CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
0.1.10 - STU1

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) - Local Development build (v0.1.10). See the Directory of published versions

: Coverage1 - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="Coverage1"/>
  <meta>
    <lastUpdated value="2020-07-07T13:26:22.0314215+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p><b>Generated Narrative</b></p><h3>Ids</h3><table class="grid"><tr><td>-</td></tr><tr><td>*</td></tr></table><h3>Meta</h3><table class="grid"><tr><td>-</td></tr><tr><td>*</td></tr></table><p><b>language</b>: en-US</p><p><b>identifier</b>: Member Number: 1234-234-1243-12345678901</p><p><b>status</b>: active</p><p><b>type</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}">health insurance plan policy</span></p><p><b>policyHolder</b>: <a href="Patient-Patient1.html">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></a></p><p><b>subscriber</b>: <a href="Patient-Patient1.html">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></a></p><p><b>subscriberId</b>: 12345678901</p><p><b>beneficiary</b>: <a href="Patient-Patient1.html">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: Jan 1, 2019, 12:00:00 AM --&gt; Oct 31, 2019, 12:00:00 AM</p><p><b>payor</b>: <a href="Organization-Payer1.html">Generated Summary: language: en-US; National Provider Identifier: 345678, Payer ID: 901234; active; name: Payer 1</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/coverage-class group}">An employee group</span></p><p><b>value</b>: 021890</p><p><b>name</b>: Acme Corporation</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/coverage-class plan}">Plan</span></p><p><b>value</b>: XYZ123</p><p><b>name</b>: XYZ123-UPMC CONSUMER ADVA</p></blockquote><p><b>network</b>: XYZ123-UPMC CONSUMER ADVA</p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="https://www.xxxhealthplan.com/fhir/memberidentifier"/>
    <value value="1234-234-1243-12345678901"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="HIP"/>
    </coding>
    <text value="health insurance plan policy"/>
  </type>
  <policyHolder>
    <reference value="Patient/Patient1"/>
  </policyHolder>
  <subscriber>
    <reference value="Patient/Patient1"/>
  </subscriber>
  <subscriberId value="12345678901"/>
  <beneficiary>
    <reference value="Patient/Patient1"/>
  </beneficiary>
  <dependent value="01"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2019-01-01T00:00:00+00:00"/>
    <end value="2019-10-31T00:00:00+00:00"/>
  </period>
  <payor>
    <reference value="Organization/Payer1"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
      <text value="An employee group"/>
    </type>
    <value value="021890"/>
    <name value="Acme Corporation"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
      <text value="Plan"/>
    </type>
    <value value="XYZ123"/>
    <name value="XYZ123-UPMC CONSUMER ADVA"/>
  </class>
  <network value="XYZ123-UPMC CONSUMER ADVA"/>
</Coverage>