CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft United States of America flag

This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Example Coverage: Coverage Example 1

Page standards status: Informative

Generated Narrative: Coverage Coverage1

Last updated: 2020-10-30 09:48:01-0400; Language: en-US

Profile: C4BB Coverageversion: {0}2.1.0-snapshot1)

identifier: An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier./88800933501

status: Active

policyHolder: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)

subscriber: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)

subscriberId: 888009335

beneficiary: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)

dependent: 01

relationship: Self

period: 2020-01-01 --> (ongoing)

payor: UPMC Health Plan

class

type: An employee group

value: MCHMO1

name: MEDICARE HMO PLAN

class

type: A specific suite of benefits.

value: GR5

name: GR5-HMO DEDUCTIBLE

network: GR5-HMO DEDUCTIBLE

Notes:

Instance: Coverage1
InstanceOf: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.1.0-snapshot1
Title: "Coverage Example 1"
Description: "Coverage Example1"
Usage: #example
* meta.lastUpdated = "2020-10-30T09:48:01.8462752-04:00"
* language = #en-US
* identifier
  * type = http://terminology.hl7.org/CodeSystem/v2-0203#MB "Member Number"
    * text = "An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier."
  * system = "https://www.upmchealthplan.com/fhir/memberidentifier"
  * value = "88800933501"
  * assigner = Reference(Payer2) "UPMC Health Plan"
* status = #active
* policyHolder = Reference(Patient1)
* subscriber = Reference(Patient1)
* subscriberId = "888009335"
* beneficiary = Reference(Patient1)
* dependent = "01"
* relationship = http://terminology.hl7.org/CodeSystem/subscriber-relationship#self
  * text = "Self"
* period.start = "2020-01-01"
* payor = Reference(Payer2) "UPMC Health Plan"
* class[0]
  * type = http://terminology.hl7.org/CodeSystem/coverage-class#group "Group"
    * text = "An employee group"
  * value = "MCHMO1"
  * name = "MEDICARE HMO PLAN"
* class[+]
  * type = http://terminology.hl7.org/CodeSystem/coverage-class#plan "Plan"
    * text = "A specific suite of benefits."
  * value = "GR5"
  * name = "GR5-HMO DEDUCTIBLE"
* network = "GR5-HMO DEDUCTIBLE"