QI-Core Implementation Guide
7.0.0-ballot - STU7 Ballot United States of America flag

This page is part of the Quality Improvement Core Framework (v7.0.0-ballot: STU7 (v7.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 6.0.0. For a full list of available versions, see the Directory of published versions

: Coverage example - Subscriber ID - XML Representation

Raw xml | Download



<Coverage xmlns="http://hl7.org/fhir">
  <id value="example-new"/>
  <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 example-new</b></p><a name="example-new"> </a><a name="hcexample-new"> </a><a name="example-new-en-US"> </a><p><b>identifier</b>: Member Number/?ngen-9?</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{https://nahdo.org/sopt 59}">Other Private Insurance</span></p><p><b>policyHolder</b>: <a href="Patient-example.html">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriber</b>: <a href="Patient-example.html">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriberId</b>: 12191</p><p><b>beneficiary</b>: <a href="Patient-example.html">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</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 --&gt; 2012-05-23</p><p><b>payor</b>: <a href="Organization-example.html">Organization Health Level Seven International</a></p><p><b>order</b>: 9</p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="https://nahdo.org/sopt"/>
      <code value="59"/>
      <display value="Other Private Insurance"/>
    </coding>
  </type>
  <policyHolder>🔗 
    <reference value="Patient/example"/>
  </policyHolder>
  <subscriber>🔗 
    <reference value="Patient/example"/>
  </subscriber>
  <subscriberId value="12191"/>
  <beneficiary>🔗 
    <reference value="Patient/example"/>
  </beneficiary>
  <dependent value="0"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>🔗 
    <reference value="Organization/example"/>
  </payor>
  <!--  No longer part of the Coverage resource in R4, not clear how to represent this in the R4 resource  -->
  <!-- grouping>
    <group value="CBI35"/>
    <groupDisplay value="Corporate Baker's Inc. Local #35"/>
    <subGroup value="123"/>
    <subGroupDisplay value="Trainee Part-time Benefits"/>
    <plan value="B37FC"/>
    <planDisplay value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
    <subPlan value="P7"/>
    <subPlanDisplay value="Includes afterlife benefits"/>
    <class value="SILVER"/>
    <classDisplay value="Silver: Family Plan spouse only"/>
    <subClass value="Tier2"/>
    <subClassDisplay value="Low deductable, max $20 copay"/>
  </grouping -->
  <order value="9"/>
</Coverage>