EnrollmentResponse
A payer reply to an EnrollmentRequest: enrollment validated, refused, or pending.
Purpose
EnrollmentResponse encodes the payer's decision on an enrollment request: approved, refused (eligibility issue, duplicate, invalid contract), or pending. It closes the administrative loop and triggers the effective activation of the Coverage on the system side.
Key elements
| Field | Type | Cardinality | Role |
|---|---|---|---|
identifier | Identifier[] | 0..* | External identifiers. |
status | code | 0..1 | `active`, `cancelled`, `draft`, `entered-in-error`. |
request | Reference(EnrollmentRequest) | 0..1 | EnrollmentRequest being answered. |
outcome | code | 0..1 | `queued`, `complete`, `error`, `partial`. |
disposition | string | 0..1 | Explanatory message. |
created | dateTime | 0..1 | Response date. |
organization | Reference(Organization) | 0..1 | Processing organisation. |
requestProvider | Reference(Practitioner | PractitionerRole | Organization) | 0..1 | Initial requester. |
JSON example
{
"resourceType": "EnrollmentResponse",
"id": "example-enrollresp-001",
"status": "active",
"request": {
"reference": "EnrollmentRequest/example-enroll-001"
},
"outcome": "complete",
"disposition": "Inscription validée. Couverture active à compter du 01/06/2026.",
"created": "2026-05-17",
"organization": {
"reference": "Organization/payer-bcbs"
}
}Common pitfalls
- No reference to the EnrollmentRequest: the requester cannot link the answer to its request.
- Outcome=error without explanatory message: impossible to remediate.
- Lag between Request and Response > 14 days: to be monitored on the payer SLA side.
Related resources
- enrollmentrequest — initial request.
- coverage — activated coverage.
- organization — payer.
- claimresponse — similar response model for claims.