Requirements: Required to provide context and coverage validation.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true

    CoverageEligibilityResponse.event Element

    FHIR Specification

    • Short: Event information
    • Definition: Information code for an event with a corresponding date or period.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    serviced?: IDataType

    CoverageEligibilityResponse.serviced[x] Element

    @ChoiceDataTypesMeta('CoverageEligibilityResponse.serviced[x]', ['date','Period',]

    FHIR Specification

    • Short: Estimated date or dates of service
    • Definition: The date or dates when the enclosed suite of services were performed or completed.
    • Requirements: Required to provide time context for the request.
    • FHIR Types: 'date', 'Period',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    created: null | DateTimeType

    CoverageEligibilityResponse.created Element

    FHIR Specification

    • Short: Response creation date
    • Definition: The date this resource was created.
    • Requirements: Need to record a timestamp for use by both the recipient and the issuer.
    • FHIR Type: dateTime
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    requestor?: Reference

    CoverageEligibilityResponse.requestor Element

    FHIR Specification

    request: null | Reference

    CoverageEligibilityResponse.request Element

    FHIR Specification

    eligibilityOutcomeEnum: EligibilityOutcomeEnum

    FHIR CodeSystem: EligibilityOutcome

    outcome: null | EnumCodeType

    CoverageEligibilityResponse.outcome Element

    FHIR Specification

    • Short: queued | complete | error | partial
    • Definition: The outcome of the request processing.
    • Comment: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
    • Requirements: To advise the requestor of an overall processing outcome.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true

    CodeSystem Enumeration: EligibilityOutcomeEnum

    disposition?: StringType

    CoverageEligibilityResponse.disposition Element

    FHIR Specification

    • Short: Disposition Message
    • Definition: A human readable description of the status of the adjudication.
    • Requirements: Provided for user display.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    insurer: null | Reference

    CoverageEligibilityResponse.insurer Element

    FHIR Specification

    • Short: Coverage issuer
    • Definition: The Insurer who issued the coverage in question and is the author of the response.
    • Requirements: Need to identify the author.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true

    CoverageEligibilityResponse.insurance Element

    FHIR Specification

    • Short: Patient insurance information
    • Definition: Financial instruments for reimbursement for the health care products and services.
    • Comment: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
    • Requirements: There must be at least one coverage for which eligibility is requested.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    preAuthRef?: StringType

    CoverageEligibilityResponse.preAuthRef Element

    FHIR Specification

    • Short: Preauthorization reference
    • Definition: A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.
    • Requirements: To provide any preauthorization reference for provider use.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    CoverageEligibilityResponse.form Element

    FHIR Specification

    • Short: Printed form identifier
    • Definition: A code for the form to be used for printing the content.
    • Comment: May be needed to identify specific jurisdictional forms.
    • Requirements: Needed to specify the specific form used for producing output for this response.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    CoverageEligibilityResponse.error Element

    FHIR Specification

    • Short: Processing errors
    • Definition: Errors encountered during the processing of the request.
    • Requirements: Need to communicate processing issues to the requestor.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

    • Assigns the provided value to the text property.

      Parameters

      Returns this

      this

    • Returns boolean

      true if the text property exists and has a value; false otherwise

    • Assigns the provided Resource array value to the contained property.

      Parameters

      • value: undefined | IResource[]

        the contained array value

      Returns this

      this

    • Returns boolean

      true if the contained property exists and has a value; false otherwise

    • Assigns the provided array of Extension values to the extension property.

      Parameters

      • extension: undefined | IExtension[]

        array of Extensions

      Returns this

      this

    • Determines if the extension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Adds the provided Extension to the extension property array.

      Parameters

      • extension: undefined | IExtension

        the Extension value to add to the extension property array

      Returns this

      this

    • Removes the Extension having the provided url from the extension property array.

      Parameters

      • url: string

        the url that identifies a specific Extension to remove

      Returns void

      AssertionError for invalid url

    • Determines if the modifierExtension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Assigns the provided PrimitiveType value to the id property.

      Parameters

      • element: undefined | IdType

        the id value

      Returns this

      this

    • Returns undefined | string

      the id property value as a primitive value

    • Assigns the provided primitive value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the id property exists and has a value; false otherwise

    • Assigns the provided value to the meta property.

      Parameters

      • value: undefined | Meta

        the meta value

      Returns this

      this

    • Returns boolean

      true if the meta property exists and has a value; false otherwise

    • Assigns the provided primitive value to the implicitRules property.

      Parameters

      • value: undefined | string

        the implicitRules value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns undefined | string

      the language property value as a primitive value

    • Assigns the provided primitive value to the language property.

      Parameters

      • value: undefined | string

        the language value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the language property exists and has a value; false otherwise

    • Returns boolean

      true if the instance is a FHIR complex or primitive datatype; false otherwise