CoverageEligibilityResponse
The CoverageEligibilityResponse resource provides eligibility and plan details from processing a CoverageEligibilityRequest resource. It combines key information from a payor as to whether a Coverage is in-force, and optionally the nature of the Policy benefit details as well as the ability for the insurer to indicate whether the insurance provides benefits for requested types of services or requires preauthorization and if so what supporting information may be required.
https://hl7.org/fhir/R4/coverageeligibilityresponse.html
Endpoints
Attributes
The identifier of the coverage eligibility response
Status of the resource
One of: active, draft, entered-in-error
Reason for the request, will always be [“benefits”]
Patient resource the eligibility response is for
Response creation date
CoverageEligibilityRequest reference the elibibility response is for
Outcome of the request processing, will always be “complete”
Payor Id for the Coverage issuer
Includes the Coverage reference and an array of items containing benefits and authorization details
The amount of information surfaced here depends on the what the payor supports. Our clearinghouse (Claim.md) performs these eligibility checks, but not all coverages will support real-time eligibility checks. For more information on coverages within Canvas, see this Zendesk article.
CoverageEligibilityResponse search
Query Parameters
The EligibilityRequest reference
Responses
Errors
curl --request GET \ --url 'https://fumage-example.canvasmedical.com/Group?request=CoverageEligibilityRequest/b41c7cda738d440cb55e0e6cb67499a1' \ --header 'Authorization: Bearer <token>' \ --header 'accept: application/json'
import requests url = "https://fumage-example.canvasmedical.com/Group?request=CoverageEligibilityRequest/b41c7cda738d440cb55e0e6cb67499a1" headers = { "accept": "application/json", "Authorization": "Bearer <token>" } response = requests.get(url, headers=headers) print(response.text)
{ "resourceType": "Bundle", "type": "searchset", "total": 1, "entry": [ { "resource": { "resourceType": "CoverageEligibilityResponse", "id": "9ad12f4e-4f35-4f54-8b4f-036516488191", "status": "active", "purpose": [ "benefits" ], "patient": { "reference": "Patient/b41c7cda738d440cb55e0e6cb67499a1", "type": "Patient" }, "created": "2023-09-19T18:16:39.551617+00:00", "request": { "reference": "CoverageEligibilityRequest/d7254641-e363-488c-91fa-b93a6170b9e0", "type": "CoverageEligibilityRequest" }, "outcome": "complete", "insurer": { "identifier": "1111", "display": "Payer ID: 1111" }, "insurance": [ { "coverage": { "reference": "Coverage/4a86f580-e192-489a-a9f0-7c915fc67111", "type": "Coverage" }, "item": [ { "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "unit": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "individual", "display": "Individual" } ], "text": "Individual" }, "benefit": [ { "type": { "text": "Co-Payment" }, "allowedMoney": { "value": 333 } }, { "type": { "text": "Co-Insurance" }, "allowedString": "0.0%" } ] }, { "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "unit": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "individual", "display": "Individual" } ], "text": "Individual" }, "benefit": [ { "type": { "text": "Co-Insurance" }, "allowedString": "0.0%" }, { "type": { "text": "Co-Insurance" }, "allowedString": "0.0%" }, { "type": { "text": "Co-Insurance" }, "allowedString": "0.0%" } ] }, { "benefit": [ { "type": { "text": "Benefit Description (Incomplete information)" } } ] }, { "benefit": [ { "type": { "text": "Active Coverage" } } ] }, { "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "benefit": [ { "type": { "text": "Active Coverage" } }, { "type": { "text": "Primary Care Provider (Incomplete information)" } }, { "type": { "text": "Benefit Description (Incomplete information)" } }, { "type": { "text": "Benefit Disclaimer (Incomplete information)" } } ] }, { "name": "Dental Care", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "unit": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "individual", "display": "Individual" } ], "text": "Individual" }, "benefit": [ { "type": { "text": "Active Coverage" } } ] }, { "name": "Health Benefit Plan Coverage", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "unit": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "individual", "display": "Individual" } ], "text": "Individual" }, "benefit": [ { "type": { "text": "Deductible (Incomplete information)" } }, { "type": { "text": "Deductible" }, "allowedMoney": { "value": 6900 }, "usedMoney": { "value": 0.0 } }, { "type": { "text": "Active Coverage" } }, { "type": { "text": "Out of Pocket (Stop Loss)" }, "allowedMoney": { "value": 6900 }, "usedMoney": { "value": 0.0 } }, { "type": { "text": "Out of Pocket (Stop Loss)" }, "allowedMoney": { "value": 6900 }, "usedMoney": { "value": 0.0 } } ] }, { "name": "Health Benefit Plan Coverage", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "benefit": [ { "type": { "text": "Benefit Description (Incomplete information)" } } ] }, { "name": "Physician Visit - Well", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "benefit": [ { "type": { "text": "Non-Covered (Incomplete information)" } } ] }, { "name": "Professional (Physician) Visit - Office", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "unit": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "individual", "display": "Individual" } ], "text": "Individual" }, "benefit": [ { "type": { "text": "Co-Insurance" }, "allowedString": "0.0%" } ] }, { "name": "Professional (Physician) Visit - Office", "network": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-network", "code": "in", "display": "In Network" } ], "text": "In Network" }, "benefit": [ { "type": { "text": "Non-Covered (Incomplete information)" } }, { "type": { "text": "Active Coverage" } } ] } ] } ] } } ] }
{ "resourceType": "OperationOutcome", "id": "101", "issue": [ { "severity": "error", "code": "invalid", "details": { "text": "Bad request" } } ] }
{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "unknown", "details": { "text": "Authentication failed" } } ] }
{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "forbidden", "details": { "text": "Authorization failed" } } ] }