Universal API Implementation Guide
1.1.19 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "uapi-status-update-3",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update"
]
},
"type" : "message",
"timestamp" : "2020-03-11T08:10:13-05:00",
"entry" : [
{
"fullUrl" : "urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MessageHeader</b><a name=\"5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa\"> </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 MessageHeader \"5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-messageheader.html\">UAPI MessageHeader</a></p></div><p><b>event</b>: status-update (Details: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type code status-update = 'status-update', stated as 'null')</p><p><b>sender</b>: <a href=\"#Organization_01c31a2f-321d-4c6e-8349-206af8a88088\">See above (urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088)</a></p><h3>Sources</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>Genentech-PACT</td><td><a href=\"https://genentech-pps.my.salesforce.com\">https://genentech-pps.my.salesforce.com</a></td></tr></table><p><b>focus</b>: <a href=\"#List_8e055260-dd74-4c89-9ccf-3d2f47135ee0\">See above (urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0)</a></p></div>"
},
"eventCoding" : {
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type",
"code" : "status-update"
},
"sender" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
},
"source" : {
"name" : "Genentech-PACT",
"endpoint" : "https://genentech-pps.my.salesforce.com"
},
"focus" : [
{
"reference" : "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"type" : "List"
}
]
}
},
{
"fullUrl" : "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"resource" : {
"resourceType" : "List",
"id" : "8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: List</b><a name=\"8e055260-dd74-4c89-9ccf-3d2f47135ee0\"> </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 List \"8e055260-dd74-4c89-9ccf-3d2f47135ee0\" </p></div><p><b>status</b>: current</p><p><b>mode</b>: changes</p><p><b>title</b>: messageContext</p><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"Bundle-uapi-query-response-1-gpf.html#urn-uuid-b3d46ea3-62e6-4171-b818-d64712edfe55\">urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Organization_01c31a2f-321d-4c6e-8349-206af8a88088\">See above (urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#CoverageEligibilityRequest_a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\">See above (urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#CoverageEligibilityResponse_e89b0285-4582-4b1b-a448-f2cc467664f4\">See above (urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#ClaimResponse_d8649c36-7586-4b5e-994a-3d6978227327\">See above (urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327)</a></p></blockquote></div>"
},
"status" : "current",
"mode" : "changes",
"title" : "messageContext",
"entry" : [
{
"item" : {
"reference" : "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55",
"type" : "Patient"
}
},
{
"item" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
}
},
{
"item" : {
"reference" : "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"type" : "CoverageEligibilityRequest"
}
},
{
"item" : {
"reference" : "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4",
"type" : "CoverageEligibilityResponse"
}
},
{
"item" : {
"reference" : "urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327",
"type" : "ClaimResponse"
}
}
]
}
},
{
"fullUrl" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"resource" : {
"resourceType" : "Organization",
"id" : "01c31a2f-321d-4c6e-8349-206af8a88088",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"01c31a2f-321d-4c6e-8349-206af8a88088\"> </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 Organization \"01c31a2f-321d-4c6e-8349-206af8a88088\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: id: HOSP-12345(use: USUAL), id: Vendor_AB_HOSP-12345(use: OFFICIAL)</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-organization-type.html\">OrganizationType</a>#prov)</span></p><p><b>name</b>: Mid Atlantic Retina</p><p><b>telecom</b>: ph: -unknown-</p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p><h3>Contacts</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Telecom</b></td></tr><tr><td>*</td><td>Venus Yardav (OFFICIAL)</td><td>ph: 8882704882(WORK), fax: 8179974042(WORK)</td></tr></table></div>"
},
"identifier" : [
{
"use" : "usual",
"system" : "http://vendor.com/ab",
"value" : "HOSP-12345",
"assigner" : {
"display" : "AB Vendor"
}
},
{
"use" : "official",
"system" : "http://dev.gene.com/fhir/mulesoft",
"value" : "Vendor_AB_HOSP-12345",
"assigner" : {
"display" : "UAPI Process API Mulesoft"
}
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "prov",
"display" : "Healthcare Provider"
}
]
}
],
