FHIR Implementation Guide for HCX
0.8.0 - CI Build
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
<CoverageEligibilityResponse xmlns="http://hl7.org/fhir">
<id value="example-01"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name="example-01"> </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 "example-01" </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>: <span/></p><p><b>serviced</b>: 2021-12-22 --> 2021-12-25</p><p><b>created</b>: 2021-12-22</p><p><b>requestor</b>: <span/></p><p><b>request</b>: <span/></p><p><b>outcome</b>: complete</p><p><b>insurer</b>: <span/></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <span/></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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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>: Copayment maximum per service <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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>: Copayment Percent per service <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html">Benefit Type Codes</a>#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 id="RVH1003">
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="SN"/>
<display value="Subscriber Number"/>
</coding>
</type>
<system value="http://gicofIndia.com/beneficiaries"/>
<value value="BEN-101"/>
</identifier>
</patient>
<servicedPeriod>
<start value="2021-12-22"/>
<end value="2021-12-25"/>
</servicedPeriod>
<created value="2021-12-22"/>
<requestor id="NPR-6897">
<identifier>
<system value="https://ndhm.gov.in/npr"/>
<value value="NPR-6897"/>
</identifier>
</requestor>
<request id="example-01">
<identifier>
<system value="https://www.tmh.in/coverage-eligibility-request"/>
<value value="dc82673b-8c71-48c2-8a17-16dcb3b035f6"/>
</identifier>
</request>
<outcome value="complete"/>
<insurer id="GICOFINDIA">
<identifier>
<system value="http://irdai.gov.in/insurers"/>
<value value="112"/>
</identifier>
</insurer>
<insurance>
<coverage id="dadde132-ad64-4d18-8c18-1d52d7e86abc">
<identifier>
<system value="https://www.gicofIndia.in/policies"/>
<value value="policy-RVH1003"/>
</identifier>
</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>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<code value="benefit"/>
</coding>
</type>
<allowedMoney>
<value value="500000"/>
<currency value="INR"/>
</allowedMoney>
</benefit>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<code value="copay-maximum"/>
</coding>
</type>
<allowedMoney>
<value value="100"/>
<currency value="INR"/>
</allowedMoney>
</benefit>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<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>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<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>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<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>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<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>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<code value="room"/>
</coding>
</type>
<allowedString value="shared"/>
</benefit>
<benefit>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
<code value="benefit"/>
</coding>
</type>
<allowedMoney>
<value value="600"/>
<currency value="INR"/>
</allowedMoney>
</benefit>
</item>
</insurance>
</CoverageEligibilityResponse>
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.8.0 based on FHIR 4.0.1. Generated 2023-03-15
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