CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.2.0 - STU 2 Ballot

This page is part of the CARIN Blue Button Implementation Guide (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Example Coverage: Coverage1

Generated Narrative

Resource "Coverage1" Updated "2020-07-07T13:26:22.031Z" (Language "en-US")

Profile: C4BB Coverage (version 1.2.0)

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

status: active

type: health insurance plan policy (ActCode#HIP)

policyHolder: Patient/Patient1 " EXAMPLE1"

subscriber: Patient/Patient1 " EXAMPLE1"

subscriberId: 12345678901

beneficiary: Patient/Patient1 " EXAMPLE1"

dependent: 01

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

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

payor: Organization/Payer1 "Payer 1"

class

type: An employee group (Coverage Class Codes#group)

value: 021890

name: Acme Corporation

class

type: Plan (Coverage Class Codes#plan)

value: XYZ123

name: XYZ123-UPMC CONSUMER ADVA

network: XYZ123-UPMC CONSUMER ADVA

Notes:

FieldValue
resourceType "Coverage"
id "Coverage1"
meta.profile[0]"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
meta.lastUpdated "2020-07-07T13:26:22.0314215+00:00"
class[0].type.coding[0].code #group
class[0].type.coding[0].system "http://terminology.hl7.org/CodeSystem/coverage-class"
class[0].type.text "An employee group"
class[0].value 021890
class[0].name "Acme Corporation"
class[1].type.coding[0].code #plan
class[1].type.coding[0].system "http://terminology.hl7.org/CodeSystem/coverage-class"
class[1].type.text "Plan"
class[1].value XYZ123
class[1].name "XYZ123-UPMC CONSUMER ADVA"
language "en-US"
status "active"
identifier[0].type.coding[0].code #MB
identifier[0].type.coding[0].system "http://terminology.hl7.org/CodeSystem/v2-0203"
identifier[0].value 1234-234-1243-12345678901
identifier[0].system "https://www.xxxhealthplan.com/fhir/memberidentifier"
type.coding[0].code #HIP
type.coding[0].system "http://terminology.hl7.org/CodeSystem/v3-ActCode"
type.text "health insurance plan policy"
policyHolder.reference "Patient/Patient1"
subscriber.reference "Patient/Patient1"
beneficiary.reference "Patient/Patient1"
subscriberId "12345678901"
dependent "01"
period.start "2019-01-01"
period.end "2019-10-31"
network "XYZ123-UPMC CONSUMER ADVA"
relationship.coding[0].code #self
relationship.coding[0].system "http://terminology.hl7.org/CodeSystem/subscriber-relationship"
payor[0].reference "Organization/Payer1"