CoverageMatchExample1
type: Coverage
node role: treeRoot
resource.id:
  value: CoverageMatchExample1
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Coverage for Robert Johnson - Subscriber ID: 12345678, Previous Health Plan, PPO-GOLD
coverage.status:
  value: draft
coverage.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ActCode
    coding.code:
      value: HIP
    coding.display:
      value: health insurance plan policy
coverage.subscriber:
  link: http://hl7.org/fhir/us/davinci-pdex/Patient/patient-prov-001
  reference.reference:
    value: Patient/patient-prov-001
coverage.subscriber id:
  value: 12345678
coverage.beneficiary:
  link: http://hl7.org/fhir/us/davinci-pdex/Patient/patient-prov-001
  reference.reference:
    value: Patient/patient-prov-001
coverage.relationship:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/subscriber-relationship
    coding.code:
      value: self
coverage.period:
  period.start:
    value: 2023-01-01
  period.end:
    value: 2023-12-31
coverage.payor:
  index: 0
  reference.identifier:
    identifier.system:
      value: http://hl7.org/fhir/sid/us-npi
    identifier.value:
      value: 9876543210
  reference.display:
    value: Previous Health Plan
coverage.class:
  index: 0
  coverage.class.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/coverage-class
      coding.code:
        value: group
  coverage.class.value:
    value: EMPLOY-12345
coverage.class:
  index: 1
  coverage.class.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/coverage-class
      coding.code:
        value: plan
  coverage.class.value:
    value: PPO-GOLD