Financial
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(v5.0.0-draft-final:
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| Financial Management Work Group | Maturity Level : N/A | Standards Status : Informative | Compartments : Patient , Practitioner |
Raw JSON ( canonical form + also see JSON Format Specification )
General Person Primary Coverage with Benefit Details and new insurance
{
"resourceType": "CoverageEligibilityResponse",
"id": "E2502",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
"resourceType" : "CoverageEligibilityResponse",
"id" : "E2502",
"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"
}
]
"contained" : [{
"resourceType" : "Coverage",
"id" : "coverage-1",
"identifier" : [{
"system" : "http://benefitsinc.com/certificate",
"value" : "12345"
}],
"status" : "active",
"kind" : "insurance",
"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"
}]
},
"insurer" : {
"identifier" : {
"system" : "http://www.bindb.com/bin",
"value" : "123456"
}
},
"class" : [{
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHCPOL"
}]
},
"subscriber": {
"reference": "Patient/f201"
"value" : {
"value" : "CBI35"
},
"beneficiary": {
"reference": "Patient/f201"
"name" : "Corporate Baker's Inc. Plan#35"
},
{
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}]
},
"dependent": "1",
"relationship": {
"coding": [
{
"code": "self"
}
]
"value" : {
"value" : "123"
},
"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": [
"name" : "Trainee Part-time Benefits"
},
{
"system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value": "8812342"
}
],
"status": "active",
"purpose": [
"validation",
"benefits"
],
"patient": {
"reference": "Patient/f201"
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}]
},
"value" : {
"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"
"created" : "2014-09-16",
"requestor" : {
"identifier" : {
"system" : "http://national.org/clinic",
"value" : "OR1234"
}
},
"request": {
"reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"
"request" : {
"reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"
},
"outcome": "complete",
"disposition": "Policy is currently in-force.",
"insurer": {
"reference": "Organization/2"
"outcome" : "complete",
"disposition" : "Policy is currently in-force.",
"insurer" : {
"reference" : "Organization/2"
},
"insurance": [
{
"coverage": {
"reference": "#coverage-1"
"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"
}]
},
"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
}
]
"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"
}]
},
{
"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"
}
}
]
"allowedMoney" : {
"value" : 500000,
"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"
}
}
]
"usedMoney" : {
"value" : 3748.00,
"currency" : "USD"
}
},
{
"type" : {
"coding" : [{
"code" : "copay-maximum"
}]
},
{
"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."
"allowedMoney" : {
"value" : 100,
"currency" : "USD"
}
]
}
],
"form": {
"coding": [
},
{
"system": "http://national.org/form",
"code": "ELRSP/2017/01"
}
]
"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"
}]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR
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HL7.org
2011+.
FHIR
Release
4B
(v4.3.0)
hl7.fhir.r4b.core#4.3.0
R5
hl7.fhir.core#5.0.0-draft-final
generated
on
Sat,
May
28,
2022
12:54+1000.
Wed,
Mar
1,
2023
23:06+1100.
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