National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting Implementation Guide
1.0.0-ballot - STU1 Ballot United States of America flag

This page is part of the National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

: Coverage - Example ACH Pass1 - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="coverage-example-ach-pass1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage coverage-example-ach-pass1</b></p><a name="coverage-example-ach-pass1"> </a><a name="hccoverage-example-ach-pass1"> </a><a name="coverage-example-ach-pass1-en-US"> </a><p><b>identifier</b>: Member Number/084536836</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode SUBSUPP}">subsidized supplemental health program</span></p><p><b>policyHolder</b>: Mom Parent</p><p><b>subscriberId</b>: 98435938934</p><p><b>beneficiary</b>: <a href="Patient-patient-example-ach-ach-pass1.html">Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN: 1601191901010308 (use: usual, ))</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship child}">Child</span></p><p><b>period</b>: 2020-08-01 --&gt; (ongoing)</p><p><b>payor</b>: Medicaid</p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
    </type>
    <system value="http://example.org/fhir/memberidentifier"/>
    <value value="084536836"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="SUBSUPP"/>
      <display value="subsidized supplemental health program"/>
    </coding>
  </type>
  <policyHolder>
    <display value="Mom Parent"/>
  </policyHolder>
  <subscriberId value="98435938934"/>
  <beneficiary>🔗 
    <reference value="Patient/patient-example-ach-ach-pass1"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="child"/>
      <display value="Child"/>
    </coding>
    <text value="Child"/>
  </relationship>
  <period>
    <start value="2020-08-01"/>
  </period>
  <payor>
    <display value="Medicaid"/>
  </payor>
</Coverage>