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 3

Generated Narrative: Coverage

Resource Coverage "Coverage3" Updated "2020-07-07 01:26:22+0000" (Language "en-US")

Profile: C4BB Coverage (version 2.0.0)

identifier: Member Number: 1234-234-1243-12345678901

status: active

type: health insurance plan policy (ActCode#HIP)

policyHolder: Patient/Patient2 " TEST"

subscriber: Patient/Patient2 " TEST"

subscriberId: 12345678901

beneficiary: Patient/Patient2 " TEST"

dependent: 01

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: 2019-01-01 --> 2019-10-31

payor: Organization/Payer1 "Organization Payer 1"

class

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

value: 021890

name: Acme Corporation

class

type: Plan (Coverage Class Codes#plan)

value: XYZ123

name: XYZ123-UPMC CONSUMER ADVA

network: XYZ123-UPMC CONSUMER ADVA

Notes:

Instance: Coverage3
InstanceOf: Coverage
Title: "Coverage Example 3"
Description: "Coverage Example 3"
Usage: #example
* meta.lastUpdated = "2020-07-07T13:26:22.0314215+00:00"
* 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
* identifier.system = "https://www.xxxhealthplan.com/fhir/memberidentifier"
* identifier.value = "1234-234-1243-12345678901"
* status = #active
* type = http://terminology.hl7.org/CodeSystem/v3-ActCode#HIP
  * text = "health insurance plan policy"
* policyHolder = Reference(Patient2)
* subscriber = Reference(Patient2)
* subscriberId = "12345678901"
* beneficiary = Reference(Patient2)
* dependent = "01"
* relationship = http://terminology.hl7.org/CodeSystem/subscriber-relationship#self
* period.start = "2019-01-01"
* period.end = "2019-10-31"
* payor = Reference(Payer1)
* class[0].type = http://terminology.hl7.org/CodeSystem/coverage-class#group
* class[=].type.text = "An employee group"
* class[=].value = "021890"
* class[=].name = "Acme Corporation"
* class[+].type = http://terminology.hl7.org/CodeSystem/coverage-class#plan
  * text = "Plan"
* class[=].value = "XYZ123"
* class[=].name = "XYZ123-UPMC CONSUMER ADVA"
* network = "XYZ123-UPMC CONSUMER ADVA"