DHIN 2025Connectathon FHIR IG, published by DHIN. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Nigeria-FHIR-Community/2025Connectathon/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Eligibility Response - Approved - JSON Representation

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{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "CER-Response-001",
  "meta" : {
    "profile" : [
      🔗 "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-response"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse CER-Response-001</b></p><a name=\"CER-Response-001\"> </a><a name=\"hcCER-Response-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage-eligibility-response.html\">NG Claim Coverage Eligibility Response</a></p></div><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-aaabbbcc-e5f6-4789-a123-456789abcdef\">Chika Okafor  Male, DoB: 1990-04-21 ( mobile: 08031112233)</a></p><p><b>created</b>: 2025-10-15 09:06:30+0100</p><p><b>request</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-dddeeeff-e5f6-4789-a123-456789abcdef\">CoverageEligibilityRequest: status = active; purpose = benefits; created = 2025-10-15 09:05:00+0100</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Eligible for covered services per active policy.</p><p><b>insurer</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-cccddde1-e5f6-4789-a123-456789abcdef\">Organization XYZ HMO</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Bundle-NgEligibilityCheck-Response.html#urn-uuid-fffaaabb-e5f6-4789-a123-456789abcdef\">Coverage: status = active; type = extended healthcare; period = 2025-01-01 --&gt; 2025-12-31</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-benefitcategory 1}\">Outpatient</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type copay}\">vision-exam</span></td><td>1</td></tr></table></blockquote></blockquote></div>"
  },
  "status" : "active",
  "purpose" : [
    "benefits"
  ],
  "patient" : {
    "reference" : "urn:uuid:aaabbbcc-e5f6-4789-a123-456789abcdef"
  },
  "created" : "2025-10-15T09:06:30+01:00",
  "request" : {
    "reference" : "urn:uuid:dddeeeff-e5f6-4789-a123-456789abcdef"
  },
  "outcome" : "complete",
  "disposition" : "Eligible for covered services per active policy.",
  "insurer" : {
    "reference" : "urn:uuid:cccddde1-e5f6-4789-a123-456789abcdef"
  },
  "insurance" : [
    {
      "coverage" : {
        "reference" : "urn:uuid:fffaaabb-e5f6-4789-a123-456789abcdef"
      },
      "inforce" : true,
      "item" : [
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "1"
              }
            ],
            "text" : "Outpatient"
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "copay"
                  }
                ],
                "text" : "vision-exam"
              },
              "allowedUnsignedInt" : 1
            }
          ]
        }
      ]
    }
  ]
}