Coverage Information

url

coverage

value: Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23

url

covered

value: conditional

url

pa-needed

value: satisfied

url

doc-needed

value: admin

url

doc-purpose

value: withclaim

url

info-needed

value: performer

url

billingCode

value: Current Procedural Terminology (CPT®) 77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

url

reason

value: Prior auth waved due to gold-card status

category: cat-other

code: Policy Link

value: http://example.org/somepayer/policy123.pdf#abc

qualification: Additional policy details can be found here

url

detail

url

questionnaire

value: http://example.org/some-payer/Questionnaire/123|1.3.0

url

date

value: 2019-02-15

url

coverage-assertion-id

value: 12345ABC

url

satisfied-pa-id

value: XXYYZ

url

contact

value: http://some-payer.org/xyz-sub-org/get-help-here.html

url

expiry-date

value: 2019-08-01

status: Draft

intent: Original Order

medication: mycophenolate mofetil 250 MG Oral Capsule [Cellcept]

subject: Jane Smith

encounter: http://example.org/Encounter/ABC

authoredOn: 2019-02-15

requester: Dr. Jones

note: By XYZ Insurance @2019-02-15 15:07:18-0500

Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission.

dosageInstruction

text: 6 tablets every 12 hours.

timing: Once per 12 hours

DoseAndRates

-	Dose[x]
*	6 tablet