HL7 FHIR® Validated Healthcare Directory Implementation Guide STU 1

Validated Healthcare Directory, published by HL7 International - Patient Admistration Working Group. This is not an authorized publication; it is the continuous build for version 0.2.0). This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions

Patriot PPO Standard

Generated Narrative with Details

id: insuranceplan1

identifier: HIOS product ID = 1234567891 (OFFICIAL)

status: active

type: Bronze (Details : {http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics code 'bronze' = 'Bronze', given as 'Bronze'})

name: Patriot PPO Standard

alias: Patriot Plus

period: Jun 6, 2018, 12:00:00 AM --> Jan 1, 2019, 12:00:00 AM

ownedBy: Homeland Health Insurance. Generated Summary: id: homeland; active; Health System; name: Homeland Health Insurance

administeredBy: Homeland Health Insurance. Generated Summary: id: homeland; active; Health System; name: Homeland Health Insurance

coverageArea: Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; Area

Contacts

-PurposeTelecom
*General information (Details : {http://terminology.hl7.org/CodeSystem/contactentity-type code 'PATINF' = 'Patient', given as 'Patient'})ph: 202-123-5555

endpoint: patriot plan endpoint hub

network:

coverage

type: Coverage related to medical inpatient, outpatient, diagnostic, and preventive care (Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})

network: Patriot Preferred Provider Network. Generated Summary: id: patriotppo; Healthcare.gov Network ID = DCN001 (SECONDARY); active; PPO; name: Patriot Preferred Provider Network; alias: Patriot PPO

benefit

type: Primary care visit to treat an injury or illness (Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})

requirement: N/A

Limits

-Code
*unlimited (Details )

coverage

type: Coverage related to dental care (Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})

network: Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; Health System; name: Patriot Dental Provider Network

benefit

type: Periodic oral checkup (Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})

requirement: N/A

Limits

-ValueCode
*2 visit/yr (Details: UCUM code {visit}/a = '{visit}/a')biannual oral checkup (Details )

plan

identifier: HIOS plan ID = 123456789101112 (OFFICIAL)

type: Bronze (Details : {[not stated] code 'bronze' = 'bronze', given as 'Bronze'})

coverageArea: Washington, DC metro area. Generated Summary: id: wash-dc-metro; status: active; name: Washington, DC metro area; Area

network: Patriot Dental Provider Network. Generated Summary: id: patriotdental; active; Health System; name: Patriot Dental Provider Network

GeneralCosts

-TypeGroupSizeCostComment
*Deductible (Details : {[not stated] code 'deductible' = 'deductible', given as 'Deductible'})1Includes all prescription and medical costs for in-network providers

specificCost

category: Medical (Details : {[not stated] code 'medical' = 'medical', given as 'Medical'})

benefit

type: Primary care visit to treat an injury or illness (Details : {[not stated] code '001' = '001', given as 'Primary care visit to treat an injury or illness'})

Costs

-TypeApplicabilityQualifiersValue
*Copay (Details : {[not stated] code 'copay' = 'copay', given as 'Copay'})In Network (Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})in-network preferred provider (Details )50 dollars (Details: urn:iso:std:iso:4217 code USD = 'United States dollar')

specificCost

category: Dental (Details : {[not stated] code 'dental' = 'dental', given as 'Dental'})

benefit

type: Basic Dental Care – Adult (Details : {[not stated] code '052' = '052', given as 'Basic Dental Care – Adult'})

Costs

-TypeApplicabilityQualifiersValue
*Coinsurance (Details : {[not stated] code 'coinsurance' = 'coinsurance', given as 'Coinsurance'})In Network (Details : {http://terminology.hl7.org/CodeSystem/applicability code 'in-network' = 'In Network', given as 'In Network'})in-network provider (Details )10 percent