Da Vinci Payer Data Exchange
2.1.0-ballot - STU2 Ballot United States of America flag

This page is part of the Da Vinci Payer Data Exchange (v2.1.0-ballot: STU2.1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

: ExampleCoverage - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="883210"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2020-10-28T09:26:23.217+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage 883210</b></p><a name="883210"> </a><a name="hc883210"> </a><a name="883210-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">version: 1; Last updated: 2020-10-28 09:26:23+0000</p><p style="margin-bottom: 0px">Profile: <a href="hhttp://hl7.org/fhir/us/davinci-hrex/2024Sep/StructureDefinition-hrex-coverage.html">HRex Coverage Profile</a></p></div><p><b>identifier</b>: Member Number/1039399818</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: 97531</p><p><b>beneficiary</b>: <a href="Patient-1.html">Johnny Appleseed  Male, DoB: 1986-01-01 ( Member Number)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>payor</b>: <a href="Organization-Payer1.html">Organization Payer 1</a></p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="http://example.org/someOrg/identifiers/whatever"/>
    <value value="1039399818"/>
  </identifier>
  <status value="active"/>
  <subscriberId value="97531"/>
  <beneficiary>🔗 
    <reference value="Patient/1"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <payor>🔗 
    <reference value="Organization/Payer1"/>
  </payor>
</Coverage>