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
<Coverage xmlns="http://hl7.org/fhir">
<id value="Coverage1"/>
<meta>
<lastUpdated value="2020-07-07T13:26:22.0314215+00:00"/>
<profile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|1.2.0"/>
</meta>
<language value="en-US"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p><b>Generated Narrative</b></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource "Coverage1" Updated "2020-07-07T13:26:22.031Z" (Language "en-US") </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-C4BB-Coverage.html">C4BB Coverage (version 1.2.0)</a></p></div><p><b>identifier</b>: Member Number: 1234-234-1243-12345678901</p><p><b>status</b>: active</p><p><b>type</b>: health insurance plan policy <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-ActCode.html">ActCode</a>#HIP)</span></p><p><b>policyHolder</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> " EXAMPLE1"</p><p><b>subscriber</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> " EXAMPLE1"</p><p><b>subscriberId</b>: 12345678901</p><p><b>beneficiary</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> " EXAMPLE1"</p><p><b>dependent</b>: 01</p><p><b>relationship</b>: Self <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-subscriber-relationship.html">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2019-01-01 --> 2019-10-31</p><p><b>payor</b>: <a href="Organization-Payer1.html">Organization/Payer1</a> "Payer 1"</p><blockquote><p><b>class</b></p><p><b>type</b>: An employee group <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: 021890</p><p><b>name</b>: Acme Corporation</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Plan <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#plan)</span></p><p><b>value</b>: XYZ123</p><p><b>name</b>: XYZ123-UPMC CONSUMER ADVA</p></blockquote><p><b>network</b>: XYZ123-UPMC CONSUMER ADVA</p></div>
</text>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MB"/>
</coding>
</type>
<system value="https://www.xxxhealthplan.com/fhir/memberidentifier"/>
<value value="1234-234-1243-12345678901"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="HIP"/>
</coding>
<text value="health insurance plan policy"/>
</type>
<policyHolder>
<reference value="Patient/Patient1"/>
</policyHolder>
<subscriber>
<reference value="Patient/Patient1"/>
</subscriber>
<subscriberId value="12345678901"/>
<beneficiary>
<reference value="Patient/Patient1"/>
</beneficiary>
<dependent value="01"/>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
</coding>
</relationship>
<period>
<start value="2019-01-01"/>
<end value="2019-10-31"/>
</period>
<payor>
<reference value="Organization/Payer1"/>
</payor>
<class>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="group"/>
</coding>
<text value="An employee group"/>
</type>
<value value="021890"/>
<name value="Acme Corporation"/>
</class>
<class>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
</coding>
<text value="Plan"/>
</type>
<value value="XYZ123"/>
<name value="XYZ123-UPMC CONSUMER ADVA"/>
</class>
<network value="XYZ123-UPMC CONSUMER ADVA"/>
</Coverage>