"name" : "Mid Atlantic Retina",
"telecom" : [
{
"system" : "phone"
}
],
"address" : [
{
"line" : [
"8 Ranoldo Terrace"
],
"city" : "Cherry Hill",
"state" : "NJ",
"postalCode" : "08034",
"country" : "US"
}
],
"contact" : [
{
"name" : {
"use" : "official",
"family" : "Yardav",
"given" : [
"Venus"
]
},
"telecom" : [
{
"system" : "phone",
"value" : "8882704882",
"use" : "work",
"rank" : 1
},
{
"system" : "fax",
"value" : "8179974042",
"use" : "work",
"rank" : 2
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2",
"resource" : {
"resourceType" : "Patient",
"id" : "7c0c0017-e08d-4a14-9889-9eea26303ff2",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"7c0c0017-e08d-4a14-9889-9eea26303ff2\"> </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 Patient \"7c0c0017-e08d-4a14-9889-9eea26303ff2\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-patient.html\">UAPI Patient</a></p></div><p><b>identifier</b>: Patient internal identifier: 540002(use: OFFICIAL), Patient internal identifier: MPAT-000123(use: USUAL)</p><p><b>name</b>: Ryan Michaelson (OFFICIAL)</p><p><b>telecom</b>: ph: 1231231234(HOME), ph: 1234561234(MOBILE), <a href=\"mailto:bobster83@example.com\">bobster83@example.com</a></p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1972-10-29</p><p><b>address</b>: 1234 Main St San Francisco CA 94105 US </p><h3>Communications</h3><table class=\"grid\"><tr><td>-</td><td><b>Language</b></td><td><b>Preferred</b></td></tr><tr><td>*</td><td>English <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ietf3066.html\">Tags for the Identification of Languages</a>#en)</span></td><td>true</td></tr></table><p><b>managingOrganization</b>: <a href=\"#Organization_01c31a2f-321d-4c6e-8349-206af8a88088\">See above (urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088)</a></p></div>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
]
},
"system" : "http://vendor.com/ab",
"value" : "540002",
"assigner" : {
"display" : "AB Vendor"
}
},
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
]
},
"system" : "http://dev.gene.com/patientmaster",
"value" : "MPAT-000123",
"assigner" : {
"display" : "Genentech Patient Master"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Michaelson",
"given" : [
"Ryan"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "1231231234",
"use" : "home",
"rank" : 1
},
{
"system" : "phone",
"value" : "1234561234",
"use" : "mobile",
"rank" : 2
},
{
"system" : "email",
"value" : "bobster83@example.com",
"use" : "home",
"rank" : 3
}
],
"gender" : "male",
"birthDate" : "1972-10-29",
"address" : [
{
"line" : [
"1234 Main St"
],
"city" : "San Francisco",
"state" : "CA",
"postalCode" : "94105",
"country" : "US"
}
],
"communication" : [
{
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en",
"display" : "English"
}
]
},
"preferred" : true
}
],
"managingOrganization" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088"
}
}
},
{
"fullUrl" : "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"resource" : {
"resourceType" : "CoverageEligibilityRequest",
"id" : "a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: CoverageEligibilityRequest</b><a name=\"a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\"> </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 CoverageEligibilityRequest \"a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-coverage-eligibility-request.html\">UAPI CoverageEligibilityRequest</a></p></div><p><b>UAPI CoverageEligibilityRequest ServiceRequestType</b>: Benefit Investigation / Prior Authorization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-uapi-sr-type.html\">UAPI Code System - Service Request Type</a>#bipa)</span></p><p><b>UAPI CoverageEligibilityRequest Product</b>: Lucentis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-uapi-product-name.html\">UAPI Code System - Product Names</a>#lucentis)</span></p><p><b>identifier</b>: id: c78bde64-95e8-41f9-8a37-b2ac9aaf33d6(use: OLD), id: Lucentis-5001P00000maWeFQAU-(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>purpose</b>: benefits</p><p><b>patient</b>: <a href=\"#Patient_7c0c0017-e08d-4a14-9889-9eea26303ff2\">See above (urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2)</a></p><p><b>created</b>: 2021-05-27 08:10:13-0500</p><p><b>provider</b>: <a href=\"#Organization_01c31a2f-321d-4c6e-8349-206af8a88088\">See above (urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088)</a></p><p><b>insurer</b>: <a href=\"Bundle-caf568e0-21b6-40e4-b0b8-1fdddef30fd2.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f</a></p></div>"
},
"contained" : [
{
"resourceType" : "Organization",
"id" : "d3637025-883d-4678-9e0a-1d243a338f9f",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
]
},
"identifier" : [
{
"use" : "usual",
"system" : "http://vendor.com/ab",
"value" : "PAY-111",
"assigner" : {
"display" : "AB Vendor"
}
