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: Coverage Example 2

Generated Narrative

Resource "CoverageEx2" Updated "2020-10-30T13:48:01.846Z" (Language "en-US")

Information Source: Organization/PayerOrganizationExample1!

Profile: C4BB Coverage (version 1.2.0)

identifier: An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501

status: active

policyHolder: Patient/ExamplePatient1 " TEST"

subscriber: Patient/ExamplePatient1 " TEST"

subscriberId: 888009335

beneficiary: Patient/ExamplePatient1 " TEST"

dependent: 01

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: 2017-01-01 --> 2017-06-30

payor: Organization/PayerOrganizationExample1: UPMC Health Plan "UPMC Health Plan"

class

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

value: MCHMO1

name: MEDICARE HMO PLAN

class

type: A specific suite of benefits. (Coverage Class Codes#plan "Plan")

value: GI8

name: GI8-HMO DEDUCTIBLE

network: GI8-HMO DEDUCTIBLE

Notes:

FieldValue
resourceType "Coverage"
id "CoverageEx2"
meta.lastUpdated "2020-10-30T09:48:01.8462752-04:00"
meta.source "Organization/PayerOrganizationExample1"
meta.profile[0]"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
language "en-US"
identifier[0].type.coding[0].system "http://terminology.hl7.org/CodeSystem/v2-0203"
identifier[0].type.coding[0].code #MB
identifier[0].type.coding[0].display "Member Number"
identifier[0].type.text "An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier."
identifier[0].system "https://www.upmchealthplan.com/fhir/memberidentifier"
identifier[0].value 88800933501
identifier[0].assigner.reference "Organization/PayerOrganizationExample1"
identifier[0].assigner.display "UPMC Health Plan"
status "active"
policyHolder.reference "Patient/ExamplePatient1"
subscriber.reference "Patient/ExamplePatient1"
subscriberId "888009335"
beneficiary.reference "Patient/ExamplePatient1"
dependent "01"
relationship.coding[0].system "http://terminology.hl7.org/CodeSystem/subscriber-relationship"
relationship.coding[0].code #self
relationship.text "Self"
period.start "2017-01-01"
period.end "2017-06-30"
payor[0].reference "Organization/PayerOrganizationExample1"
payor[0].display "UPMC Health Plan"
class[0].type.coding[0].system "http://terminology.hl7.org/CodeSystem/coverage-class"
class[0].type.coding[0].code #group
class[0].type.coding[0].display "Group"
class[0].type.text "An employee group"
class[0].value MCHMO1
class[0].name "MEDICARE HMO PLAN"
class[1].type.coding[0].system "http://terminology.hl7.org/CodeSystem/coverage-class"
class[1].type.coding[0].code #plan
class[1].type.coding[0].display "Plan"
class[1].type.text "A specific suite of benefits."
class[1].value GI8
class[1].name "GI8-HMO DEDUCTIBLE"
network "GI8-HMO DEDUCTIBLE"