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

• Narrative Content
• XML
• JSON

: CoverageDental1 - JSON Representation

Raw json | Download

{
  "resourceType" : "Coverage",
  "id" : "CoverageDental1",
  "meta" : {
    "lastUpdated" : "2021-01-01T14:22:01.0314215+00:00",
    "profile" : [
      "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|1.2.0"
    ]
  },
  "language" : "en-US",
  "text" : {
    "status" : "generated",
    "div" : "<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 \"CoverageDental1\" Updated \"2021-01-01T14:22:01.031Z\"  (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: 210300002</p><p><b>status</b>: active</p><p><b>type</b>: dental care 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>#DENTAL)</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>: 10300007</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>: 2021-01-01 --&gt; 2021-12-31</p><p><b>payor</b>: <a href=\"Organization-OrganizationDentalPayer1.html\">Organization/OrganizationDentalPayer1</a> \"INSURANCE COMPANY XYZ\"</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>: 10300007</p><p><b>name</b>: Transcorp - dental</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>: 66783JJT</p><p><b>name</b>: INSURANCE COMPANY XYZ - PRIME</p></blockquote><p><b>network</b>: INSURANCE COMPANY XYZ - PRIME</p></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "https://www.xxxhealthplan.com/fhir/memberidentifier",
      "value" : "210300002"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "DENTAL"
      }
    ],
    "text" : "dental care policy"
  },
  "policyHolder" : {
    "reference" : "Patient/Patient1"
  },
  "subscriber" : {
    "reference" : "Patient/Patient1"
  },
  "subscriberId" : "10300007",
  "beneficiary" : {
    "reference" : "Patient/Patient1"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2021-01-01",
    "end" : "2021-12-31"
  },
  "payor" : [
    {
      "reference" : "Organization/OrganizationDentalPayer1"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "10300007",
      "name" : "Transcorp - dental"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ],
        "text" : "Plan"
      },
      "value" : "66783JJT",
      "name" : "INSURANCE COMPANY XYZ - PRIME"
    }
  ],
  "network" : "INSURANCE COMPANY XYZ - PRIME"
}