Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1 United States of America flag

This page is part of the Documentation Templates and Rules (v2.1.0: STU 2.1) 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

: CoverageExample - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage CoverageExample</b></p><a name="CoverageExample"> </a><a name="hcCoverageExample"> </a><a name="CoverageExample-en-US"> </a><p><b>status</b>: Active</p><p><b>subscriber</b>: <a href="Patient-examplepatient.html">Anonymous Patient Male, DoB: 1996-12-23</a></p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href="Patient-examplepatient.html">Anonymous Patient Male, DoB: 1996-12-23</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2022-01-01 --&gt; 2023-01-01</p><p><b>payor</b>: <a href="#hcCoverageExample/OrgExample">Organization Insurance Company</a></p><h3>Classes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}">Plan</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Organization #OrgExample</b></p><a name="CoverageExample/OrgExample"> </a><a name="hcCoverageExample/OrgExample"> </a><a name="CoverageExample/OrgExample-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-CLIA.html" title="&quot;The Centers for Medicare &amp; Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total, CLIA covers approximately 330,000 laboratory entities. The Division of Clinical Laboratory Improvement &amp; Quality, within the Quality, Safety &amp; Oversight Group, under the Center for Clinical Standards and Quality (CCSQ) has the responsibility for implementing the CLIA Program.

The objective of the CLIA program is to ensure quality laboratory testing. Although all clinical laboratories must be properly certified to receive Medicare or Medicaid payments, CLIA has no direct Medicare or Medicaid program responsibilities.&quot;

CMS CLIA certified laboratories will be assigned a10-digit alphanumeric CLIA identification number, with the &quot;D&quot; in the third position identifying the provider/supplier as a laboratory certified under CLIA.&quot;

CLIA is maintained by CMS. It is in the public domain and free to use without restriction.

See http://cms.gov/regulations-and-guidance/legislation/clia.">Clinical Laboratory Improvement Amendments</a>/10D0202020</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/organization-type pay}">Payer</span></p><p><b>name</b>: Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(Work)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US </p></blockquote></div>
  </text>
  <contained>
    <Organization>
      <id value="OrgExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"/>
      </meta>
      <identifier>
        <system value="urn:oid:2.16.840.1.113883.4.7"/>
        <value value="10D0202020"/>
      </identifier>
      <active value="true"/>
      <type>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/organization-type"/>
          <code value="pay"/>
          <display value="Payer"/>
        </coding>
      </type>
      <name value="Insurance Company"/>
      <telecom>
        <system value="phone"/>
        <value value="860-547-5001"/>
        <use value="work"/>
      </telecom>
      <address>
        <line value="680 Asylum Street"/>
        <city value="Hartford"/>
        <state value="CT"/>
        <postalCode value="06155"/>
        <country value="US"/>
      </address>
    </Organization>
  </contained>
  <status value="active"/>
  <subscriber>🔗 
    <reference value="Patient/examplepatient"/>
  </subscriber>
  <subscriberId value="PFP123450000"/>
  <beneficiary>🔗 
    <reference value="Patient/examplepatient"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
      <display value="Self"/>
    </coding>
  </relationship>
  <period>
    <start value="2022-01-01"/>
    <end value="2023-01-01"/>
  </period>
  <payor>
    <reference value="#OrgExample"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
        <display value="Plan"/>
      </coding>
    </type>
    <value value="Premim Family Plus"/>
    <name value="Premim Family Plus Plan"/>
  </class>
</Coverage>