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins"
}
]
}
],
"name" : "Dakotacare",
"telecom" : [
{
"system" : "phone",
"value" : "8778472862",
"use" : "work",
"rank" : 1
}
]
}
],
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/SRType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type",
"code" : "bipa",
"display" : "Benefit Investigation / Prior Authorization"
}
]
}
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/Product",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.developer.gene.com/CodeSystem/uapi-product-name",
"code" : "lucentis",
"display" : "Lucentis"
}
]
}
}
],
"identifier" : [
{
"use" : "old",
"system" : "https://fhir.developer.gene.com/enrollment/bundle-enrollment-id",
"value" : "c78bde64-95e8-41f9-8a37-b2ac9aaf33d6"
},
{
"use" : "official",
"system" : "https://genentech-pps.my.salesforce.com/Product-Case-Insurance",
"value" : "Lucentis-5001P00000maWeFQAU-"
}
],
"status" : "active",
"purpose" : [
"benefits"
],
"patient" : {
"reference" : "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2",
"type" : "Patient"
},
"created" : "2021-05-27T08:10:13-05:00",
"provider" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
},
"insurer" : {
"reference" : "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f",
"type" : "Organization"
}
}
},
{
"fullUrl" : "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4",
"resource" : {
"resourceType" : "CoverageEligibilityResponse",
"id" : "e89b0285-4582-4b1b-a448-f2cc467664f4",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name=\"e89b0285-4582-4b1b-a448-f2cc467664f4\"> </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 CoverageEligibilityResponse \"e89b0285-4582-4b1b-a448-f2cc467664f4\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-coverage-eligibility-response.html\">UAPI CoverageEligibilityResponse</a></p></div><p><b>UAPI CoverageEligibilityResponse Status</b>: Approved <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-uapi-coverage-outcome.html\">UAPI Code System - CoverageEligibilityRequest outcome</a>#approved)</span></p><p><b>UAPI PreD Est. TAT</b>: 5-7 Business Days</p><p><b>UAPI PCP Referral Required?</b>: No</p><p><b>UAPI PCP Referral Effective Date</b>: 2022-05-14</p><p><b>UAPI PCP Referral On-file?</b>: Yes</p><p><b>UAPI PCP Referral Recertification Date</b>: 2022-05-14</p><p><b>UAPI Spend Down Frequency</b>: 6</p><p><b>UAPI Peer to Peer Available</b>: Yes</p><p><b>UAPI # of Appeals Allowed</b>: 2</p><p><b>UAPI Appeal Submission Deadline</b>: 2022-05-14</p><p><b>UAPI Additional Documents Required</b>: Denial Letter</p><p><b>UAPI Estimated Appeal TAT</b>: 4</p><p><b>status</b>: active</p><p><b>purpose</b>: benefits</p><p><b>patient</b>: <a href=\"#Patient_7c0c0017-e08d-4a14-9889-9eea26303ff2\">See above (urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2)</a></p><p><b>serviced</b>: 2021-06-01</p><p><b>created</b>: 2021-05-27 08:10:13-0500</p><p><b>request</b>: <a href=\"#CoverageEligibilityRequest_a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\">See above (urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de)</a></p><p><b>outcome</b>: complete</p><p><b>disposition</b>: Yes, if medically necessary</p><p><b>insurer</b>: <a href=\"Bundle-caf568e0-21b6-40e4-b0b8-1fdddef30fd2.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a name=\"42b41bdb-1781-49aa-a091-78cdd92129df\"> </a></p><blockquote><p></p><p><a name=\"42b41bdb-1781-49aa-a091-78cdd92129df\"> </a></p><p><b>UAPI Coverage Plan Year</b>: Calendar Year</p><p><b>UAPI Coverage Reference Number</b>: jhgfdsd56e5r76</p><p><b>status</b>: active</p><p><b>type</b>: health insurance plan policy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#HIP)</span></p><p><b>subscriber</b>: <a href=\"Bundle-caf568e0-21b6-40e4-b0b8-1fdddef30fd2.html#urn-uuid-4db51d32-65c3-4f8c-959e-0155c6d14545\">urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545</a></p><p><b>subscriberId</b>: 4353</p><p><b>beneficiary</b>: <a href=\"Bundle-caf568e0-21b6-40e4-b0b8-1fdddef30fd2.html#urn-uuid-fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c</a></p><p><b>period</b>: 2021-08-31 --> 2021-09-07</p><p><b>payor</b>: <a href=\"Bundle-caf568e0-21b6-40e4-b0b8-1fdddef30fd2.