FHIR Implementation Guide for HCX
0.7.0 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.7.0). See the Directory of published versions

: HCX Coverage Eligibility Request Document example - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "CoverageEligibilityRequestDocument-example-01",
  "meta" : {
    "lastUpdated" : "2022-02-08T21:49:55.458+05:30"
  },
  "identifier" : {
    "system" : "https://www.tmh.in/bundle",
    "value" : "CoverageEligibilityRequestDocument-example-01"
  },
  "type" : "document",
  "timestamp" : "2022-02-08T21:49:55.458+05:30",
  "entry" : [
    {
      "fullUrl" : "Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee",
      "resource" : {
        "resourceType" : "Composition",
        "id" : "42ff4a07-3e36-402f-a99e-29f16c0c9eee",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"42ff4a07-3e36-402f-a99e-29f16c0c9eee\"> </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 Composition \"42ff4a07-3e36-402f-a99e-29f16c0c9eee\" </p></div><p><b>identifier</b>: id: 42ff4a07-3e36-402f-a99e-29f16c0c9eee</p><p><b>status</b>: final</p><p><b>type</b>: Coverage Eligibility Request Doc <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (document-type#HcxCoverageEligibilityRequest)</span></p><p><b>date</b>: 2022-02-08 09:49:55+0530</p><p><b>author</b>: <a href=\"#Organization_Tmh01\">See above (Organization/Tmh01)</a></p><p><b>title</b>: Coverage Eligibility Request</p></div>"
        },
        "identifier" : {
          "system" : "https://www.tmh.in/hcx-documents",
          "value" : "42ff4a07-3e36-402f-a99e-29f16c0c9eee"
        },
        "status" : "final",
        "type" : {
          "coding" : [
            {
              "system" : "https://www.hcx.org/document-type",
              "code" : "HcxCoverageEligibilityRequest",
              "display" : "Coverage Eligibility Request Doc"
            }
          ]
        },
        "subject" : {
          "reference" : "Patient/RVH1003"
        },
        "date" : "2022-02-08T21:49:55+05:30",
        "author" : [
          {
            "reference" : "Organization/Tmh01"
          }
        ],
        "title" : "Coverage Eligibility Request",
        "section" : [
          {
            "title" : "# Eligibility Request",
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/ValueSet/resource-types",
                  "code" : "CoverageEligibilityRequest",
                  "display" : "Coverage Eligibility Request"
                }
              ],
              "text" : "CoverageEligibilityRequest"
            },
            "entry" : [
              {
                "reference" : "CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "Organization/Tmh01",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "Tmh01",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"Tmh01\"> </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 \"Tmh01\" </p></div><p><b>identifier</b>: id: HFR-ID-FOR-TMH, id: IRDA-ID-FOR-TMH</p><p><b>name</b>: Tata Memorial Hospital</p><p><b>alias</b>: TMH, TMC</p><p><b>telecom</b>: ph: (+91) 022-2417-7000</p><p><b>address</b>: Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012 Mumbai Maharashtra 400012 INDIA </p><p><b>endpoint</b>: <a href=\"https://www.tmc.gov.in/\">https://www.tmc.gov.in/: Website</a></p></div>"
        },
        "identifier" : [
          {
            "system" : "http://abdm.gov.in/facilities",
            "value" : "HFR-ID-FOR-TMH"
          },
          {
            "system" : "http://irdai.gov.in/facilities",
            "value" : "IRDA-ID-FOR-TMH"
          }
        ],
        "name" : "Tata Memorial Hospital",
        "alias" : [
          "TMH",
          "TMC"
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(+91) 022-2417-7000"
          }
        ],
        "address" : [
          {
            "line" : [
              "Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012"
            ],
            "city" : "Mumbai",
            "state" : "Maharashtra",
            "postalCode" : "400012",
            "country" : "INDIA"
          }
        ],
        "endpoint" : [
          {
            "reference" : "https://www.tmc.gov.in/",
            "display" : "Website"
          }
        ]
      }
    },
    {
      "fullUrl" : "Patient/RVH1003",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "RVH1003",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"RVH1003\"> </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 \"RVH1003\" </p></div><p><b>identifier</b>: Subscriber Number: BEN-101, id: hinapatel@abdm</p><p><b>name</b>: Hina Patel</p><p><b>gender</b>: female</p></div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "SN",
