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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{
  "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 &quot;AB_GUJ_UniqueIdForTheObject&quot; </p></div><p><b>identifier</b>: id:\u00a0AB_GUJ_Plan1\u00a0(use:\u00a0USUAL,\u00a0period:\u00a02001-05-06 --&gt; (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 &amp; Mukhyamantri Vatsalya</p><p><b>period</b>: 2020-09-23 --&gt; (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"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}