xCaliber healthCare Data Mesh

Insurance Benefit Details

Source Object: Insurance Benefit Details

Overview and Usage: The "Insurance Benefit Details" source object in athena EHR contains essential information related to insurance benefits and coverage. It's a valuable resource for managing patient insurance information and understanding the specifics of healthcare coverage. Here's a brief overview of its key fields and their usage:

  • ANSI 271: Contains data from ANSI 271 transactions, which are standard electronic responses from insurance providers regarding eligibility, benefits, and coverage.
  • Date of Service: Records the date on which healthcare services were provided or scheduled.
  • Last Check Date: Indicates the most recent date on which the benefit information was verified or checked.
  • Service Type Code: Specifies the code for the type of healthcare service or procedure covered by the insurance.

The "Insurance Benefit Details" source object serves as a vital reference for both healthcare providers and patients. It helps ensure that services are appropriately covered by insurance plans, reducing billing errors and improving cost transparency. Developers can utilize this source object to build applications that facilitate insurance verification and streamline billing processes.

Mapping Table

Data FieldExample ValueSource Data Field DescriptionSource Field Data TypeSource Data Field CardinalityMapped FHIR++ ResourceMapped FHIR Data FieldAugmented MappingAssociated Coding SystemAssociated FHIR Data Field ExtensionMapping Context
ansi271-271 data from the payer.string0..1CoverageEligibilityResponseextension.valueStringansi-271Top Level
dateofservice-Date on which eligibility was checked.string0..1CoverageEligibilityResponseservicedDateTop Level
lastcheckdate-The last time we did an eligibilty check for this patient.string0..1CoverageEligibilityResponseevent.whenDateTimetype=last-checked,system=athenaTop Level
servicetypecode-STC Code for which we are checking the eligibility.string0..1CoverageEligibilityRequestextension.valueStringservice-type-codeTop Level
dateofservice-Date on which eligibility was checked.string0..1CoverageEligibilityRequestservicedDateTop Level