CoverageEligibilityResponse-GET
Description
Retrieves detailed eligibility response information, allowing healthcare developers to access and display real-time data regarding patients' insurance coverage, facilitating streamlined verification and validation within clinical workflows.
Use Cases
- Patient Benefit Verification: Access details guiding finances
- Claim Denial Triage: Check policies for billing
- Care Pathway Eligibility Checks: Confirm regimen coverage
- Referring Provider Network Validation: Verify coverage alignment
- Clinical Trial Pre-qualification: Screen prescription adequacy
Request Sample
Athena
Elation
Canvas
cURL
JavaScript
Java
Python
Source Specific Details
| EHR | APIs | mandatory filters | optional filters |
|---|---|---|---|
| Athena |
|
|
|
Filters
| FilterName | Description | Default Value | Allowed Values |
|---|---|---|---|
| _count | Pagination params | ||
| _offset | Pagination params. Athena: Starting point of entries; 0-indexed | ||
| date-of-service | Fetches the eligibility on that specific date. | ||
| departmentId | Identifier for the department | ||
| include | List of fields which needed to be shown in result | ||
| insuranceId | insuranceid | ||
| patient | Patient reference for any fhir resource | ||
| practitioner | Practitioner reference for the any fhir resource | ||
| quorum | sets sync/async mode | true | |
| service-type-code | STC Code for which we are checking the eligibility |