This page is part of the Da Vinci Payer Data Exchange (v2.1.0: STU2.1) 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

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: coveragein2 - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="coverage-2"/>
  <meta>
    <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">Default Generated text for resource.</div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="http://example.org/old-payer"/>
    <value value="DH10001235"/>
  </identifier>
  <status value="draft"/>
  <subscriberId value="9876543789"/>
  <beneficiary>
    <reference value="Patient/2"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9876543210"/>
    </identifier>
    <display value="Old Health Plan"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="subplan"/>
      </coding>
    </type>
    <value value="P7"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="class"/>
      </coding>
    </type>
    <value value="SILVER"/>
  </class>
</Coverage>