Bundle uapi-copay-response-2 of type message

Entry 1 - Full URL = urn:uuid:410f399f-e309-4bc9-be19-8ab330e40397

Resource MessageHeader:

Generated Narrative: MessageHeader

Resource MessageHeader "410f399f-e309-4bc9-be19-8ab330e40397"

Texts

-	Div
*	<div></div>

event: Enrollment Response (Details: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type code enrollment-response = 'enrollment-response', stated as 'Enrollment Response')

Sources

-	Name	Endpoint
*	Genentech-FHIR-DEV	https://fhir.developer.gene.com/$process-message

Responses

-	Identifier	Code
*	id: 1-63c61a26-4965b3a156f488da6e0800ed	OK

focus: See above (urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1)

Entry 2 - Full URL = urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1

Resource Parameters:

Parameters

responder-patient	urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55
search-result	urn:uuid:aecbb129-9a73-4b59-9d66-ff5cdb3f3164

Entry 3 - Full URL = urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9

Resource Patient:

Ryan Michaelson (OFFICIAL) Male, DoB: 1972-10-29 ( Patient internal identifier: ca3c6274-e70b-45cf-a65a-30e8386d50bb(use: USUAL))

Entry 4 - Full URL = urn:uuid:b1fc009a-3710-49d8-81ad-cfa8e4a979fb

Resource Bundle:

Bundle b1fc009a-3710-49d8-81ad-cfa8e4a979fb of type searchset

---

Entry 1 - Full URL = urn:uuid:0d8ed4d1-26e8-4715-bf3d-34f368fe9585

Search:mode = match

Resource ExplanationOfBenefit:

Generated Narrative: ExplanationOfBenefit

Resource ExplanationOfBenefit "0d8ed4d1-26e8-4715-bf3d-34f368fe9585"

Texts

-	Div
*	<div></div>

identifier: id: 2747b8b5-97a7-ed11-827b-8ee762650010(use: USUAL)

status: ACTIVE

type: pharmacy ([not stated]#pharmacy)

use: PREDETERMINATION

patient: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

created: 2023-02-08 05:02:36+0000

insurer: urn:uuid:d02db104-a75c-433f-8764-9778c2e20626

provider: urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1

outcome: COMPLETE

Insurances

-	Focal	Coverage
*	true	See above (urn:uuid:597540c9-6248-466e-81e0-58e78f15454e)

---

Entry 2 - Full URL = urn:uuid:597540c9-6248-466e-81e0-58e78f15454e

Search:mode = include

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "597540c9-6248-466e-81e0-58e78f15454e"

Profile: UAPI Coverage

Texts

-	Div
*	<div></div>

UAPI Coverage - Card issuance date: 2023-01-01

status: ACTIVE

type: Pay (ActCode#pay)

subscriber: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

subscriberId: id: EYE00044117

beneficiary: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

period: 2023-01-01 --> 2023-12-31

class

type: RX BIN (Coverage Class Codes#rxbin)

value: id: 600426

name: BIN

class

type: RX PCN (Coverage Class Codes#rxpcn)

value: id: 54

name: PCN

class

type: Group (Coverage Class Codes#group)

value: id: EC38517002

name: Group Number

class

type: Plan (Coverage Class Codes#plan)

value: id: Vabysmo-Drug

name: Ophthalmology Co Pay program

order: 1

network: Genentech

---

Entry 3 - Full URL = urn:uuid:d9acfd1d-addc-4e0d-b7a6-ff921bde9236

Search:mode = match

Resource ExplanationOfBenefit:

Generated Narrative: ExplanationOfBenefit

Resource ExplanationOfBenefit "d9acfd1d-addc-4e0d-b7a6-ff921bde9236"

Texts

-	Div
*	<div></div>

identifier: id: ad44f19a-42b6-ed11-827c-9e11af077484(use: USUAL)

status: ACTIVE

type: institutional ([not stated]#institutional)

use: PREDETERMINATION

patient: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

created: 2023-02-26 09:01:11+0000

insurer: urn:uuid:d02db104-a75c-433f-8764-9778c2e20626

provider: urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1

outcome: COMPLETE

Insurances

-	Focal	Coverage
*	true	See above (urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e)

---

Entry 4 - Full URL = urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e

Search:mode = include

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "5c2e19ac-8227-4de5-a893-069dec07448e"

Profile: UAPI Coverage

Texts

-	Div
*	<div></div>

UAPI Coverage - Card issuance date: 2023-02-26

status: ACTIVE

type: Pay (ActCode#pay)

subscriber: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

subscriberId: id: EYE00044137

beneficiary: See above (urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9)

period: 2023-02-08 --> 2199-12-31

class

type: RX BIN (Coverage Class Codes#rxbin)

value: id: 600426

name: BIN

class

type: RX PCN (Coverage Class Codes#rxpcn)

value: id: 54

name: PCN

class

type: Group (Coverage Class Codes#group)

value: id: EC38532005

name: Group Number

class

type: Plan (Coverage Class Codes#plan)

value: id: Ophtha Administration

name: Ophthalmology Co Pay program

order: 1

network: Genentech