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f</a></p><blockquote><p><b>class</b></p><p><b>type</b>: SubPlan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-coverage-class.html\">Coverage Class Codes</a>#subplan)</span></p><p><b>value</b>: CHAMPVA</p><p><b>name</b>: SubPlan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></p><p><b>value</b>: Miltary</p><p><b>name</b>: Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: 12344frgr</p><p><b>name</b>: Group</p></blockquote><p><b>order</b>: 1</p><p><b>network</b>: Dakotacare</p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: Billing Code <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-product-service#billing)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Full BI <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#fullBI)</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Does Deductible Apply? <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DeductibleApply)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: does ind ded apply to family <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#doesIndDedApplyFamily)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Must Fam Ded Be Met Before Bene Cov <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#FamDedMetBefore)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Does OOP Apply <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#OOPApply)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Does Individual OOP Apply to Family <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#IndividualOOPFamily)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: 100% Cov only if Family OOP Met <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#100%Cov)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Insurer Cost Share % <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#InsurerCostShare)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Patient Cost Share % <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#PatientCostShare)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Buy and Bill <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#BuyBill)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Drug Tier Level <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DrugTierLevel)</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Patient Cost Share % **Initial Coverage Stage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#PatientCostInitial)</span></p><p><b>allowed</b>: 25</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Day Supply **Initial Coverage Stage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DaysSupplyInitial)</span></p><p><b>allowed</b>: 30 day supply</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Drug Copay **Initial Coverage Stage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DrugCopayInitial)</span></p><p><b>allowed</b>: 30.00</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Patient Cost Share % **Catastrophic Coverage Stage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#PatientCostCatastrophic)</span></p><p><b>allowed</b>: 15</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Drug Co-pay **Catastrophic Coverage Stage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DrugCopayCatastrophic)</span></p><p><b>allowed</b>: 10</p></blockquote><p><b>authorizationRequired</b>: true</p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: Admin Code <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-product-service#admin)</span></p><p><b>unit</b>: Indivitual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-insurance-unit#indivitual)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#deductible)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: OOP MAx <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#OOPMax)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Max Benefit/Year <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#MaxBenefit/Year)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Max Lifetime Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#MaxLifetimeAmount)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Spent Down Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#SpentDownAmount)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Coverage Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#CoverageGap)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><p><b>authorizationRequired</b>: true</p><p><b>authorizationSupporting</b>: Form <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-authorization-supporting#form)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: Billing Code <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-product-service#billing)</span></p><p><b>unit</b>: Family <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-insurance-unit#family)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#deductible)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: OOP Max <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#OOPMax)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Max Benefit/Year <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#MaxBenefit/Year)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: Billing Code <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-product-service#billing)</span></p><p><b>network</b>: In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-benefit-network.html\">Network Type Codes</a>#in)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Drug Co-Pay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DrugCo-Pay)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Specialist Co-Pay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#SpecialistCo-Pay)</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Does Deductible Apply to OOP <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-benefit-type#DeductibleApplyOOP)</span></p><p><b>allowed</b>: Yes</p></blockquote></blockquote></blockquote></div>"
