{"resourceType":"CoverageEligibilityResponse","id":"E2503","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the CoverageEligibilityResponse.\u003c/div\u003e"},"identifier":[{"system":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse","value":"8812343"}],"status":"active","purpose":["validation"],"patient":{"reference":"Patient/f201"},"created":"2014-09-16","requestor":{"identifier":{"system":"http://national.org/clinic","value":"OR1234"}},"request":{"reference":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332406"},"outcome":"error","disposition":"Eligibiliy request could not be processed, please address errors before submitting.","insurer":{"reference":"Organization/2"},"form":{"coding":[{"system":"http://national.org/form","code":"ELRSP/2017/01"}]},"error":[{"code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication-error","code":"a001"}]}}]}
{"resourceType":"CoverageEligibilityResponse","id":"E2502","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the CoverageEligibilityResponse.\u003c/div\u003e"},"contained":[{"resourceType":"Coverage","id":"coverage-1","identifier":[{"system":"http://benefitsinc.com/certificate","value":"12345"}],"status":"active","kind":"insurance","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActCode","code":"EHCPOL"}]},"subscriber":{"reference":"Patient/f201"},"beneficiary":{"reference":"Patient/f201"},"dependent":"1","relationship":{"coding":[{"code":"self"}]},"insurer":{"identifier":{"system":"http://www.bindb.com/bin","value":"123456"}},"class":[{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActCode","code":"EHCPOL"}]},"value":{"value":"CBI35"},"name":"Corporate Baker\u0027s Inc. Plan#35"},{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"subplan"}]},"value":{"value":"123"},"name":"Trainee Part-time Benefits"},{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"sequence"}]},"value":{"value":"1"}}]}],"identifier":[{"system":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse","value":"8812342"}],"status":"active","purpose":["validation","benefits"],"patient":{"reference":"Patient/f201"},"created":"2014-09-16","requestor":{"identifier":{"system":"http://national.org/clinic","value":"OR1234"}},"request":{"reference":"http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"},"outcome":"complete","disposition":"Policy is currently in-force.","insurer":{"reference":"Organization/2"},"insurance":[{"coverage":{"reference":"#coverage-1"},"inforce":true,"item":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"30","display":"Health Benefit Plan Coverage"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":500000,"currency":"USD"},"usedMoney":{"value":3748.00,"currency":"USD"}},{"type":{"coding":[{"code":"copay-maximum"}]},"allowedMoney":{"value":100,"currency":"USD"}},{"type":{"coding":[{"code":"copay-percent"}]},"allowedUnsignedInt":20}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"69","display":"Maternity"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":15000,"currency":"USD"}}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"F3","display":"Dental Coverage"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":2000,"currency":"USD"}}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"F6","display":"Vision Coverage"}]},"excluded":true,"name":"Vision","description":"Vision products and services such as exams, glasses and contact lenses."}]}],"form":{"coding":[{"system":"http://national.org/form","code":"ELRSP/2017/01"}]}}
{"resourceType":"CoverageEligibilityResponse","id":"E2501","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the CoverageEligibilityResponse.\u003c/div\u003e"},"identifier":[{"system":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse","value":"881234"}],"status":"active","purpose":["validation","benefits"],"patient":{"reference":"Patient/pat1"},"servicedDate":"2014-09-17","created":"2014-08-16","request":{"reference":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"},"outcome":"complete","disposition":"Policy is currently in-force.","insurer":{"reference":"Organization/2"},"insurance":[{"coverage":{"reference":"Coverage/9876B1"},"inforce":true,"item":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"30","display":"Health Benefit Plan Coverage"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":500000,"currency":"SAR"}},{"type":{"coding":[{"code":"copay-maximum"}]},"allowedMoney":{"value":100,"currency":"SAR"}},{"type":{"coding":[{"code":"copay-percent"}]},"allowedUnsignedInt":20}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"69","display":"Maternity"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":15000,"currency":"SAR"}}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"F3","display":"Dental Coverage"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":2000,"currency":"SAR"}}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"F6","display":"Vision Coverage"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"annual"}]},"benefit":[{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":400,"currency":"SAR"}}]},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-benefitcategory","code":"49","display":"Hospital Room and Board"}]},"network":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-network","code":"in"}]},"unit":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-unit","code":"individual"}]},"term":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/benefit-term","code":"day"}]},"benefit":[{"type":{"coding":[{"code":"room"}]},"allowedString":"shared"},{"type":{"coding":[{"code":"benefit"}]},"allowedMoney":{"value":600,"currency":"SAR"}}]}]}]}
{"resourceType":"CoverageEligibilityResponse","id":"E2500","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the CoverageEligibilityResponse.\u003c/div\u003e"},"identifier":[{"system":"http://www.BenefitsInc.com/fhir/coverageeligibilityresponse","value":"881234"}],"status":"active","purpose":["validation"],"patient":{"reference":"Patient/pat1"},"created":"2014-08-16","request":{"reference":"http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332402"},"outcome":"complete","disposition":"Policy is currently in-force.","insurer":{"reference":"Organization/2"},"insurance":[{"coverage":{"reference":"Coverage/9876B1"},"inforce":true}]}