FHIR Implementation Guide for HCX
0.8.0 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="CoverageEligibilityResponseDocument-example-01"/>
  <meta>
    <lastUpdated value="2021-12-22T15:32:26.605+05:30"/>
  </meta>
  <identifier>
    <system value="https://www.tmh.in/bundle"/>
    <value value="CoverageEligibilityResponseDocument-example-01"/>
  </identifier>
  <type value="document"/>
  <timestamp value="2021-12-22T15:32:26.605+05:30"/>
  <entry>
    <fullUrl value="Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
    <resource>
      <Composition>
        <id value="42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"> Coverage Eligibility Response document example</div>
        </text>
        <identifier>
          <system value="https://www.tmh.in/hcx-documents"/>
          <value value="42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
        </identifier>
        <status value="final"/>
        <type>
          <coding>
            <system value="https://hcx.org/document-types"/>
            <code value="HCXCoverageElibilityResponse"/>
            <display value="Coverage Eligibility Response"/>
          </coding>
        </type>
        <subject>
          <reference value="Patient/RVH1003"/>
        </subject>
        <date value="2021-12-22T15:32:26.605+05:30"/>
        <author>
          <reference value="Practitioner/1"/>
        </author>
        <title value="Coverage Eligibility Response"/>
        <section>
          <title value="Coverage Eligibility Response"/>
          <code>
            <coding>
              <system
                      value="https://www.hl7.org/fhir/valueset-resource-types"/>
              <code value="CoverageEligibilityResponse"/>
              <display value="Coverage Eligibility Response"/>
            </coding>
            <text value="CoverageEligibilityResponse"/>
          </code>
          <entry>
            <reference value="CoverageEligibilityResponse/res-id-1"/>
          </entry>
        </section>
      </Composition>
    </resource>
  </entry>
  <entry>
    <fullUrl value="CoverageEligibilityResponse/res-id-1"/>
    <resource>
      <CoverageEligibilityResponse>
        <id value="res-id-1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name="res-id-1"> </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 &quot;res-id-1&quot; </p></div><p><b>identifier</b>: id: urn:uuiad:581da6a9</p><p><b>status</b>: active</p><p><b>purpose</b>: discovery, benefits</p><p><b>patient</b>: <a href="#Patient_1">See above (Patient/1: Hina Patel)</a></p><p><b>serviced</b>: 2021-12-22 --&gt; 2021-12-25</p><p><b>created</b>: 2021-12-22</p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href="Coverage/9876B1">Coverage/9876B1</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>category</b>: Health Benefit Plan Coverage <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#30)</span></p><p><b>network</b>: In Network <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-network.html">Network Type Codes</a>#in)</span></p><p><b>unit</b>: Individual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-unit.html">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Annual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-term.html">Benefit Term Codes</a>#annual)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: benefit <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#benefit)</span></p><p><b>allowed</b>: <span title="Indian Rupee">₹500,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: copay-maximum <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#copay-maximum)</span></p><p><b>allowed</b>: <span title="Indian Rupee">₹100.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: copay-percent <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#copay-percent)</span></p><p><b>allowed</b>: 20</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>category</b>: Maternity <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#69)</span></p><p><b>network</b>: In Network <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-network.html">Network Type Codes</a>#in)</span></p><p><b>unit</b>: Individual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-unit.html">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Annual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-term.html">Benefit Term Codes</a>#annual)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td></tr><tr><td>*</td><td>benefit <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#benefit)</span></td><td><span title="Indian Rupee">₹15,000.00</span> (INR)</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>category</b>: Dental Coverage <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#F3)</span></p><p><b>network</b>: In Network <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-network.html">Network Type Codes</a>#in)</span></p><p><b>unit</b>: Individual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-unit.html">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Annual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-term.html">Benefit Term Codes</a>#annual)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td></tr><tr><td>*</td><td>benefit <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#benefit)</span></td><td><span title="Indian Rupee">₹2,000.00</span> (INR)</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>category</b>: Vision Coverage <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#F6)</span></p><p><b>network</b>: In Network <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-network.html">Network Type Codes</a>#in)</span></p><p><b>unit</b>: Individual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-unit.html">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Annual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-term.html">Benefit Term Codes</a>#annual)</span></p><h3>Benefits</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td></tr><tr><td>*</td><td>benefit <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#benefit)</span></td><td><span title="Indian Rupee">₹400.00</span> (INR)</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>category</b>: Hospital Room and Board <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#49)</span></p><p><b>network</b>: In Network <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-network.html">Network Type Codes</a>#in)</span></p><p><b>unit</b>: Individual <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-unit.html">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Day <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-term.html">Benefit Term Codes</a>#day)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: room <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#room)</span></p><p><b>allowed</b>: shared</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: benefit <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#benefit)</span></p><p><b>allowed</b>: <span title="Indian Rupee">₹600.00</span> (INR)</p></blockquote></blockquote></blockquote></div>
        </text>
        <identifier>
          <system value="urn:ietf:rfc:3986"/>
          <value value="urn:uuiad:581da6a9"/>
        </identifier>
        <status value="active"/>
        <purpose value="discovery"/>
        <purpose value="benefits"/>
        <patient>
          <reference value="Patient/1"/>
          <display value="Hina Patel"/>
        </patient>
        <servicedPeriod>
          <start value="2021-12-22"/>
          <end value="2021-12-25"/>
        </servicedPeriod>
        <created value="2021-12-22"/>
        <insurance>
          <coverage>
            <reference value="Coverage/9876B1"/>
          </coverage>
          <inforce value="true"/>
          <item>
            <category>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                <code value="30"/>
                <display value="Health Benefit Plan Coverage"/>
              </coding>
            </category>
            <network>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                <code value="in"/>
              </coding>
            </network>
            <unit>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                <code value="individual"/>
              </coding>
