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
id
string
The identifier of the coverage eligibility response
status
string
Status of the resource
One of: active, draft, entered-in-error
purpose
array[string]
Reason for the request, will always be [“benefits”]
patient
json
Patient resource the eligibility response is for
created
datetime
Response creation date
request
json
CoverageEligibilityRequest reference the elibibility response is for
outcome
string
Outcome of the request processing, will always be “complete”
insurer
json
Payor Id for the Coverage issuer
insurance
array[json]
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.
get
/CoverageEligibilityResponse
CoverageEligibilityResponse search
Query Parameters
request required
string
The EligibilityRequest reference
Responses
200 OK
Request was successful.
Errors
400 Bad Request
The request was invalid or cannot be otherwise served. An accompanying error message will explain further.
401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
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" } } ] }