Implementation Guide
23.x.x - R4 APIs

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Logical Model: Profile - Athena Custom Eligibility

Official URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-eligibility-profile Version: 23.x.x
Active as of 2023-03-01 Computable Name: Eligibility

The Eligibility is used by providers and payors, insurers, to exchange the financial information, and supporting clinical information, regarding the provision of health care services.


This Eligibility profile is part of the custom resource profiles supported by the API server used with the Athena Practice product used with the athenaPractice 23.0.0. This is not a FHIR Conformant Resource. It further describes read and search capabilities of these products.
Note: Create and Update operations are NOT supported for this resource.

Overview

The Eligibility resource provides medical insurance coverage information for patients. This information includes stated coverage is valid and in-force and optionally to provide the insurance details of the policy and potentially the amount of coverage which may be available to any services classes identified.

Scope and Usage

This profile is used to define the content that will be returned by the API Server in response to requests to access Eligibility resources. All elements listed in the differential profile view are Supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

Source

The Eligibility resource contains patient eligibility information from a given insurer. This information is extracted from PatientInsurance, InsuranceCarriers, MedLists, PatientProfile tables.

Example

Example for the athena-eligibility-profile Profile.

Eligibility Example

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format

This structure is derived from Base

Summary

Mandatory: 0 element (3 nested mandatory elements)
Must-Support: 3 elements

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-eligibility-profile 0..*Base
... meta Σ0..1MetaMetadata about the resource
... pid SΣ1..1integerPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
... patient 0..1Reference(Patient)Who/what is the patient for Eligibility
.... reference 0..1stringReference to the Patient
.... display 0..1stringPatient name
... patientProfileId SΣ1..1unsignedIntPatient specific id for practice management data including financial information
... orderForClaims 0..1integerClaims-order link to the patient visit
... patientInsuranceStatus 0..1stringStatus of Patient insurance
... patientInsuranceGroupId 0..1stringPolicy group number
... patientInsuranceGroupName 0..1stringPolicy group name
... claimOfficeNumber 0..1stringOffice number of Claim.
... insuredId 0..1stringInsured person's insurance ID
... patientInsuranceMediGapId 0..1stringThe Medigap ID for this insurance carrier if the policy type is set to Medigap.
... insuranceCardEffectiveDate 0..1dateTimeEffective date of this insurance policy.
... insuranceCardTerminationDate 0..1dateTimeTermination date of this insurance policy.
... patientCopayAmount 0..1MoneyPatient copay for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... patientInsuranceDeductible 0..1MoneyPatient Insurance deductible 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... champusBranch 0..1stringA CHAMPUS branch identifies and tracks the branch of the military to which a patient belongs.
... champusGrade 0..1stringA CHAMPUS Grade list option identifies and tracks the ranking of a patient in the military
... champusStatus 0..1stringA CHAMPUS status identifies and tracks the status of a patient in the military (whether active or retired).
... patientRelatedToInsured 0..1stringRelation of patient with the Insured person.
... employer 0..1Reference(Organization)Employer details
.... reference 0..1stringInsurance Carrier Id refering to employer
.... display 0..1stringInsurance carrier Name
... employeeId 0..1stringIdentifier for Employee
... eligibilityVerified 0..1integerInteger code for the eligibility status for this insurance carrier for this patient
... eligibilityVerifiedDate 0..1dateTimeDate the eligibility information was verified.
... eligibilityVerifiedBy 0..1stringPerson who has verified Eligibility.
... eligibilityNotes 0..1stringNotes from this insurance carrier about the eligibility for this patient.
... patientInsuranceNotes 0..1stringInsuranceNotes related to patient
... insurancePolicyTypes 0..1stringInsurance policy type
... dateOfServiceFrom 0..1dateTimeStart date of service for this procedure
... dateOfServiceTo 0..1dateTimeStop date of service for this procedure.
... otherInsuredId 0..1stringInsured person's another insurance ID
... otherIdQualifier 0..1stringOtherId Qualifier
... otherCopayAmount 0..1MoneyOtherCopayAmt for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... familyDeductible 0..1MoneyFamilyDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... coInsurance 0..1MoneyCoInsurance for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... otherDeductible 0..1MoneyOtherDeductible for each Insurance Eligibility 271 parsed response
.... value 0..1decimalMoney value
.... currency 0..1stringCurrency
... masterInsuranceCarriersId 0..1integerIf this carrier was imported from the master list, then this is the ID of the carrier that was imported.
... inactiveInsuranceCarrier 0..1booleanFlag for insurance carrier is marked inactive.
... insuranceCarrier 0..1Reference(Organization)insurance Carrier details
.... reference 0..1stringInsurance Carrier Id refering to Organization
.... display 0..1stringInsurance carrier Name
... collectionsGroup 0..1stringCollections group to which this insurance carrier belongs.
... carrierType 0..1stringCarrier type of this insurance carrier.
... carrierTypeANSI 0..1stringCarrier type ANSI of this insurance carrier
... patientFinancialClass 0..1stringFinancial class of this insurance carrier.
... insuranceGroupName 0..1stringInsurance Group Name.

doco Documentation for this format

This structure is derived from Base

Summary

Mandatory: 0 element (3 nested mandatory elements)
Must-Support: 3 elements

 

Other representations of profile: CSV, Excel

Notes:

Supported Interactions

The Interactions supported by this resource are listed below.

Search Parameters

Search parameters are executed as specified in the HL7 FHIR RESTful API implementation definition. To search for Eligibility resources, an application shall perform an HTTP GET, specifying the query parameters associated with the resource.

GET [base]/customresource/Eligibility?{search-parameters}

Where:

Name Description
[base] Specifies the base URL of the FHIR Server, e.g., https://ap22sandbox.athenahealth.com/demoAPIServer
_id (token) The ID of the resource
patientProfileId known id of the patient.
patient (reference) The patient this person is related to.
[_include] Specifies the supported hl7 resources include which are defined as reference in examples. Note: The Patient and Organization resources are supported via the _include parameter.
HTTP Response Codes

The following HTTP response codes are returned by this API call:

200 OK The query was performed and any results found are contained within the body of the HTTP response. Note: The search API will return 200 OK when the query itself is successful, regardless of whether or not any matching results were found.
401 Unauthorized Authorization is required for this request, and either the Authorization header is missing or the supplied user credentials in the Authorization header are not valid or have expired. The body of the HTTP response will contain an OperationOutcome resource that indicates that Authorization is required.
500 Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.