},
"contained" : [
{
"resourceType" : "Organization",
"id" : "d3637025-883d-4678-9e0a-1d243a338f9f",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
]
},
"identifier" : [
{
"use" : "usual",
"system" : "http://vendor.com/ab",
"value" : "PAY-111",
"assigner" : {
"display" : "AB Vendor"
}
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins"
}
]
}
],
"name" : "Dakotacare",
"telecom" : [
{
"system" : "phone",
"value" : "8778472862",
"use" : "work",
"rank" : 1
}
]
},
{
"resourceType" : "Coverage",
"id" : "42b41bdb-1781-49aa-a091-78cdd92129df",
"meta" : {
"profile" : [
"https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"
]
},
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/PlanYear",
"valueString" : "Calendar Year"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber",
"valueString" : "jhgfdsd56e5r76"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "HIP",
"display" : "health insurance plan policy"
}
]
},
"subscriber" : {
"reference" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
"type" : "RelatedPerson"
},
"subscriberId" : "4353",
"beneficiary" : {
"reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
"type" : "Patient"
},
"period" : {
"start" : "2021-08-31",
"end" : "2021-09-07"
},
"payor" : [
{
"reference" : "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f",
"type" : "Organization"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan",
"display" : "SubPlan"
}
]
},
"value" : "CHAMPVA",
"name" : "SubPlan"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan",
"display" : "Plan"
}
]
},
"value" : "Miltary",
"name" : "Plan"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group",
"display" : "Group"
}
]
},
"value" : "12344frgr",
"name" : "Group"
}
],
"order" : 1,
"network" : "Dakotacare"
}
],
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/statusOutcome",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.developer.gene.com/CodeSystem/uapi-coverage-outcome",
"code" : "approved",
"display" : "Approved"
}
]
}
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/predAuthTAT",
"valueString" : "5-7 Business Days"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired",
"valueString" : "No"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate",
"valueString" : "2022-05-14"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile",
"valueString" : "Yes"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate",
"valueString" : "2022-05-14"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency",
"valueString" : "6"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable",
"valueString" : "Yes"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed",
"valueString" : "2"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline",
"valueString" : "2022-05-14"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired",
"valueString" : "Denial Letter"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT",
"valueString" : "4"
}
],
"status" : "active",
"purpose" : [
"benefits"
],
"patient" : {
"reference" : "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2",
"type" : "Patient"
},
"servicedDate" : "2021-06-01",
"created" : "2021-05-27T08:10:13-05:00",
"request" : {
"reference" : "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"type" : "CoverageEligibilityRequest"
},
"outcome" : "complete",
"disposition" : "Yes, if medically necessary",
"insurer" : {
"reference" : "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f",
"type" : "Organization"
},
"insurance" : [
{
"coverage" : {
"reference" : "#42b41bdb-1781-49aa-a091-78cdd92129df"
},
"item" : [
{
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service",
"code" : "billing",
"display" : "Billing Code"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "fullBI",
"display" : "Full BI"
}
]
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DeductibleApply",
"display" : "Does Deductible Apply?"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "doesIndDedApplyFamily",
"display" : "does ind ded apply to family"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "FamDedMetBefore",
"display" : "Must Fam Ded Be Met Before Bene Cov"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "OOPApply",
"display" : "Does OOP Apply"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "IndividualOOPFamily",
