FHIR Implementation Guide for HCX
0.7.1 - CI Build
FHIR Implementation Guide for HCX
0.7.1 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.7.1). See the Directory of published versions
{
"resourceType" : "InsurancePlan",
"id" : "AB_GUJ_UniqueIdForTheObject",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: InsurancePlan</b><a name=\"AB_GUJ_UniqueIdForTheObject\"> </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 InsurancePlan "AB_GUJ_UniqueIdForTheObject" </p></div><p><b>identifier</b>: id:\u00a0AB_GUJ_Plan1\u00a0(use:\u00a0USUAL,\u00a0period:\u00a02001-05-06 --> (ongoing))</p><p><b>status</b>: active</p><p><b>type</b>: Medical <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-insurance-plan-type.html\">Insurance plan type</a>#medical)</span></p><p><b>name</b>: PMJAY-Mukhyamantri Amrutam & Mukhyamantri Vatsalya</p><p><b>period</b>: 2020-09-23 --> (ongoing)</p><p><b>ownedBy</b>: <a href=\"Organization/AB_GUJ_SHA\">Organization/AB_GUJ_SHA: Gujarat State Health Protection Society</a></p><p><b>administeredBy</b>: <a href=\"Organization/AB_GUJ_TPA_1\">Organization/AB_GUJ_TPA_1: MD India Healthcare Service (TPA) Pvt. Ltd.</a></p><p><b>coverageArea</b>: <a href=\"Location/GUJARAT\">Location/GUJARAT: Gujarat</a></p><blockquote><p><b>coverage</b></p><p><b>type</b>: Medical <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (coverage-type#Medical)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Inpatient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (benefit-type#Inpatient)</span></p><h3>Limits</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>500000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>type</b>: PMJAY_GUJ_GOLD_CARD <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (plan-type#PMJAY_GUJ_GOLD_CARD)</span></p><blockquote><p><b>specificCost</b></p><p><b>category</b>: Inpatient-packages <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (cost-category#Inpatient-packages)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Vertebroplasty <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (packages#IN010)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>hospitalization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (pacakgeCostTypes#hospitalization)</span></td><td>Gujarat SHA empaneled hospitals <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (applicabilityCodes#in-network)</span></td><td>22800 INR</td></tr></table></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: ABC Surgery <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (procedures#MC999A; unknown#ICD_PCS_001)</span></p><blockquote><p><b>cost</b></p><p><b>type</b>: hospitalization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (pacakgeCostTypes#hospitalization)</span></p><p><b>applicability</b>: Gujarat SHA empaneled hospitals <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (applicabilityCodes#in-network)</span></p><p><b>value</b>: 11000 INR</p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: hospitalization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (pacakgeCostTypes#hospitalization)</span></p><p><b>applicability</b>: Gujarat SHA empaneled hospitals <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (applicabilityCodes#in-network)</span></p><p><b>qualifiers</b>: STRAT002 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (stratificationTypes#STRAT002)</span>, IMP0005 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (implantCodes#IMP0005)</span></p><p><b>value</b>: 12000 INR</p></blockquote></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Microlaryngoscopic Surgery <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (packages#HBP_PACKAGE_00003)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Applicability</b></td><td><b>Qualifiers</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>hospitalization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (pacakgeCostTypes#hospitalization)</span></td><td>Gujarat SHA empaneled hospitals <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (applicabilityCodes#in-network)</span></td><td>STRAT002 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (stratificationTypes#STRAT002)</span>, IMP0005 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (implantCodes#IMP0005)</span></td><td>18500 INR</td></tr></table></blockquote></blockquote></blockquote></div>"
},
"identifier" : [
{
"use" : "usual",
"value" : "AB_GUJ_Plan1",
"period" : {
"start" : "2001-05-06"
}
}
],
"status" : "active",
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
"code" : "medical"
}
]
}
],
"name" : "PMJAY-Mukhyamantri Amrutam & Mukhyamantri Vatsalya",
"period" : {
"start" : "2020-09-23"
},
"ownedBy" : {
"reference" : "Organization/AB_GUJ_SHA",
"display" : "Gujarat State Health Protection Society"
},
"administeredBy" : {
"reference" : "Organization/AB_GUJ_TPA_1",
"display" : "MD India Healthcare Service (TPA) Pvt. Ltd."
