This page is part of the CARIN Blue Button Implementation Guide (v1.0.0: STU 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

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: Coverage1 - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "Coverage1",
  "meta" : {
    "lastUpdated" : "2020-07-07T13:26:22.0314215+00:00",
    "profile" : [
      "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
    ]
  },
  "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><p><b>identifier</b>: Member Number: 1234-234-1243-12345678901</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>policyHolder</b>: <a href=\"Patient-Patient1.html\">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></a></p><p><b>subscriber</b>: <a href=\"Patient-Patient1.html\">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></a></p><p><b>subscriberId</b>: 12345678901</p><p><b>beneficiary</b>: <a href=\"Patient-Patient1.html\">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2019-01-01 --&gt; 2019-10-31</p><p><b>payor</b>: <a href=\"Organization-Payer1.html\">Generated Summary: language: en-US; National Provider Identifier: 345678, Payer ID: 901234; active; name: Payer 1</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class group}\">An employee 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>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class plan}\">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>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "https://www.xxxhealthplan.com/fhir/memberidentifier",
      "value" : "1234-234-1243-12345678901"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "HIP"
      }
    ],
    "text" : "health insurance plan policy"
  },
  "policyHolder" : {
    "reference" : "Patient/Patient1"
  },
  "subscriber" : {
    "reference" : "Patient/Patient1"
  },
  "subscriberId" : "12345678901",
  "beneficiary" : {
    "reference" : "Patient/Patient1"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2019-01-01",
    "end" : "2019-10-31"
  },
  "payor" : [
    {
      "reference" : "Organization/Payer1"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "021890",
      "name" : "Acme Corporation"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ],
        "text" : "Plan"
      },
      "value" : "XYZ123",
      "name" : "XYZ123-UPMC CONSUMER ADVA"
    }
  ],
  "network" : "XYZ123-UPMC CONSUMER ADVA"
}