This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw XML (canonical form + also see XML Format Specification)
General Person Primary Coverage with Benefit Details and new insurance (id = "E2502")
<?xml version="1.0" encoding="UTF-8"?> <CoverageEligibilityResponse xmlns="http://hl7.org/fhir"> <id value="E2502"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityResponse.</div> </text> <contained> <Coverage> <id value="coverage-1"/> <identifier> <system value="http://benefitsinc.com/certificate"/> <value value="12345"/> </identifier> <status value="active"/> <kind value="insurance"/> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> <code value="EHCPOL"/> </coding> </type> <subscriber> <reference value="Patient/f201"/> </subscriber> <beneficiary> <reference value="Patient/f201"/> </beneficiary> <dependent value="1"/> <relationship> <coding> <code value="self"/> </coding> </relationship> <insurer> <identifier> <system value="http://www.bindb.com/bin"/> <value value="123456"/> </identifier> </insurer> <class> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> <code value="EHCPOL"/> </coding> </type> <value> <value value="CBI35"/> </value> <name value="Corporate Baker's Inc. Plan#35"/> </class> <class> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="subplan"/> </coding> </type> <value> <value value="123"/> </value> <name value="Trainee Part-time Benefits"/> </class> <class> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="sequence"/> </coding> </type> <value> <value value="1"/> </value> </class> </Coverage> </contained> <identifier> <system value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"/> <value value="8812342"/> </identifier> <status value="active"/> <purpose value="validation"/> <purpose value="benefits"/> <patient> <reference value="Patient/f201"/> </patient> <created value="2014-09-16"/> <requestor> <identifier> <system value="http://national.org/clinic"/> <value value="OR1234"/> </identifier> </requestor> <request> <reference value="http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"/> </request> <outcome value="complete"/> <disposition value="Policy is currently in-force."/> <insurer> <reference value="Organization/2"/> </insurer> <insurance> <coverage> <reference value="#coverage-1"/> </coverage> <inforce value="true"/> <item> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> <code value="30"/> <display value="Health Benefit Plan Coverage"/> </coding> </category> <network> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/> <code value="annual"/> </coding> </term> <benefit> <type> <coding> <code value="benefit"/> </coding> </type> <allowedMoney> <value value="500000"/> <currency value="USD"/> </allowedMoney> <usedMoney> <value value="3748.00"/> <currency value="USD"/> </usedMoney> </benefit> <benefit> <type> <coding> <code value="copay-maximum"/> </coding> </type> <allowedMoney> <value value="100"/> <currency value="USD"/> </allowedMoney> </benefit> <benefit> <type> <coding> <code value="copay-percent"/> </coding> </type> <allowedUnsignedInt value="20"/> </benefit> </item> <item> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> <code value="69"/> <display value="Maternity"/> </coding> </category> <network> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/> <code value="annual"/> </coding> </term> <benefit> <type> <coding> <code value="benefit"/> </coding> </type> <allowedMoney> <value value="15000"/> <currency value="USD"/> </allowedMoney> </benefit> </item> <item> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> <code value="F3"/> <display value="Dental Coverage"/> </coding> </category> <network> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/> <code value="annual"/> </coding> </term> <benefit> <type> <coding> <code value="benefit"/> </coding> </type> <allowedMoney> <value value="2000"/> <currency value="USD"/> </allowedMoney> </benefit> </item> <item> <category> <coding> <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> <code value="F6"/> <display value="Vision Coverage"/> </coding> </category> <excluded value="true"/> <!-- this benefit category is not covered under the plan --> <name value="Vision"/> <description value="Vision products and services such as exams, glasses and contact lenses."/> </item> </insurance> <form> <coding> <system value="http://national.org/form"/> <code value="ELRSP/2017/01"/> </coding> </form> </CoverageEligibilityResponse>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Wed, Oct 2, 2024 17:57+0000.
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