FHIR Implementation Guide for ABDM
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This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CoverageEligibilityResponse - Mappings

Draft as of 2025-03-18

Mappings for the CoverageEligibilityResponse resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

CoverageEligibilityResponse
CoverageEligibilityResponseEvent
   identifierEvent.identifier
   statusEvent.status
   patientEvent.subject
   requestEvent.basedOn
   dispositionEvent.note

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

CoverageEligibilityResponse
CoverageEligibilityResponse
   identifierFiveWs.identifier
   statusFiveWs.status
   purposeFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   serviced[x]FiveWs.done[x]
   createdFiveWs.recorded
   requestorFiveWs.source
   requestFiveWs.why[x]
   insurance
      item
         providerFiveWs.source

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

CoverageEligibilityResponse
CoverageEligibilityResponse
   patientC06,C07,C08, C05, C04
   serviced[x]F09
   requestorB01
   requestA02|G01
   insurance
      item
         providerB01
   preAuthRefF03
   formG42

Mappings for RIM Mapping (http://hl7.org/v3)

CoverageEligibilityResponse
CoverageEligibilityResponseEntity. Role, or Act
   textAct.text?
   containedN/A
   extensionN/A
   modifierExtensionN/A
   insurance
      idn/a
      extensionn/a
      modifierExtensionN/A
      item
         idn/a
         extensionn/a
         modifierExtensionN/A
         category
            idn/a
            extensionn/a
            codingunion(., ./translation)
               idn/a
               extensionn/a
               system./codeSystem
               version./codeSystemVersion
               code./code
               displayCV.displayName
               userSelectedCD.codingRationale
            text./originalText[mediaType/code="text/plain"]/data
         productOrService
            idn/a
            extensionn/a
            codingunion(., ./translation)
               idn/a
               extensionn/a
               system./codeSystem
               version./codeSystemVersion
               code./code
               displayCV.displayName
               userSelectedCD.codingRationale
            text./originalText[mediaType/code="text/plain"]/data
         benefit
            idn/a
            extensionn/a
            modifierExtensionN/A
   preAuthRef23
   error
      idn/a
      extensionn/a
      modifierExtensionN/A