Finance and Insurance Service (FAIS)
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Finance and Insurance Service (FAIS), published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 1.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.Finance/ and changes regularly. See the Directory of published versions

: Use Case 2 - Example Coverage Eligibility Response Bundle - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "ex-check-coverage-resp-bundle-2",
  "meta" : {
    "profile" : [
      🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CEResponse.Bundle"
    ]
  },
  "type" : "collection",
  "entry" : [
    {
      "fullUrl" : "https://profiles.ihe.net/ITI/FAIS/CoverageEligibilityResponse/ex-check-coverage-resp-2",
      "resource" : {
        "resourceType" : "CoverageEligibilityResponse",
        "id" : "ex-check-coverage-resp-2",
        "meta" : {
          "profile" : [
            🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_ex-check-coverage-resp-2\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse ex-check-coverage-resp-2</b></p><a name=\"ex-check-coverage-resp-2\"> </a><a name=\"hcex-check-coverage-resp-2\"> </a><a name=\"ex-check-coverage-resp-2-en-US\"> </a><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-06-01 15:01:00+0000</p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-ex-check-coverage-2.html\">CoverageEligibilityRequest: status = active; purpose = benefits; serviced[x] = 2024-07-01 --&gt; 2024-12-31; created = 2024-06-01 15:00:00+0000</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Allowed</p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Coverage</b></td><td><b>Inforce</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Coverage-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --&gt; 2024-12-31</a></td><td>true</td></tr></table></div>"
        },
        "status" : "active",
        "purpose" : [
          "benefits"
        ],
        "patient" : {
          🔗 "reference" : "Patient/ex-beneficiary-1"
        },
        "created" : "2024-06-01T15:01:00Z",
        "request" : {
          🔗 "reference" : "CoverageEligibilityRequest/ex-check-coverage-2"
        },
        "outcome" : "complete",
        "disposition" : "Allowed",
        "insurer" : {
          🔗 "reference" : "Organization/ex-insurer-1"
        },
        "insurance" : [
          {
            "coverage" : {
              🔗 "reference" : "Coverage/ex-coverage-1"
            },
            "inforce" : true
          }
        ]
      }
    },
    {
      "fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "ex-insurer-1",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_ex-insurer-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name=\"ex-insurer-1\"> </a><a name=\"hcex-insurer-1\"> </a><a name=\"ex-insurer-1-en-US\"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>"
        },
        "name" : "National Health Insurance Scheme"
      }
    },
    {
      "fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "ex-beneficiary-1",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_ex-beneficiary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name=\"ex-beneficiary-1\"> </a><a name=\"hcex-beneficiary-1\"> </a><a name=\"ex-beneficiary-1-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Purity Atieno  Female, DoB: 2000-05-04</p><hr/></div>"
        },
        "name" : [
          {
            "family" : "Atieno",
            "given" : [
              "Purity"
            ]
          }
        ],
        "gender" : "female",
        "birthDate" : "2000-05-04"
      }
    },
    {
      "fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "ex-coverage-1",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_ex-coverage-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name=\"ex-coverage-1\"> </a><a name=\"hcex-coverage-1\"> </a><a name=\"ex-coverage-1-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}\">public healthcare</span></p><p><b>policyHolder</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2024-01-01 --&gt; 2024-12-31</p><p><b>payor</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p></div>"
        },
        "status" : "active",
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "PUBLICPOL",
              "display" : "public healthcare"
            }
          ]
        },
        "policyHolder" : {
          🔗 "reference" : "Patient/ex-beneficiary-1"
        },
        "subscriber" : {
          🔗 "reference" : "Patient/ex-beneficiary-1"
        },
        "subscriberId" : "05710b56-4448-11ef-b676-774a043da147",
        "beneficiary" : {
          🔗 "reference" : "Patient/ex-beneficiary-1"
        },
        "relationship" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code" : "self",
              "display" : "Self"
            }
          ]
        },
        "period" : {
          "start" : "2024-01-01",
          "end" : "2024-12-31"
        },
        "payor" : [
          {
            🔗 "reference" : "Organization/ex-insurer-1"
          }
        ]
      }
    }
  ]
}