EligibilityResponse
Introduction #
The EligibilityResponse model represents a coverage eligibility (271) response returned by a payer for a patient’s Coverage, along with the originating EligibilityRequest (270). An EligibilityResponse also derives a check status (Active, Inactive, or Failed) from the payer’s response.
Basic usage #
To get an eligibility response by identifier, use the get method on the EligibilityResponse model manager:
from canvas_sdk.v1.data.eligibility_response import EligibilityResponse
response = EligibilityResponse.objects.get(id="b80b1cdc-2e6a-4aca-90cc-ebc02e683f35")
Eligibility requests and responses are linked to a Coverage. From a coverage object, use the requests and eligibility_responses attributes:
from canvas_sdk.v1.data.coverage import Coverage
coverage = Coverage.objects.get(id="b80b1cdc-2e6a-4aca-90cc-ebc02e683f35")
requests = coverage.requests.all()
responses = coverage.eligibility_responses.all()
Eligibility status #
EligibilityResponse.status returns an EligibilityResponseStatus derived from the payer’s response — FAILED when the check errored, INACTIVE when the payer reports an inactive benefit section, otherwise ACTIVE:
from canvas_sdk.v1.data.coverage import Coverage
from canvas_sdk.v1.data.eligibility_response import EligibilityResponseStatus
coverage = Coverage.objects.get(id="b80b1cdc-2e6a-4aca-90cc-ebc02e683f35")
response = coverage.eligibility_responses.order_by("created").last()
is_active = response is not None and response.status == EligibilityResponseStatus.ACTIVE
A coverage with no eligibility responses (an empty coverage.eligibility_responses queryset) has not been verified.
Attributes #
EligibilityRequest #
| Field Name | Type |
|---|---|
| id | UUID |
| dbid | Integer |
| created | DateTime |
| modified | DateTime |
| coverage | Coverage |
| trading_partner_id | String |
| member | JSON |
| provider | JSON |
| payload | String |
| control_number | String |
EligibilityResponse #
| Field Name | Type |
|---|---|
| id | UUID |
| dbid | Integer |
| created | DateTime |
| modified | DateTime |
| eligibility_request | EligibilityRequest |
| coverage | Coverage |
| client_id | String |
| correlation_id | String |
| deductible | JSON |
| out_of_pocket | JSON |
| coverage_info | JSON |
| payer | JSON |
| provider | JSON |
| service_type_codes | List[String] |
| service_types | List[String] |
| subscriber | JSON |
| trading_partner_id | String |
| valid_request | Boolean |
| errors | List[String] |
| eligid | String |
| x12_response | String |
| parsed_x12_response | JSON |
| status | EligibilityResponseStatus (read-only property) |
| eligibility_or_benefit_information | List (read-only property) |
status and eligibility_or_benefit_information are computed from errors and parsed_x12_response rather than stored, so neither can be used in filter(). To select responses by outcome, filter on the columns they derive from — a failed check is one with a non-empty errors:
from canvas_sdk.v1.data.eligibility_response import EligibilityResponse
failed = EligibilityResponse.objects.exclude(errors=None).exclude(errors=[])
Enumeration types #
EligibilityResponseStatus #
| Name | Value |
|---|---|
| ACTIVE | Active |
| INACTIVE | Inactive |
| FAILED | Failed |
| UNKNOWN | Unknown |
Questions? Create an issue.