Da Vinci - Member Attribution (ATR) List
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This page is part of the Risk Based Contracts Member Attribution List FHIR IG (v2.0.0: STU2 Release 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Coverage For Patient 1 - Example - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "1",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2019-06-06T03:04:12.348-04:00"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS",
            "code" : "commppo",
            "display" : "Commercial PPO"
          }
        ]
      }
    }
  ],
  "identifier" : [
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ]
      },
      "system" : "https://sitenv.org",
      "value" : "123456"
    }
  ],
  "status" : "active",
  "policyHolder" : {
    🔗 "reference" : "Patient/1"
  },
  "subscriber" : {
    🔗 "reference" : "Patient/1"
  },
  "subscriberId" : "AB3658",
  "beneficiary" : {
    🔗 "reference" : "Patient/1"
  },
  "dependent" : "00",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      🔗 "reference" : "Organization/2"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ]
      },
      "value" : "PPO"
    }
  ]
}