Coverage Eligibility Verification

Type: Information Object

Status: Planned
Industry Sector: Healthcare
Sensitivity Level: Confidential
Personal Information: Sensitive PII

Description:
Result of checking a patient or payer coverage status before service delivery or billing.

Accessed by Application(s):

• Patient Administration System
• Prior Authorization Management System
• Revenue Cycle Management System

 Yes

Attributes

Order	Name	Description	Type	Cardinality	Example value
1	Eligibility Verification ID	Unique identifier for the eligibility verification	GUID	Mandatory
2	Patient ID	Reference to the patient whose coverage is verified	Reference	Mandatory
3	Payer Name	Name of the payer or insurer	String	Mandatory
4	Verification Date	Date when eligibility was checked	Date	Mandatory
5	Coverage Status	Result of the eligibility verification	Enumeration	Mandatory
6	Plan Reference	Reference to the payer plan or policy	String	Optional
7	Valid From	Start date of verified coverage	Date	Optional
8	Valid To	End date of verified coverage	Date	Optional

 Yes
 
 Planned
 Sensitive PII
 Confidential
 Healthcare
 Result of checking a patient or payer coverage status before service delivery or billing.

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