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 3

Page standards status: Informative

Generated Narrative: Coverage Coverage3

Last updated: 2020-07-07 13:26:22+0000; Language: en-US

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

identifier: Member Number/1234-234-1243-12345678901

status: Active

type: health insurance plan policy

policyHolder: Member 01 Test Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)

subscriber: Member 01 Test Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)

subscriberId: 12345678901

beneficiary: Member 01 Test Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)

dependent: 01

relationship: Self

period: 2019-01-01 --> 2019-10-31

payor: Organization Organization Payer 1

class

type: An employee group

value: 021890

name: Acme Corporation

class

type: Plan

value: XYZ123

name: XYZ123-UPMC CONSUMER ADVA

network: XYZ123-UPMC CONSUMER ADVA

Notes:

Instance: Coverage3
InstanceOf: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.1.0-snapshot1
Title: "Coverage Example 3"
Description: "Coverage Example 3"
Usage: #example
* meta.lastUpdated = "2020-07-07T13:26:22.0314215+00:00"
* language = #en-US
* identifier
  * type = http://terminology.hl7.org/CodeSystem/v2-0203#MB
  * system = "https://www.xxxhealthplan.com/fhir/memberidentifier"
  * value = "1234-234-1243-12345678901"
* status = #active
* type = http://terminology.hl7.org/CodeSystem/v3-ActCode#HIP
  * text = "health insurance plan policy"
* policyHolder = Reference(Patient2)
* subscriber = Reference(Patient2)
* subscriberId = "12345678901"
* beneficiary = Reference(Patient2)
* dependent = "01"
* relationship = http://terminology.hl7.org/CodeSystem/subscriber-relationship#self
* period
  * start = "2019-01-01"
  * end = "2019-10-31"
* payor = Reference(Payer1)
* class[0]
  * type = http://terminology.hl7.org/CodeSystem/coverage-class#group
    * text = "An employee group"
  * value = "021890"
  * name = "Acme Corporation"
* class[+]
  * type = http://terminology.hl7.org/CodeSystem/coverage-class#plan
    * text = "Plan"
  * value = "XYZ123"
  * name = "XYZ123-UPMC CONSUMER ADVA"
* network = "XYZ123-UPMC CONSUMER ADVA"