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

: Coverage Example 1 - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "CoverageEx1",
  "meta" : {
    "lastUpdated" : "2020-10-30T09:48:01.8462752-04:00",
    "source" : "Organization/PayerOrganizationExample1",
    "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 \"CoverageEx1\" Updated \"2020-10-30T13:48:01.846Z\"  (Language \"en-US\") </p><p style=\"margin-bottom: 0px\">Information Source: Organization/PayerOrganizationExample1!</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>: An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501</p><p><b>status</b>: active</p><p><b>policyHolder</b>: <a href=\"Patient-ExamplePatient1.html\">Patient/ExamplePatient1</a> \" TEST\"</p><p><b>subscriber</b>: <a href=\"Patient-ExamplePatient1.html\">Patient/ExamplePatient1</a> \" TEST\"</p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-ExamplePatient1.html\">Patient/ExamplePatient1</a> \" TEST\"</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>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-PayerOrganizationExample1.html\">Organization/PayerOrganizationExample1: UPMC Health Plan</a> \"UPMC Health Plan\"</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 \"Group\")</span></p><p><b>value</b>: MCHMO1</p><p><b>name</b>: MEDICARE HMO PLAN</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: A specific suite of benefits. <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 \"Plan\")</span></p><p><b>value</b>: GR5</p><p><b>name</b>: GR5-HMO DEDUCTIBLE</p></blockquote><p><b>network</b>: GR5-HMO DEDUCTIBLE</p></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "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" : "Organization/PayerOrganizationExample1",
        "display" : "UPMC Health Plan"
      }
    }
  ],
  "status" : "active",
  "policyHolder" : {
    "reference" : "Patient/ExamplePatient1"
  },
  "subscriber" : {
    "reference" : "Patient/ExamplePatient1"
  },
  "subscriberId" : "888009335",
  "beneficiary" : {
    "reference" : "Patient/ExamplePatient1"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ],
    "text" : "Self"
  },
  "period" : {
    "start" : "2020-01-01"
  },
  "payor" : [
    {
      "reference" : "Organization/PayerOrganizationExample1",
      "display" : "UPMC Health Plan"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group",
            "display" : "Group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "MCHMO1",
      "name" : "MEDICARE HMO PLAN"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ],
        "text" : "A specific suite of benefits."
      },
      "value" : "GR5",
      "name" : "GR5-HMO DEDUCTIBLE"
    }
  ],
  "network" : "GR5-HMO DEDUCTIBLE"
}