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Unknown message CoverageEligibilityResponse "E2503" Version "1"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the CoverageEligibilityResponse.

{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "E2503",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2019-01-13T15:33:19.265Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "identifier" : [
    {
      "system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value" : "8812343"
    }
  ],
  "status" : "active",
  "purpose" : [
    "validation"
  ],
  "patient" : {
    "reference" : "Patient/f201"
  },
  "created" : "2014-09-16",
  "requestor" : {
    "identifier" : {
      "system" : "http://national.org/clinic",
      "value" : "OR1234"
    }
  },
  "request" : {
    "reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332406"
  },
  "outcome" : "error",
  "disposition" : "Eligibiliy request could not be processed, please address errors before submitting.",
  "insurer" : {
    "reference" : "Organization/2"
  },
  "form" : {
    "coding" : [
      {
        "system" : "http://national.org/form",
        "code" : "ELRSP/2017/01"
      }
    ]
  },
  "error" : [
    {
      "code" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication-error",
            "code" : "a001"
          }
        ]
      }
    }
  ]
}

Unknown message CoverageEligibilityResponse "E2502" Version "1"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the CoverageEligibilityResponse.

{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "E2502",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2019-01-13T15:33:19.234Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "contained" : [
    {
      "resourceType" : "Coverage",
      "id" : "coverage-1",
      "identifier" : [
        {
          "system" : "http://benefitsinc.com/certificate",
          "value" : "12345"
        }
      ],
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "EHCPOL"
          }
        ]
      },
      "subscriber" : {
        "reference" : "Patient/f201"
      },
      "beneficiary" : {
        "reference" : "Patient/f201"
      },
      "dependent" : "1",
      "relationship" : {
        "coding" : [
          {
            "code" : "self"
          }
        ]
      },
      "payor" : [
        {
          "identifier" : {
            "system" : "http://www.bindb.com/bin",
            "value" : "123456"
          }
        }
      ],
      "class" : [
        {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code" : "EHCPOL"
              }
            ]
          },
          "value" : "CBI35",
          "name" : "Corporate Baker's Inc. Plan#35"
        },
        {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "subplan"
              }
            ]
          },
          "value" : "123",
          "name" : "Trainee Part-time Benefits"
        },
        {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "sequence"
              }
            ]
          },
          "value" : "1"
        }
      ]
    }
  ],
  "identifier" : [
    {
      "system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value" : "8812342"
    }
  ],
  "status" : "active",
  "purpose" : [
    "validation",
    "benefits"
  ],
  "patient" : {
    "reference" : "Patient/f201"
  },
  "created" : "2014-09-16",
  "requestor" : {
    "identifier" : {
      "system" : "http://national.org/clinic",
      "value" : "OR1234"
    }
  },
  "request" : {
    "reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"
  },
  "outcome" : "complete",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    "reference" : "Organization/2"
  },
  "insurance" : [
    {
      "coverage" : {
        "reference" : "#coverage-1"
      },
      "inforce" : true,
      "item" : [
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "30",
                "display" : "Health Benefit Plan Coverage"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 500000,
                "currency" : "USD"
              },
              "usedMoney" : {
                "value" : 3748.00,
                "currency" : "USD"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "copay-maximum"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 100,
                "currency" : "USD"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "copay-percent"
                  }
                ]
              },
              "allowedUnsignedInt" : 20
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "69",
                "display" : "Maternity"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 15000,
                "currency" : "USD"
              }
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "F3",
                "display" : "Dental Coverage"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 2000,
                "currency" : "USD"
              }
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "F6",
                "display" : "Vision Coverage"
              }
            ]
          },
          "excluded" : true,
          "name" : "Vision",
          "description" : "Vision products and services such as exams, glasses and contact lenses."
        }
      ]
    }
  ],
  "form" : {
    "coding" : [
      {
        "system" : "http://national.org/form",
        "code" : "ELRSP/2017/01"
      }
    ]
  }
}

Unknown message CoverageEligibilityResponse "E2501" Version "1"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the CoverageEligibilityResponse.

{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "E2501",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2019-01-13T15:33:19.202Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "identifier" : [
    {
      "system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value" : "881234"
    }
  ],
  "status" : "active",
  "purpose" : [
    "validation",
    "benefits"
  ],
  "patient" : {
    "reference" : "Patient/pat1"
  },
  "servicedDate" : "2014-09-17",
  "created" : "2014-08-16",
  "request" : {
    "reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"
  },
  "outcome" : "complete",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    "reference" : "Organization/2"
  },
  "insurance" : [
    {
      "coverage" : {
        "reference" : "Coverage/9876B1"
      },
      "inforce" : true,
      "item" : [
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "30",
                "display" : "Health Benefit Plan Coverage"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 500000,
                "currency" : "SAR"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "copay-maximum"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 100,
                "currency" : "SAR"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "copay-percent"
                  }
                ]
              },
              "allowedUnsignedInt" : 20
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "69",
                "display" : "Maternity"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 15000,
                "currency" : "SAR"
              }
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "F3",
                "display" : "Dental Coverage"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 2000,
                "currency" : "SAR"
              }
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "F6",
                "display" : "Vision Coverage"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "annual"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 400,
                "currency" : "SAR"
              }
            }
          ]
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                "code" : "49",
                "display" : "Hospital Room and Board"
              }
            ]
          },
          "network" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
                "code" : "in"
              }
            ]
          },
          "unit" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
                "code" : "individual"
              }
            ]
          },
          "term" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
                "code" : "day"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "room"
                  }
                ]
              },
              "allowedString" : "shared"
            },
            {
              "type" : {
                "coding" : [
                  {
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 600,
                "currency" : "SAR"
              }
            }
          ]
        }
      ]
    }
  ]
}

Unknown message CoverageEligibilityResponse "E2500" Version "1"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the CoverageEligibilityResponse.

{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "E2500",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2019-01-13T15:33:19.156Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "identifier" : [
    {
      "system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value" : "881234"
    }
  ],
  "status" : "active",
  "purpose" : [
    "validation"
  ],
  "patient" : {
    "reference" : "Patient/pat1"
  },
  "created" : "2014-08-16",
  "request" : {
    "reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332402"
  },
  "outcome" : "complete",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    "reference" : "Organization/2"
  },
  "insurance" : [
    {
      "coverage" : {
        "reference" : "Coverage/9876B1"
      },
      "inforce" : true
    }
  ]
}