This page is part of the Da Vinci Payer Data Exchange (v2.2.0: STU2.2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Page standards status: Informative |
<Coverage xmlns="http://hl7.org/fhir">
<id value="CoverageMatchExample2"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>Coverage for Sarah Williams - Subscriber ID: 87654321, Another Health Plan, HMO-BASIC</p></div>
</text>
<status value="draft"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="HIP"/>
<display value="health insurance plan policy"/>
</coding>
</type>
<subscriber>🔗
<reference value="Patient/patient-prov-002"/>
</subscriber>
<subscriberId value="87654321"/>
<beneficiary>🔗
<reference value="Patient/patient-prov-002"/>
</beneficiary>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
</coding>
</relationship>
<period>
<start value="2023-06-01"/>
<end value="2024-05-31"/>
</period>
<payor>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1111111111"/>
</identifier>
<display value="Another Health Plan"/>
</payor>
<class>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="group"/>
</coding>
</type>
<value value="EMPLOY-67890"/>
</class>
<class>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
</coding>
</type>
<value value="HMO-BASIC"/>
</class>
</Coverage>