Da Vinci Payer Data Exchange
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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

: Coverage to Match Example 2 - XML Representation

Page standards status: Informative

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<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>