            </unit>
            <term>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                <code value="annual"/>
              </coding>
            </term>
            <benefit>
              <type>
                <coding>
                  <code value="benefit"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="500000"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
            <benefit>
              <type>
                <coding>
                  <code value="copay-maximum"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="100"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
            <benefit>
              <type>
                <coding>
                  <code value="copay-percent"/>
                </coding>
              </type>
              <allowedUnsignedInt value="20"/>
            </benefit>
          </item>
          <item>
            <category>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                <code value="69"/>
                <display value="Maternity"/>
              </coding>
            </category>
            <network>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                <code value="in"/>
              </coding>
            </network>
            <unit>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                <code value="individual"/>
              </coding>
            </unit>
            <term>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                <code value="annual"/>
              </coding>
            </term>
            <benefit>
              <type>
                <coding>
                  <code value="benefit"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="15000"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
          </item>
          <item>
            <category>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                <code value="F3"/>
                <display value="Dental Coverage"/>
              </coding>
            </category>
            <network>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                <code value="in"/>
              </coding>
            </network>
            <unit>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                <code value="individual"/>
              </coding>
            </unit>
            <term>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                <code value="annual"/>
              </coding>
            </term>
            <benefit>
              <type>
                <coding>
                  <code value="benefit"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="2000"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
          </item>
          <item>
            <category>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                <code value="F6"/>
                <display value="Vision Coverage"/>
              </coding>
            </category>
            <network>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                <code value="in"/>
              </coding>
            </network>
            <unit>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                <code value="individual"/>
              </coding>
            </unit>
            <term>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                <code value="annual"/>
              </coding>
            </term>
            <benefit>
              <type>
                <coding>
                  <code value="benefit"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="400"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
          </item>
          <item>
            <category>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                <code value="49"/>
                <display value="Hospital Room and Board"/>
              </coding>
            </category>
            <network>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                <code value="in"/>
              </coding>
            </network>
            <unit>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                <code value="individual"/>
              </coding>
            </unit>
            <term>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                <code value="day"/>
              </coding>
            </term>
            <benefit>
              <type>
                <coding>
                  <code value="room"/>
                </coding>
              </type>
              <allowedString value="shared"/>
            </benefit>
            <benefit>
              <type>
                <coding>
                  <code value="benefit"/>
                </coding>
              </type>
              <allowedMoney>
                <value value="600"/>
                <currency value="INR"/>
              </allowedMoney>
            </benefit>
          </item>
        </insurance>
      </CoverageEligibilityResponse>
    </resource>
  </entry>
  <entry>
    <fullUrl value="Patient/1"/>
    <resource>
      <Patient>
        <id value="1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Patient</b><a name="1"> </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 &quot;1&quot; </p></div><p><b>identifier</b>: PHRADDR: 654321, PMJAYID: QWRT12345</p><p><b>name</b>: Hina Patel (OFFICIAL)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1974-12-25</p></div>
        </text>
        <identifier>
          <type>
            <coding>
              <system value="http://ndhm.gov.in/ValueSet/identifier-type"/>
              <code value="PHRADDR"/>
            </coding>
          </type>
          <system value="http://ndhm.gov.in/healthId"/>
          <value value="654321"/>
        </identifier>
        <identifier>
          <type>
            <coding>
              <system value="http://ndhm.gov.in/ValueSet/identifier-type"/>
              <code value="PMJAYID"/>
            </coding>
          </type>
          <system value="http://ndhm.gov.in/pmjay"/>
          <value value="QWRT12345"/>
        </identifier>
        <name>
          <use value="official"/>
          <family value="Patel"/>
          <given value="Hina"/>
        </name>
        <gender value="female"/>
        <birthDate value="1974-12-25"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl value="Organization/MaxSaket01"/>
    <resource>
      <Organization>
        <id value="MaxSaket01"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Organization</b><a name="MaxSaket01"> </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 &quot;MaxSaket01&quot; </p></div><p><b>identifier</b>: id: HFR-10000005</p><p><b>name</b>: Max Super Speciality Hospital, Saket</p></div>
        </text>
        <identifier>
          <system value="https://ndhm.gov.in/hfr"/>
          <value value="HFR-10000005"/>
        </identifier>
        <name value="Max Super Speciality Hospital, Saket"/>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="Organization/2"/>
    <resource>
      <Organization>
        <id value="2"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Organization</b><a name="2"> </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 &quot;2&quot; </p></div><p><b>identifier</b>: id: PMJAY</p><p><b>name</b>: PMJAY, MoHFW, Govt Of India</p></div>
        </text>
        <identifier>
          <system value="https://hcx.org/orgs"/>
          <value value="PMJAY"/>
        </identifier>
        <name value="PMJAY, MoHFW, Govt Of India"/>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="Practitioner/1"/>
    <resource>
      <Practitioner>
        <id value="1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Practitioner</b><a name="1"> </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 Practitioner &quot;1&quot; </p></div><p><b>identifier</b>: id: NPR-6897</p><p><b>name</b>: Sudhir Naik (PMJAY Gujrat)</p></div>
        </text>
        <identifier>
          <system value="https://ndhm.gov.in/npr"/>
          <value value="NPR-6897"/>
        </identifier>
        <name>
          <text value="Sudhir Naik (PMJAY Gujrat)"/>
          <prefix value="Dr"/>
          <suffix value="MD"/>
        </name>
      </Practitioner>
    </resource>
  </entry>
</Bundle>