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: Dental Coverage Example1

Generated Narrative: Coverage

Resource Coverage "CoverageDental1" Updated "2021-01-01 02:22:01+0000" (Language "en-US")

Profile: C4BB Coverage (version 2.0.0)

identifier: Member Number: 210300002

status: active

type: dental care policy (ActCode#DENTAL)

policyHolder: Patient/Patient2 " TEST"

subscriber: Patient/Patient2 " TEST"

subscriberId: 10300007

beneficiary: Patient/Patient2 " TEST"

dependent: 01

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: 2021-01-01 --> 2021-12-31

payor: Organization/DentalPayer1 "INSURANCE COMPANY XYZ"

class

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

value: 10300007

name: Transcorp - dental

class

type: Plan (Coverage Class Codes#plan)

value: 66783JJT

name: INSURANCE COMPANY XYZ - PRIME

network: INSURANCE COMPANY XYZ - PRIME

Notes:

Instance: CoverageDental1
InstanceOf: Coverage
Title: "Dental Coverage Example1"
Description: "Dental Coverage Example1"
Usage: #example
* meta.lastUpdated = "2021-01-01T14:22:01.0314215+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 = "210300002"
* status = #active
* type = http://terminology.hl7.org/CodeSystem/v3-ActCode#DENTAL
  * text = "dental care policy"
* policyHolder = Reference(Patient2)
* subscriber = Reference(Patient2)
* subscriberId = "10300007"
* beneficiary = Reference(Patient2)
* dependent = "01"
* relationship = http://terminology.hl7.org/CodeSystem/subscriber-relationship#self
* period.start = "2021-01-01"
* period.end = "2021-12-31"
* payor = Reference(DentalPayer1)
* class[0].type = http://terminology.hl7.org/CodeSystem/coverage-class#group
* class[=].type.text = "An employee group"
* class[=].value = "10300007"
* class[=].name = "Transcorp - dental"
* class[+].type = http://terminology.hl7.org/CodeSystem/coverage-class#plan
  * text = "Plan"
* class[=].value = "66783JJT"
* class[=].name = "INSURANCE COMPANY XYZ - PRIME"
* network = "INSURANCE COMPANY XYZ - PRIME"