Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 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

: Submit Claim Insurance Example - XML Representation

Page standards status: Informative

Raw xml | Download



<Coverage xmlns="http://hl7.org/fhir">
  <id value="InsuranceExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Coverage</b><a name="InsuranceExample"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Coverage &quot;InsuranceExample&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-profile-coverage.html">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href="Patient-SubscriberExample.html">Patient/SubscriberExample</a> &quot; SMITH&quot;</p><p><b>payor</b>: <a href="Organization-InsurerExample.html">Organization/InsurerExample</a> &quot;MARYLAND CAPITAL INSURANCE COMPANY&quot;</p></div>
  </text>
  <status value="active"/>
  <beneficiary>🔗 
    <reference value="Patient/SubscriberExample"/>
  </beneficiary>
  <payor>🔗 
    <reference value="Organization/InsurerExample"/>
  </payor>
</Coverage>