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
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Bundle;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "uapi-status-update-3"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update> ]
];
fhir:Bundle.type [ fhir:value "message"];
fhir:Bundle.timestamp [ fhir:value "2020-03-11T08:10:13-05:00"^^xsd:dateTime];
fhir:Bundle.entry [
fhir:index 0;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa" ];
fhir:Bundle.entry.resource <urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa>
], [
fhir:index 1;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0" ];
fhir:Bundle.entry.resource <urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0>
], [
fhir:index 2;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ];
fhir:Bundle.entry.resource <urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088>
], [
fhir:index 3;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2" ];
fhir:Bundle.entry.resource <urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2>
], [
fhir:index 4;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de" ];
fhir:Bundle.entry.resource <urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de>
], [
fhir:index 5;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4" ];
fhir:Bundle.entry.resource <urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4>
], [
fhir:index 6;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327" ];
fhir:Bundle.entry.resource <urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327>
].
<urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa> a fhir:MessageHeader;
fhir:Resource.id [ fhir:value "5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:MessageHeader.eventCoding [
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type" ];
fhir:Coding.code [ fhir:value "status-update" ]
];
fhir:MessageHeader.sender [
fhir:Reference.reference [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:MessageHeader.source [
fhir:MessageHeader.source.name [ fhir:value "Genentech-PACT" ];
fhir:MessageHeader.source.endpoint [ fhir:value "https://genentech-pps.my.salesforce.com" ]
];
fhir:MessageHeader.focus [
fhir:index 0;
fhir:Reference.reference [ fhir:value "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0" ];
fhir:Reference.type [ fhir:value "List" ]
].
<urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0> a fhir:List;
fhir:Resource.id [ fhir:value "8e055260-dd74-4c89-9ccf-3d2f47135ee0"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:List.status [ fhir:value "current"];
fhir:List.mode [ fhir:value "changes"];
fhir:List.title [ fhir:value "messageContext"];
fhir:List.entry [
fhir:index 0;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55" ];
fhir:Reference.type [ fhir:value "Patient" ] ]
], [
fhir:index 1;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ];
fhir:Reference.type [ fhir:value "Organization" ] ]
], [
fhir:index 2;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de" ];
fhir:Reference.type [ fhir:value "CoverageEligibilityRequest" ] ]
], [
fhir:index 3;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4" ];
fhir:Reference.type [ fhir:value "CoverageEligibilityResponse" ] ]
], [
fhir:index 4;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327" ];
fhir:Reference.type [ fhir:value "ClaimResponse" ] ]
].
<urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088> a fhir:Organization;
fhir:Resource.id [ fhir:value "01c31a2f-321d-4c6e-8349-206af8a88088"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "HOSP-12345" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.system [ fhir:value "http://dev.gene.com/fhir/mulesoft" ];
fhir:Identifier.value [ fhir:value "Vendor_AB_HOSP-12345" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "UAPI Process API Mulesoft" ] ]
];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "prov" ];
fhir:Coding.display [ fhir:value "Healthcare Provider" ] ]
];
fhir:Organization.name [ fhir:value "Mid Atlantic Retina"];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ]
];
fhir:Organization.address [
fhir:index 0;
fhir:Address.line [
fhir:value "8 Ranoldo Terrace";
fhir:index 0 ];
fhir:Address.city [ fhir:value "Cherry Hill" ];
fhir:Address.state [ fhir:value "NJ" ];
fhir:Address.postalCode [ fhir:value "08034" ];
fhir:Address.country [ fhir:value "US" ]
];
fhir:Organization.contact [
fhir:index 0;
fhir:Organization.contact.name [
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Yardav" ];
fhir:HumanName.given [
fhir:value "Venus";
fhir:index 0 ] ];
fhir:Organization.contact.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8882704882" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ] ], [
fhir:index 1;
fhir:ContactPoint.system [ fhir:value "fax" ];
fhir:ContactPoint.value [ fhir:value "8179974042" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "2"^^xsd:positiveInteger ] ]
].
<urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2> a fhir:Patient;
fhir:Resource.id [ fhir:value "7c0c0017-e08d-4a14-9889-9eea26303ff2"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-patient";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-patient> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:Patient.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "PI" ];
fhir:Coding.display [ fhir:value "Patient internal identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "540002" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "PI" ];
fhir:Coding.display [ fhir:value "Patient internal identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://dev.gene.com/patientmaster" ];
fhir:Identifier.value [ fhir:value "MPAT-000123" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Genentech Patient Master" ] ]
];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Michaelson" ];
fhir:HumanName.given [
fhir:value "Ryan";
fhir:index 0 ]
];
fhir:Patient.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "1231231234" ];
fhir:ContactPoint.use [ fhir:value "home" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ]
], [
fhir:index 1;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "1234561234" ];
fhir:ContactPoint.use [ fhir:value "mobile" ];
fhir:ContactPoint.rank [ fhir:value "2"^^xsd:positiveInteger ]
], [
fhir:index 2;
fhir:ContactPoint.system [ fhir:value "email" ];
fhir:ContactPoint.value [ fhir:value "bobster83@example.com" ];
fhir:ContactPoint.use [ fhir:value "home" ];
fhir:ContactPoint.rank [ fhir:value "3"^^xsd:positiveInteger ]
];
fhir:Patient.gender [ fhir:value "male"];
fhir:Patient.birthDate [ fhir:value "1972-10-29"^^xsd:date];
fhir:Patient.address [
fhir:index 0;
fhir:Address.line [
fhir:value "1234 Main St";
fhir:index 0 ];
fhir:Address.city [ fhir:value "San Francisco" ];
fhir:Address.state [ fhir:value "CA" ];
fhir:Address.postalCode [ fhir:value "94105" ];
fhir:Address.country [ fhir:value "US" ]
];
fhir:Patient.communication [
fhir:index 0;
fhir:Patient.communication.language [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
fhir:Coding.code [ fhir:value "en" ];
fhir:Coding.display [ fhir:value "English" ] ] ];
fhir:Patient.communication.preferred [ fhir:value "true"^^xsd:boolean ]
];
fhir:Patient.managingOrganization [
fhir:Reference.reference [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ]
].
<urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de> a fhir:CoverageEligibilityRequest;
fhir:Resource.id [ fhir:value "a0e6a72c-a35b-4e1c-890e-6d34ed51d4de"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.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>"
];
fhir:DomainResource.contained [
a fhir:Organization;
fhir:index 0;
fhir:Resource.id [ fhir:value "d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ] ];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "PAY-111" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ] ];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "ins" ] ] ];
fhir:Organization.name [ fhir:value "Dakotacare" ];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8778472862" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ] ]
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/SRType" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type" ];
fhir:Coding.code [ fhir:value "bipa" ];
fhir:Coding.display [ fhir:value "Benefit Investigation / Prior Authorization" ] ] ]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/Product" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/uapi-product-name" ];
fhir:Coding.code [ fhir:value "lucentis" ];
fhir:Coding.display [ fhir:value "Lucentis" ] ] ]
];
fhir:CoverageEligibilityRequest.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "old" ];
fhir:Identifier.system [ fhir:value "https://fhir.developer.gene.com/enrollment/bundle-enrollment-id" ];
fhir:Identifier.value [ fhir:value "c78bde64-95e8-41f9-8a37-b2ac9aaf33d6" ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.system [ fhir:value "https://genentech-pps.my.salesforce.com/Product-Case-Insurance" ];
fhir:Identifier.value [ fhir:value "Lucentis-5001P00000maWeFQAU-" ]
];
fhir:CoverageEligibilityRequest.status [ fhir:value "active"];
fhir:CoverageEligibilityRequest.purpose [
fhir:value "benefits";
fhir:index 0
];
fhir:CoverageEligibilityRequest.patient [
fhir:Reference.reference [ fhir:value "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:CoverageEligibilityRequest.created [ fhir:value "2021-05-27T08:10:13-05:00"^^xsd:dateTime];
fhir:CoverageEligibilityRequest.provider [
fhir:Reference.reference [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:CoverageEligibilityRequest.insurer [
fhir:Reference.reference [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Reference.type [ fhir:value "Organization" ]
].
<urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4> a fhir:CoverageEligibilityResponse;
fhir:Resource.id [ fhir:value "e89b0285-4582-4b1b-a448-f2cc467664f4"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.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>"
];
fhir:DomainResource.contained [
a fhir:Organization;
fhir:index 0;
fhir:Resource.id [ fhir:value "d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ] ];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "PAY-111" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ] ];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "ins" ] ] ];
fhir:Organization.name [ fhir:value "Dakotacare" ];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8778472862" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ] ]
], [
a fhir:Coverage;
fhir:index 1;
fhir:Resource.id [ fhir:value "42b41bdb-1781-49aa-a091-78cdd92129df" ];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage> ] ];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/PlanYear" ];
fhir:Extension.valueString [ fhir:value "Calendar Year" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber" ];
fhir:Extension.valueString [ fhir:value "jhgfdsd56e5r76" ] ];
fhir:Coverage.status [ fhir:value "active" ];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "HIP" ];
fhir:Coding.display [ fhir:value "health insurance plan policy" ] ] ];
fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545" ];
fhir:Reference.type [ fhir:value "RelatedPerson" ] ];
fhir:Coverage.subscriberId [ fhir:value "4353" ];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ] ];
fhir:Coverage.period [
fhir:Period.start [ fhir:value "2021-08-31"^^xsd:date ];
fhir:Period.end [ fhir:value "2021-09-07"^^xsd:date ] ];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.reference [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Reference.type [ fhir:value "Organization" ] ];
fhir:Coverage.class [
fhir:index 0;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "subplan" ];
fhir:Coding.display [ fhir:value "SubPlan" ] ] ];
fhir:Coverage.class.value [ fhir:value "CHAMPVA" ];
fhir:Coverage.class.name [ fhir:value "SubPlan" ] ], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "plan" ];
fhir:Coding.display [ fhir:value "Plan" ] ] ];
fhir:Coverage.class.value [ fhir:value "Miltary" ];
fhir:Coverage.class.name [ fhir:value "Plan" ] ], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "group" ];
fhir:Coding.display [ fhir:value "Group" ] ] ];
fhir:Coverage.class.value [ fhir:value "12344frgr" ];
fhir:Coverage.class.name [ fhir:value "Group" ] ];
fhir:Coverage.order [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Coverage.network [ fhir:value "Dakotacare" ]
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/statusOutcome" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/uapi-coverage-outcome" ];
fhir:Coding.code [ fhir:value "approved" ];
fhir:Coding.display [ fhir:value "Approved" ] ] ]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/predAuthTAT" ];
fhir:Extension.valueString [ fhir:value "5-7 Business Days" ]
], [
fhir:index 2;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired" ];
fhir:Extension.valueString [ fhir:value "No" ]
], [
fhir:index 3;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate" ];
fhir:Extension.valueString [ fhir:value "2022-05-14" ]
], [
fhir:index 4;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile" ];
fhir:Extension.valueString [ fhir:value "Yes" ]
], [
fhir:index 5;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate" ];
fhir:Extension.valueString [ fhir:value "2022-05-14" ]
], [
fhir:index 6;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency" ];
fhir:Extension.valueString [ fhir:value "6" ]
], [
fhir:index 7;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable" ];
fhir:Extension.valueString [ fhir:value "Yes" ]
], [
fhir:index 8;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed" ];
fhir:Extension.valueString [ fhir:value "2" ]
], [
fhir:index 9;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline" ];
fhir:Extension.valueString [ fhir:value "2022-05-14" ]
], [
fhir:index 10;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired" ];
fhir:Extension.valueString [ fhir:value "Denial Letter" ]
], [
fhir:index 11;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT" ];
fhir:Extension.valueString [ fhir:value "4" ]
];
fhir:CoverageEligibilityResponse.status [ fhir:value "active"];
fhir:CoverageEligibilityResponse.purpose [
fhir:value "benefits";
fhir:index 0
];
fhir:CoverageEligibilityResponse.patient [
fhir:Reference.reference [ fhir:value "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:CoverageEligibilityResponse.servicedDate [ fhir:value "2021-06-01"^^xsd:date];
fhir:CoverageEligibilityResponse.created [ fhir:value "2021-05-27T08:10:13-05:00"^^xsd:dateTime];
fhir:CoverageEligibilityResponse.request [
fhir:Reference.reference [ fhir:value "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de" ];
fhir:Reference.type [ fhir:value "CoverageEligibilityRequest" ]
];
fhir:CoverageEligibilityResponse.outcome [ fhir:value "complete"];
fhir:CoverageEligibilityResponse.disposition [ fhir:value "Yes, if medically necessary"];
fhir:CoverageEligibilityResponse.insurer [
fhir:Reference.reference [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:CoverageEligibilityResponse.insurance [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.coverage [
fhir:Reference.reference [ fhir:value "#42b41bdb-1781-49aa-a091-78cdd92129df" ] ];
fhir:CoverageEligibilityResponse.insurance.item [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service" ];
fhir:Coding.code [ fhir:value "billing" ];
fhir:Coding.display [ fhir:value "Billing Code" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "fullBI" ];
fhir:Coding.display [ fhir:value "Full BI" ] ] ] ], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DeductibleApply" ];
fhir:Coding.display [ fhir:value "Does Deductible Apply?" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "doesIndDedApplyFamily" ];
fhir:Coding.display [ fhir:value "does ind ded apply to family" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 3;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "FamDedMetBefore" ];
fhir:Coding.display [ fhir:value "Must Fam Ded Be Met Before Bene Cov" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 4;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "OOPApply" ];