                  "display" : "Subscriber Number"
                }
              ]
            },
            "system" : "http://gicofIndia.com/beneficiaries",
            "value" : "BEN-101"
          },
          {
            "system" : "http://abdm.gov.in/patients",
            "value" : "hinapatel@abdm"
          }
        ],
        "name" : [
          {
            "text" : "Hina Patel"
          }
        ],
        "gender" : "female"
      }
    },
    {
      "fullUrl" : "CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6",
      "resource" : {
        "resourceType" : "CoverageEligibilityRequest",
        "id" : "dc82673b-8c71-48c2-8a17-16dcb3b035f6",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: CoverageEligibilityRequest</b><a name=\"dc82673b-8c71-48c2-8a17-16dcb3b035f6\"> </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 \"dc82673b-8c71-48c2-8a17-16dcb3b035f6\" </p></div><p><b>identifier</b>: id: dc82673b-8c71-48c2-8a17-16dcb3b035f6</p><p><b>status</b>: active</p><p><b>purpose</b>: discovery</p><p><b>patient</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>serviced</b>: 2022-02-07 09:49:56+0530 --&gt; 2022-02-09 09:49:56+0530</p><p><b>created</b>: 2022-02-08 09:49:56+0530</p><p><b>provider</b>: <a href=\"#Organization_Tmh01\">See above (Organization/Tmh01)</a></p><p><b>insurer</b>: <a href=\"#Organization_GICOFINDIA\">See above (Organization/GICOFINDIA)</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"#Coverage_dadde132-ad64-4d18-8c18-1d52d7e86abc\">See above (Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc)</a></td></tr></table></div>"
        },
        "identifier" : [
          {
            "system" : "https://www.tmh.in/coverage-eligibility-request",
            "value" : "dc82673b-8c71-48c2-8a17-16dcb3b035f6"
          }
        ],
        "status" : "active",
        "purpose" : [
          "discovery"
        ],
        "patient" : {
          "reference" : "Patient/RVH1003"
        },
        "servicedPeriod" : {
          "start" : "2022-02-07T21:49:56+05:30",
          "end" : "2022-02-09T21:49:56+05:30"
        },
        "created" : "2022-02-08T21:49:56+05:30",
        "provider" : {
          "reference" : "Organization/Tmh01"
        },
        "insurer" : {
          "reference" : "Organization/GICOFINDIA"
        },
        "insurance" : [
          {
            "focal" : true,
            "coverage" : {
              "reference" : "Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc"
            }
          }
        ]
      }
    },
    {
      "fullUrl" : "Organization/GICOFINDIA",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "GICOFINDIA",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"GICOFINDIA\"> </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 \"GICOFINDIA\" </p></div><p><b>identifier</b>: id: 112</p><p><b>name</b>: General Insurance Corporation of India</p></div>"
        },
        "identifier" : [
          {
            "system" : "http://irdai.gov.in/insurers",
            "value" : "112"
          }
        ],
        "name" : "General Insurance Corporation of India"
      }
    },
    {
      "fullUrl" : "Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "dadde132-ad64-4d18-8c18-1d52d7e86abc",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"dadde132-ad64-4d18-8c18-1d52d7e86abc\"> </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 Coverage \"dadde132-ad64-4d18-8c18-1d52d7e86abc\" </p></div><p><b>identifier</b>: id: policy-RVH1003</p><p><b>status</b>: active</p><p><b>subscriber</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>subscriberId</b>: SN-RVH1003</p><p><b>beneficiary</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>relationship</b>: self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (subscriber-relationship#self)</span></p><p><b>payor</b>: <a href=\"#Organization_GICOFINDIA\">See above (Organization/GICOFINDIA)</a></p></div>"
        },
        "identifier" : [
          {
            "system" : "https://www.gicofIndia.in/policies",
            "value" : "policy-RVH1003"
          }
        ],
        "status" : "active",
        "subscriber" : {
          "reference" : "Patient/RVH1003"
        },
        "subscriberId" : "SN-RVH1003",
        "beneficiary" : {
          "reference" : "Patient/RVH1003"
        },
        "relationship" : {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/ValueSet/subscriber-relationship",
              "code" : "self"
            }
          ]
        },
        "payor" : [
          {
            "reference" : "Organization/GICOFINDIA"
          }
        ]
      }
    }
  ]
}