This page is part of the Post Acute Orders FHIR IG (v0.2.0: STU 1 Ballot 2) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Coverage",
"id" : "example",
"meta" : {
"versionId" : "8",
"lastUpdated" : "2020-08-09T23:27:39.427+00:00",
"source" : "#QPwVk0hKzW9hvHtn",
"profile" : [
"http://hl7.org/fhir/us/dme-orders/StructureDefinition/PAOX-coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>id</b>: example</p><p><b>meta</b>: </p><p><b>identifier</b>: id: 12345</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}\">extended healthcare</span></p><p><b>subscriber</b>: <a href=\"Patient-example1.html\">Generated Summary: id: example1; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME); gender: female; birthDate: 1987-02-20</a></p><p><b>beneficiary</b>: <a href=\"Patient-example1.html\">Generated Summary: id: example1; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME); gender: female; birthDate: 1987-02-20</a></p><p><b>dependent</b>: 0</p><p><b>relationship</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2011-05-23 --> 2012-05-23</p><p><b>payor</b>: <a href=\"Organization-Inpatient.html\">Generated Summary: id: Inpatient; id: 1063494177; active; name: St. Michael's Hospital; ph: (816)932-2000(WORK), http://www.stmichaelmedicalcenter.org(WORK)</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: CB135</p><p><b>name</b>: Corporate Baker's Inc. Local #35</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class subgroup}\">SubGroup</span></p><p><b>value</b>: 123</p><p><b>name</b>: Trainee Part-time Benefits</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: B37FC</p><p><b>name</b>: Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class subplan}\">SubPlan</span></p><p><b>value</b>: P7</p><p><b>name</b>: Includes afterlife benefits</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class class}\">Class</span></p><p><b>value</b>: SILVER</p><p><b>name</b>: Silver: Family Plan spouse only</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class subclass}\">SubClass</span></p><p><b>value</b>: Tier2</p><p><b>name</b>: Low deductable, max $20 copay</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class sequence}\">Sequence</span></p><p><b>value</b>: 9</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class rxid}\">RX Id</span></p><p><b>value</b>: MDF12345</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class rxbin}\">RX BIN</span></p><p><b>value</b>: 987654</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class rxgroup}\">RX Group</span></p><p><b>value</b>: M35PT</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}\">RX PCN</span></p><p><b>value</b>: 234516</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/coverage-class sequence}\">Sequence</span></p><p><b>value</b>: 9</p></blockquote></div>"
},
"identifier" : [
{
"system" : "http://benefitsinc.com/certificate",
"value" : "12345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"subscriber" : {
"reference" : "Patient/example1"
},
"beneficiary" : {
"reference" : "Patient/example1"
},
"dependent" : "0",
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2011-05-23",
"end" : "2012-05-23"
},
"payor" : [
{
"reference" : "Organization/Inpatient"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "CB135",
"name" : "Corporate Baker's Inc. Local #35"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subgroup"
}
]
},
"value" : "123",
"name" : "Trainee Part-time Benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "B37FC",
"name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}
]
},
"value" : "P7",
"name" : "Includes afterlife benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "class"
}
]
},
"value" : "SILVER",
"name" : "Silver: Family Plan spouse only"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subclass"
}
]
},
"value" : "Tier2",
"name" : "Low deductable, max $20 copay"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxid"
}
]
},
"value" : "MDF12345"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxbin"
}
]
},
"value" : "987654"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxgroup"
}
]
},
"value" : "M35PT"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxpcn"
}
]
},
"value" : "234516"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
}
]
}