Bidirectional Services eReferral (BSeR)
2.0.0-ballot - STU2 United States of America flag

This page is part of the Bidirectional Services eReferrals (BSeR) (v2.0.0-ballot: STU 2) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Example Coverage: Coverage - Eve Everywoman

Generated Narrative: Coverage

Resource Coverage "coverage-bser-coverage-eve-everywoman"

Profile: BSeR Coverage

identifier: Member Number: 12345

status: active

type: extended healthcare (ActCode#EHCPOL)

subscriber: RelatedPerson/relatedperson-us-core-relatedperson-self-eve-everywoman: Eve Everywoman " EVERYWOMAN"

beneficiary: Patient/patient-us-core-patient-eve-everywoman: Eve Everywoman " EVERYWOMAN"

relationship: self (RoleCode#ONESELF)

period: 2019-05-23 --> 2020-05-23

payor: Organization/organization-us-core-organization-saint-luke "Saint Luke's Hospital of Kansas City"

class

type: Group (Coverage Class Codes#group; Coverage Class Codes#subgroup)

value: 123

name: Full Coverage: Medical, Dental, Pharmacy, Vision, EHC

class

type: Plan (Coverage Class Codes#plan; Coverage Class Codes#subplan)

value: P7

name: Includes afterlife benefits

class

type: Class (Coverage Class Codes#class)

value: SILVER

name: Silver: Family Plan spouse only

class

type: SubClass (Coverage Class Codes#subclass)

value: Tier2

name: Low deductable, max $20 copay

class

type: Sequence (Coverage Class Codes#sequence)

value: 9

class

type: RX Id (Coverage Class Codes#rxid)

value: MDF12345

class

type: RX BIN (Coverage Class Codes#rxbin)

value: 987654

class

type: RX Group (Coverage Class Codes#rxgroup)

value: M35PT

class

type: RX PCN (Coverage Class Codes#rxpcn)

value: 234516

class

type: Sequence (Coverage Class Codes#sequence)

value: 9