"display" : "Does Individual OOP Apply to Family"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "100%Cov",
"display" : "100% Cov only if Family OOP Met"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "InsurerCostShare",
"display" : "Insurer Cost Share %"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "PatientCostShare",
"display" : "Patient Cost Share %"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "BuyBill",
"display" : "Buy and Bill"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DrugTierLevel",
"display" : "Drug Tier Level"
}
]
},
"allowedString" : "Yes"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "PatientCostInitial",
"display" : "Patient Cost Share % **Initial Coverage Stage"
}
]
},
"allowedString" : "25"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DaysSupplyInitial",
"display" : "Day Supply **Initial Coverage Stage"
}
]
},
"allowedString" : "30 day supply"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DrugCopayInitial",
"display" : "Drug Copay **Initial Coverage Stage"
}
]
},
"allowedString" : "30.00"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "PatientCostCatastrophic",
"display" : "Patient Cost Share % **Catastrophic Coverage Stage"
}
]
},
"allowedString" : "15"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DrugCopayCatastrophic",
"display" : "Drug Co-pay **Catastrophic Coverage Stage"
}
]
},
"allowedString" : "10"
}
],
"authorizationRequired" : true
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service",
"code" : "admin",
"display" : "Admin Code"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit",
"code" : "indivitual",
"display" : "Indivitual"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "deductible",
"display" : "deductible"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "OOPMax",
"display" : "OOP MAx"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "MaxBenefit/Year",
"display" : "Max Benefit/Year"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "MaxLifetimeAmount",
"display" : "Max Lifetime Amount"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "SpentDownAmount",
"display" : "Spent Down Amount"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "CoverageGap",
"display" : "Coverage Gap"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
}
],
"authorizationRequired" : true,
"authorizationSupporting" : [
{
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting",
"code" : "form",
"display" : "Form"
}
]
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service",
"code" : "billing",
"display" : "Billing Code"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit",
"code" : "family",
"display" : "Family"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "deductible",
"display" : "deductible"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "OOPMax",
"display" : "OOP Max"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "MaxBenefit/Year",
"display" : "Max Benefit/Year"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
},
"usedMoney" : {
"value" : 25,
"currency" : "USD"
}
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service",
"code" : "billing",
"display" : "Billing Code"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in",
"display" : "In Network"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DrugCo-Pay",
"display" : "Drug Co-Pay"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "SpecialistCo-Pay",
"display" : "Specialist Co-Pay"
}
]
},
"allowedMoney" : {
"value" : 25,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type",
"code" : "DeductibleApplyOOP",
"display" : "Does Deductible Apply to OOP"
}
]
},
"allowedString" : "Yes"
}
]
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "d8649c36-7586-4b5e-994a-3d6978227327",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"d8649c36-7586-4b5e-994a-3d6978227327\"> </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 ClaimResponse \"d8649c36-7586-4b5e-994a-3d6978227327\" </p></div><p><b>status</b>: active</p><p><b>type</b>: pharmacy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Bundle-uapi-query-response-1-gpf.html#urn-uuid-b3d46ea3-62e6-4171-b818-d64712edfe55\">urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55</a></p><p><b>created</b>: 2021-05-27 08:10:13-0500</p><p><b>insurer</b>: <a href=\"#Organization_01c31a2f-321d-4c6e-8349-206af8a88088\">See above (urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088)</a></p><p><b>outcome</b>: complete</p></div>"
},
"status" : "active",
"type" : {
"text" : "pharmacy"
},
"use" : "claim",
"patient" : {
"reference" : "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55"
},
"created" : "2021-05-27T08:10:13-05:00",
"insurer" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088"
},
"outcome" : "complete"
}
}
]
}
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
Links: Table of Contents |
QA Report