CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.0.0 - STU 2 US

This page is part of the CARIN Blue Button Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Coverage: Coverage Example 1

Generated Narrative: Coverage

Resource Coverage "Coverage1" Updated "2020-10-30 09:48:01-0400" (Language "en-US")

Profile: C4BB Coverage (version 2.0.0)

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/Patient1 " EXAMPLE1"

subscriber: Patient/Patient1 " EXAMPLE1"

subscriberId: 888009335

beneficiary: Patient/Patient1 " EXAMPLE1"

dependent: 01

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: 2020-01-01 --> (ongoing)

payor: Organization/Payer2: 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: GR5

name: GR5-HMO DEDUCTIBLE

network: GR5-HMO DEDUCTIBLE

Notes:

Instance: Coverage1
InstanceOf: Coverage
Title: "Coverage Example 1"
Description: "Coverage Example1"
Usage: #example
* meta.lastUpdated = "2020-10-30T09:48:01.8462752-04:00"
* meta.profile = "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.0.0"
* language = #en-US
* identifier.type = http://terminology.hl7.org/CodeSystem/v2-0203#MB "Member Number"
  * text = "An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier."
* identifier.system = "https://www.upmchealthplan.com/fhir/memberidentifier"
* identifier.value = "88800933501"
* identifier.assigner = Reference(Payer2) "UPMC Health Plan"
* status = #active
* policyHolder = Reference(Patient1)
* subscriber = Reference(Patient1)
* subscriberId = "888009335"
* beneficiary = Reference(Patient1)
* dependent = "01"
* relationship = http://terminology.hl7.org/CodeSystem/subscriber-relationship#self
  * text = "Self"
* period.start = "2020-01-01"
* payor = Reference(Payer2) "UPMC Health Plan"
* class[0].type = http://terminology.hl7.org/CodeSystem/coverage-class#group "Group"
* class[=].type.text = "An employee group"
* class[=].value = "MCHMO1"
* class[=].name = "MEDICARE HMO PLAN"
* class[+].type = http://terminology.hl7.org/CodeSystem/coverage-class#plan "Plan"
  * text = "A specific suite of benefits."
* class[=].value = "GR5"
* class[=].name = "GR5-HMO DEDUCTIBLE"
* network = "GR5-HMO DEDUCTIBLE"