},
"coverageArea" : [
{
"reference" : "Location/GUJARAT",
"display" : "Gujarat"
}
],
"coverage" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/coverage-type",
"code" : "Medical"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/benefit-type",
"code" : "Inpatient"
}
]
},
"limit" : [
{
"value" : {
"value" : 500000,
"unit" : "INR"
}
}
]
}
]
}
],
"plan" : [
{
"extension" : [
{
"extension" : [
{
"url" : "ProofOfIdentificationDocumentCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://hcx-valuesets/proofOfIdentificationDocumentCodes",
"version" : "1.0.0",
"code" : "12345",
"display" : "Aadhar Card"
}
]
}
},
{
"url" : "ProofOfIdentificationDocumentRequiredFlag",
"valueBoolean" : true
},
{
"url" : "ProofOfIdentificationDocumentMimeType",
"valueCode" : "application/pdf"
},
{
"url" : "ClinicalDiagnosticDocumentClaimUse",
"valueCode" : "preauthorization"
},
{
"url" : "DocumentationUrl",
"valueUrl" : "http://documentation-url"
}
],
"url" : "https://hcx-base-url/StructureDefinition/HCXProofOfIdentificationExtension"
},
{
"extension" : [
{
"url" : "ProofOfPresenceDocumentCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://hcx-valuesets/proofOfPresenceDocumentCodes",
"version" : "1.0.0",
"code" : "45678",
"display" : "Aadhar Verification XML"
}
]
}
},
{
"url" : "ProofOfPresenceDocumentRequiredFlag",
"valueBoolean" : true
},
{
"url" : "ProofOfPresenceDocumentMimeType",
"valueCode" : "application/xml"
},
{
"url" : "ClinicalDiagnosticDocumentClaimUse",
"valueCode" : "preauthorization"
},
{
"url" : "DocumentationUrl",
"valueUrl" : "http://documentation-url"
}
],
"url" : "https://hcx-base-url/StructureDefinition/HCXProofOfPresenceExtension"
}
],
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/plan-type",
"code" : "PMJAY_GUJ_GOLD_CARD"
}
]
},
"specificCost" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/cost-category",
"code" : "Inpatient-packages"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/packages",
"code" : "IN010",
"display" : "Vertebroplasty"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/pacakgeCostTypes",
"code" : "hospitalization"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/applicabilityCodes",
"code" : "in-network",
"display" : "Gujarat SHA empaneled hospitals"
}
]
},
"value" : {
"value" : 22800,
"unit" : "INR"
}
}
]
},
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/procedures",
"code" : "MC999A",
"display" : "ABC Surgery"
},
{
"system" : "ICD PCS codes",
"code" : "ICD_PCS_001"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/pacakgeCostTypes",
"code" : "hospitalization"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/applicabilityCodes",
"code" : "in-network",
"display" : "Gujarat SHA empaneled hospitals"
}
]
},
"value" : {
"value" : 11000,
"unit" : "INR"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/pacakgeCostTypes",
"code" : "hospitalization"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/applicabilityCodes",
"code" : "in-network",
"display" : "Gujarat SHA empaneled hospitals"
}
]
},
"qualifiers" : [
{
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/stratificationTypes",
"code" : "STRAT002"
}
]
},
{
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/implantCodes",
"code" : "IMP0005"
}
]
}
],
"value" : {
"value" : 12000,
"unit" : "INR"
}
}
]
},
{
"extension" : [
{
"extension" : [
{
"url" : "ClinicalDiagnosticDocumentCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://hcx-valuesets/clinicalDiagnosticsDocumentCodes",
"version" : "1.0.0",
"code" : "DOC-001",
"display" : "Investigation Report 1"
}
]
}
},
{
"url" : "ClinicalDiagnosticDocumentRequiredFlag",
"valueBoolean" : true
},
{
"url" : "ClinicalDiagnosticDocumentMimeType",
"valueCode" : "application/pdf"
},
{
"url" : "ClinicalDiagnosticDocumentClaimUse",
"valueCode" : "claim"
},
{
"url" : "DocumentationUrl",
"valueUrl" : "http://documentation-url"
}
],
"url" : "https://hcx-base-url/StructureDefinition/HCXDiagnosticDocumentsExtension"
},
{
"extension" : [
{
"url" : "InformationalMessagesCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://hcx-valuesets/InformationalMessagesCodes",
"version" : "1.0.0",
"code" : "INF-001",
"display" : "Information Message 1"
}
]
}
},
{
"url" : "InformationalMessageCode",
"valueCode" : "information"
},
{
"url" : "InformationalMessageClaimUse",
"valueCode" : "claim"
},
{
"url" : "DocumentationUrl",
"valueUrl" : "http://documentation-url"
}
],
"url" : "https://hcx-base-url/StructureDefinition/HCXInformationalMessagesExtension"
},
{
"extension" : [
{
"url" : "Questionnaire",
"valueReference" : {
"reference" : "Questionnnaire/1"
}
},
{
"url" : "QuestionnaireRequiredFlag",
"valueBoolean" : true
},
{
"url" : "QuestionnaireClaimUse",
"valueCode" : "claim"
},
{
"url" : "DocumentationUrl",
"valueUrl" : "http://documentation-url"
}
],
"url" : "https://hcx-base-url/StructureDefinition/HCXQuestionnairesExtension"
}
],
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/packages",
"code" : "HBP_PACKAGE_00003",
"display" : "Microlaryngoscopic Surgery"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/pacakgeCostTypes",
"code" : "hospitalization"
}
]
},
"applicability" : {
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/applicabilityCodes",
"code" : "in-network",
"display" : "Gujarat SHA empaneled hospitals"
}
]
},
"qualifiers" : [
{
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/stratificationTypes",
"code" : "STRAT002"
}
]
},
{
"coding" : [
{
"system" : "http://terminologyServer/ValueSets/implantCodes",
"code" : "IMP0005"
}
]
}
],
"value" : {
"value" : 18500,
"unit" : "INR"
}
}
]
}
]
}
]
}
]
}
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