BSeR: Bidirectional Services_eReferral
BSeR: Bidirectional Services_eReferral
This page is part of the Bidirectional Services eReferrals (BSeR) (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions 
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{
"resourceType" : "Coverage",
"id" : "coverage-BSeR-Coverage-eve-everywoman",
"meta" : {
"versionId" : "3",
"lastUpdated" : "2020-01-18T00:10:51.000-05:00",
"profile" : [
"http://hl7.org/fhir/us/bser/StructureDefinition/BSeR-Coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <tr>\n <td style=\"font-weight: bold\">id</td>\n <td>\n <div title=\"id\">coverage-BSeR-Coverage-eve-everywoman</div>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">meta</td>\n <td>\n <table>\n <tr>\n <td style=\"font-weight: bold\">profile</td>\n <td>\n <div title=\"profile\">http://hl7.org/fhir/us/bser/StructureDefinition/BSeR-Coverage</div>\n </td>\n </tr>\n </table>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">identifier</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <div title=\"system\">\n <a href=\"http://benefitsinc.com/certificate\">http://benefitsinc.com/certificate</a>\n </div>\n </li>\n <li>\n <div title=\"value\">12345</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">status</td>\n <td>\n <div title=\"status\">active</div>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">type</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <div title=\"display\">extended healthcare</div> (\n \n \n <div title=\"code\">EHCPOL</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/v3-ActCode\">http://terminology.hl7.org/CodeSystem/v3-ActCode</a>\n </div>\n </li>\n </ul>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">subscriber</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li/>\n <li>\n <a href=\"RelatedPerson-relatedperson-self-eve-everywoman.html\">Eve Everywoman</a>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">beneficiary</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li/>\n <li>\n <a href=\"Patient-patient-us-core-patient-eve-everywoman.html\">Eve Everywoman</a>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">relationship</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">self</div> )\n \n \n \n </li>\n </ul>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">period</td>\n <td>\n <table>\n <tr>\n <td style=\"font-weight: bold\">start</td>\n <td>\n <div title=\"start\">2019-05-23</div>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">end</td>\n <td>\n <div title=\"end\">2020-05-23</div>\n </td>\n </tr>\n </table>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">payor</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <a href=\"Organization-organization-bser-organization-saint-luke.html\">Organization/organization-bser-organization-saint-luke</a>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">group</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">CB135</div>\n </li>\n <li>\n <div title=\"name\">Corporate Baker's Inc. Local #35</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">subgroup</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">123</div>\n </li>\n <li>\n <div title=\"name\">Trainee Part-time Benefits</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">plan</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">B37FC</div>\n </li>\n <li>\n <div title=\"name\">Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">subplan</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">P7</div>\n </li>\n <li>\n <div title=\"name\">Includes afterlife benefits</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">class</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">SILVER</div>\n </li>\n <li>\n <div title=\"name\">Silver: Family Plan spouse only</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">subclass</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">Tier2</div>\n </li>\n <li>\n <div title=\"name\">Low deductable, max $20 copay</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">sequence</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">9</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">rxid</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">MDF12345</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">rxbin</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">987654</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">rxgroup</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">M35PT</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">rxpcn</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">234516</div>\n </li>\n </ul>\n </td>\n </tr>\n <tr>\n <td style=\"font-weight: bold\">class</td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li> (\n \n \n <div title=\"code\">sequence</div> )\n \n \n \n </li>\n <li>\n <div title=\"system\">\n <a href=\"http://terminology.hl7.org/CodeSystem/coverage-class\">http://terminology.hl7.org/CodeSystem/coverage-class</a>\n </div>\n </li>\n </ul>\n </li>\n <li>\n <div title=\"value\">9</div>\n </li>\n </ul>\n </td>\n </tr>\n </table>\n </div>"
},
"identifier" : [
{
"system" : "http://benefitsinc.com/certificate",
"value" : "12345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"subscriber" : {
"reference" : "RelatedPerson/relatedperson-self-eve-everywoman",
"display" : "Eve Everywoman"
},
"beneficiary" : {
"reference" : "Patient/patient-us-core-patient-eve-everywoman",
"display" : "Eve Everywoman"
},
"relationship" : {
"coding" : [
{
"code" : "self"
}
]
},
"period" : {
"start" : "2019-05-23",
"end" : "2020-05-23"
},
"payor" : [
{
"reference" : "Organization/organization-bser-organization-saint-luke"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "CB135",
"name" : "Corporate Baker's Inc. Local #35"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subgroup"
}
]
},
"value" : "123",
"name" : "Trainee Part-time Benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "B37FC",
"name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}
]
},
"value" : "P7",
"name" : "Includes afterlife benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "class"
}
]
},
"value" : "SILVER",
"name" : "Silver: Family Plan spouse only"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subclass"
}
]
},
"value" : "Tier2",
"name" : "Low deductable, max $20 copay"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxid"
}
]
},
"value" : "MDF12345"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxbin"
}
]
},
"value" : "987654"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxgroup"
}
]
},
"value" : "M35PT"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxpcn"
}
]
},
"value" : "234516"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
}
]
}
IG © 2019+ HL7 International - Public Health Work Group. Package hl7.fhir.us.bser#1.0.0 based on FHIR 4.0.1. Generated 2020-03-02
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