{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "NgCoverageEligibilityResponse-ChikaXrayApproved",
  "meta" : {
    "profile" : ["https://fhir-ig.digitalhealth.gov.ng/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 NgCoverageEligibilityResponse-ChikaXrayApproved</b></p><a name=\"NgCoverageEligibilityResponse-ChikaXrayApproved\"> </a><a name=\"hcNgCoverageEligibilityResponse-ChikaXrayApproved\"> </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>identifier</b>: <code>https://fhir-ig.digitalhealth.gov.ng/CodeSystem/eligibility-request-id</code>/ELAPPROVE02</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage Validation</p><p><b>patient</b>: <a href=\"Patient-Patient-Chika-Okafor.html\">Chika Okafor</a></p><p><b>created</b>: 2025-11-07 00:09:00+0100</p><p><b>requestor</b>: <a href=\"Organization-Organization-PortHarcourt-Hospital.html\">Port Harcourt Emergency Hospital</a></p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-NgCoverageEligibilityRequest-ChikaEmergency.html\">CoverageEligibilityRequest: identifier = https://fhir-ig.digitalhealth.gov.ng/CodeSystem/eligibility-request-id#ELAPPROVE01; status = active; purpose = validation; created = 2025-11-06 23:47:00+0100</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Pre-authorization APPROVED. Approved amount: ₦15,000. Patient copay: ₦1,500. Authorization code: PA-2025-8847. Valid until: 10-Nov-2025.</p><p><b>insurer</b>: <a href=\"Organization-Organization-Truth-HMO.html\">Truth HMO</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Coverage-Coverage-Chika-TruthHMO.html\">Truth HMO Policy - Chika Okafor</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 73610}\">Ankle X-ray - Right ankle sprain (ICD-10: S93.4)</span></p><p><b>description</b>: Pre-authorization approved for emergency ankle X-ray. Valid until 10-Nov-2025.</p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN15,000.00</span> (NGN)</p><p><b>used</b>: <span title=\"Nigerian Naira\">NGN0.00</span> (NGN)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type copay}\">Copayment per service</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN1,500.00</span> (NGN)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type room}\">HMO Coverage Amount</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN13,500.00</span> (NGN)</p></blockquote><p><b>authorizationRequired</b>: true</p><p><b>authorizationSupporting</b>: <span title=\"Codes:\">Emergency presentation with suspected fracture</span></p><p><b>authorizationUrl</b>: <a href=\"CodeSystem-eligibility-request-id.html\">https://fhir-ig.digitalhealth.gov.ng/CodeSystem/eligibility-request-id#PA-2025-8847</a></p></blockquote></blockquote><p><b>preAuthRef</b>: PA-2025-8847</p></div>"
  },
  "identifier" : [{
    "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/eligibility-request-id",
    "value" : "ELAPPROVE02"
  }],
  "status" : "active",
  "purpose" : ["validation"],
  "patient" : {
    "reference" : "Patient/Patient-Chika-Okafor",
    "display" : "Chika Okafor"
  },
  "created" : "2025-11-07T00:09:00+01:00",
  "requestor" : {
    "reference" : "Organization/Organization-PortHarcourt-Hospital",
    "display" : "Port Harcourt Emergency Hospital"
  },
  "request" : {
    "reference" : "CoverageEligibilityRequest/NgCoverageEligibilityRequest-ChikaEmergency"
  },
  "outcome" : "complete",
  "disposition" : "Pre-authorization APPROVED. Approved amount: ₦15,000. Patient copay: ₦1,500. Authorization code: PA-2025-8847. Valid until: 10-Nov-2025.",
  "insurer" : {
    "reference" : "Organization/Organization-Truth-HMO",
    "display" : "Truth HMO"
  },
  "insurance" : [{
    "coverage" : {
      "reference" : "Coverage/Coverage-Chika-TruthHMO",
      "display" : "Truth HMO Policy - Chika Okafor"
    },
    "inforce" : true,
    "item" : [{
      "productOrService" : {
        "coding" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "73610",
          "display" : "Radiologic examination, ankle; complete, minimum of 3 views"
        }],
        "text" : "Ankle X-ray - Right ankle sprain (ICD-10: S93.4)"
      },
      "description" : "Pre-authorization approved for emergency ankle X-ray. Valid until 10-Nov-2025.",
      "benefit" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
            "code" : "benefit",
            "display" : "Benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 15000,
          "currency" : "NGN"
        },
        "usedMoney" : {
          "value" : 0,
          "currency" : "NGN"
        }
      },
      {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
            "code" : "copay",
            "display" : "Copayment per service"
          }]
        },
        "allowedMoney" : {
          "value" : 1500,
          "currency" : "NGN"
        }
      },
      {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
            "code" : "room",
            "display" : "Room"
          }],
          "text" : "HMO Coverage Amount"
        },
        "allowedMoney" : {
          "value" : 13500,
          "currency" : "NGN"
        }
      }],
      "authorizationRequired" : true,
      "authorizationSupporting" : [{
        "text" : "Emergency presentation with suspected fracture"
      }],
      "authorizationUrl" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/eligibility-request-id#PA-2025-8847"
    }]
  }],
  "preAuthRef" : "PA-2025-8847"
}