fhir:Coding.display [ fhir:value "Does OOP Apply" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 5;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "IndividualOOPFamily" ];
fhir:Coding.display [ fhir:value "Does Individual OOP Apply to Family" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 6;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "100%Cov" ];
fhir:Coding.display [ fhir:value "100% Cov only if Family OOP Met" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 7;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "InsurerCostShare" ];
fhir:Coding.display [ fhir:value "Insurer Cost Share %" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 8;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "PatientCostShare" ];
fhir:Coding.display [ fhir:value "Patient Cost Share %" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 9;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "BuyBill" ];
fhir:Coding.display [ fhir:value "Buy and Bill" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 10;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DrugTierLevel" ];
fhir:Coding.display [ fhir:value "Drug Tier Level" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ], [
fhir:index 11;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "PatientCostInitial" ];
fhir:Coding.display [ fhir:value "Patient Cost Share % **Initial Coverage Stage" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "25" ] ], [
fhir:index 12;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DaysSupplyInitial" ];
fhir:Coding.display [ fhir:value "Day Supply **Initial Coverage Stage" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "30 day supply" ] ], [
fhir:index 13;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DrugCopayInitial" ];
fhir:Coding.display [ fhir:value "Drug Copay **Initial Coverage Stage" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "30.00" ] ], [
fhir:index 14;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "PatientCostCatastrophic" ];
fhir:Coding.display [ fhir:value "Patient Cost Share % **Catastrophic Coverage Stage" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "15" ] ], [
fhir:index 15;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DrugCopayCatastrophic" ];
fhir:Coding.display [ fhir:value "Drug Co-pay **Catastrophic Coverage Stage" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "10" ] ];
fhir:CoverageEligibilityResponse.insurance.item.authorizationRequired [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service" ];
fhir:Coding.code [ fhir:value "admin" ];
fhir:Coding.display [ fhir:value "Admin Code" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit" ];
fhir:Coding.code [ fhir:value "indivitual" ];
fhir:Coding.display [ fhir:value "Indivitual" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "deductible" ];
fhir:Coding.display [ fhir:value "deductible" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "OOPMax" ];
fhir:Coding.display [ fhir:value "OOP MAx" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "MaxBenefit/Year" ];
fhir:Coding.display [ fhir:value "Max Benefit/Year" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 3;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "MaxLifetimeAmount" ];
fhir:Coding.display [ fhir:value "Max Lifetime Amount" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 4;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "SpentDownAmount" ];
fhir:Coding.display [ fhir:value "Spent Down Amount" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 5;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "CoverageGap" ];
fhir:Coding.display [ fhir:value "Coverage Gap" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.authorizationRequired [ fhir:value "true"^^xsd:boolean ];
fhir:CoverageEligibilityResponse.insurance.item.authorizationSupporting [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting" ];
fhir:Coding.code [ fhir:value "form" ];
fhir:Coding.display [ fhir:value "Form" ] ] ] ], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service" ];
fhir:Coding.code [ fhir:value "billing" ];
fhir:Coding.display [ fhir:value "Billing Code" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit" ];
fhir:Coding.code [ fhir:value "family" ];
fhir:Coding.display [ fhir:value "Family" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "deductible" ];
fhir:Coding.display [ fhir:value "deductible" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "OOPMax" ];
fhir:Coding.display [ fhir:value "OOP Max" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "MaxBenefit/Year" ];
fhir:Coding.display [ fhir:value "Max Benefit/Year" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ] ], [
fhir:index 3;
fhir:CoverageEligibilityResponse.insurance.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service" ];
fhir:Coding.code [ fhir:value "billing" ];
fhir:Coding.display [ fhir:value "Billing Code" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ];
fhir:Coding.display [ fhir:value "In Network" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DrugCo-Pay" ];
fhir:Coding.display [ fhir:value "Drug Co-Pay" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "SpecialistCo-Pay" ];
fhir:Coding.display [ fhir:value "Specialist Co-Pay" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type" ];
fhir:Coding.code [ fhir:value "DeductibleApplyOOP" ];
fhir:Coding.display [ fhir:value "Does Deductible Apply to OOP" ] ] ];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "Yes" ] ] ]
].
<urn:uuid:d8649c36-7586-4b5e-994a-3d6978227327> a fhir:ClaimResponse;
fhir:Resource.id [ fhir:value "d8649c36-7586-4b5e-994a-3d6978227327"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:ClaimResponse.status [ fhir:value "active"];
fhir:ClaimResponse.type [
fhir:CodeableConcept.text [ fhir:value "pharmacy" ]
];
fhir:ClaimResponse.use [ fhir:value "claim"];
fhir:ClaimResponse.patient [
fhir:Reference.reference [ fhir:value "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55" ]
];
fhir:ClaimResponse.created [ fhir:value "2021-05-27T08:10:13-05:00"^^xsd:dateTime];
fhir:ClaimResponse.insurer [
fhir:Reference.reference [ fhir:value "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ]
];
fhir:ClaimResponse.outcome [ fhir:value "complete"].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
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