FHIR R4 CoverageEligibilityResponse API

Overview

This asset is a component of MuleSoft Accelerator for Healthcare.

MuleSoft Accelerator for Healthcare enables healthcare providers to unlock critical patient data to build a patient 360 within Salesforce Health Cloud, faster and easier than ever before. The solution includes pre-built APIs, connectors, integration templates, and prescriptive end-to-end reference architecture to bring patient demographics information and COVID-19 test results from any EHR into Health Cloud using HL7 V2 or FHIR standards.

The solution also provides a library of United States Core Data for Interoperability (USCDI) and FHIR R4 resources to help healthcare developers adhere to interoperability needs and jumpstart the development of healthcare digital transformation initiatives.

Use case covered

The CoverageEligibilityResponse resource provides eligibility and plan details from the processing of an 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.

The CoverageEligibilityResponse resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.

This API uses FHIR R4 CoverageEligibilityResponse Library.

More information about FHIR R4 CoverageEligibilityResponse specification can be found here.