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
<InsurancePlan xmlns="http://hl7.org/fhir">
<id value="AB_GUJ_UniqueIdForTheObject"/>
<text>
<status value="generated"/>
<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: AB_GUJ_Plan1 (use: USUAL, period: 2001-05-06 --> (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>
</text>
<identifier>
<use value="usual"/>
<value value="AB_GUJ_Plan1"/>
<period>
<start value="2001-05-06"/>
</period>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/insurance-plan-type"/>
<code value="medical"/>
</coding>
</type>
<name value="PMJAY-Mukhyamantri Amrutam & Mukhyamantri Vatsalya"/>
<period>
<start value="2020-09-23"/>
</period>
<ownedBy>
<reference value="Organization/AB_GUJ_SHA"/>
<display value="Gujarat State Health Protection Society"/>
</ownedBy>
<administeredBy>
<reference value="Organization/AB_GUJ_TPA_1"/>
<display value="MD India Healthcare Service (TPA) Pvt. Ltd."/>
</administeredBy>
<coverageArea>
<reference value="Location/GUJARAT"/>
<display value="Gujarat"/>
</coverageArea>
<coverage>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/coverage-type"/>
<code value="Medical"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/benefit-type"/>
<code value="Inpatient"/>
</coding>
</type>
<limit>
<value>
<value value="500000"/>
<unit value="INR"/>
</value>
</limit>
</benefit>
</coverage>
<plan>
<extension
url="https://hcx-base-url/StructureDefinition/HCXProofOfIdentificationExtension">
<extension url="ProofOfIdentificationDocumentCode">
<valueCodeableConcept>
<coding>
<system
value="https://hcx-valuesets/proofOfIdentificationDocumentCodes"/>
<version value="1.0.0"/>
<code value="12345"/>
<display value="Aadhar Card"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="ProofOfIdentificationDocumentRequiredFlag">
<valueBoolean value="true"/>
</extension>
<extension url="ProofOfIdentificationDocumentMimeType">
<valueCode value="application/pdf"/>
</extension>
<extension url="ClinicalDiagnosticDocumentClaimUse">
<valueCode value="preauthorization"/>
</extension>
<extension url="DocumentationUrl">
<valueUrl value="http://documentation-url"/>
</extension>
</extension>
<extension
url="https://hcx-base-url/StructureDefinition/HCXProofOfPresenceExtension">
<extension url="ProofOfPresenceDocumentCode">
<valueCodeableConcept>
<coding>
<system
value="https://hcx-valuesets/proofOfPresenceDocumentCodes"/>
<version value="1.0.0"/>
<code value="45678"/>
<display value="Aadhar Verification XML"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="ProofOfPresenceDocumentRequiredFlag">
<valueBoolean value="true"/>
</extension>
<extension url="ProofOfPresenceDocumentMimeType">
<valueCode value="application/xml"/>
</extension>
<extension url="ClinicalDiagnosticDocumentClaimUse">
<valueCode value="preauthorization"/>
</extension>
<extension url="DocumentationUrl">
<valueUrl value="http://documentation-url"/>
</extension>
</extension>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/plan-type"/>
<code value="PMJAY_GUJ_GOLD_CARD"/>
</coding>
</type>
<specificCost>
<category>
<coding>
<system value="http://terminologyServer/ValueSets/cost-category"/>
<code value="Inpatient-packages"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/packages"/>
<code value="IN010"/>
<display value="Vertebroplasty"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://terminologyServer/ValueSets/pacakgeCostTypes"/>
<code value="hospitalization"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminologyServer/ValueSets/applicabilityCodes"/>
<code value="in-network"/>
<display value="Gujarat SHA empaneled hospitals"/>
</coding>
</applicability>
<value>
<value value="22800"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
<benefit>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/procedures"/>
<code value="MC999A"/>
<display value="ABC Surgery"/>
</coding>
<coding>
<system value="ICD PCS codes"/>
<code value="ICD_PCS_001"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://terminologyServer/ValueSets/pacakgeCostTypes"/>
<code value="hospitalization"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminologyServer/ValueSets/applicabilityCodes"/>
<code value="in-network"/>
<display value="Gujarat SHA empaneled hospitals"/>
</coding>
</applicability>
<value>
<value value="11000"/>
<unit value="INR"/>
</value>
</cost>
<cost>
<type>
<coding>
<system
value="http://terminologyServer/ValueSets/pacakgeCostTypes"/>
<code value="hospitalization"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminologyServer/ValueSets/applicabilityCodes"/>
<code value="in-network"/>
<display value="Gujarat SHA empaneled hospitals"/>
</coding>
</applicability>
<qualifiers>
<coding>
<system
value="http://terminologyServer/ValueSets/stratificationTypes"/>
<code value="STRAT002"/>
</coding>
</qualifiers>
<qualifiers>
<coding>
<system
value="http://terminologyServer/ValueSets/implantCodes"/>
<code value="IMP0005"/>
</coding>
</qualifiers>
<value>
<value value="12000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
<benefit>
<extension
url="https://hcx-base-url/StructureDefinition/HCXDiagnosticDocumentsExtension">
<extension url="ClinicalDiagnosticDocumentCode">
<valueCodeableConcept>
<coding>
<system
value="https://hcx-valuesets/clinicalDiagnosticsDocumentCodes"/>
<version value="1.0.0"/>
<code value="DOC-001"/>
<display value="Investigation Report 1"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="ClinicalDiagnosticDocumentRequiredFlag">
<valueBoolean value="true"/>
</extension>
<extension url="ClinicalDiagnosticDocumentMimeType">
<valueCode value="application/pdf"/>
</extension>
<extension url="ClinicalDiagnosticDocumentClaimUse">
<valueCode value="claim"/>
</extension>
<extension url="DocumentationUrl">
<valueUrl value="http://documentation-url"/>
</extension>
</extension>
<extension
url="https://hcx-base-url/StructureDefinition/HCXInformationalMessagesExtension">
<extension url="InformationalMessagesCode">
<valueCodeableConcept>
<coding>
<system
value="https://hcx-valuesets/InformationalMessagesCodes"/>
<version value="1.0.0"/>
<code value="INF-001"/>
<display value="Information Message 1"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="InformationalMessageCode">
<valueCode value="information"/>
</extension>
<extension url="InformationalMessageClaimUse">
<valueCode value="claim"/>
</extension>
<extension url="DocumentationUrl">
<valueUrl value="http://documentation-url"/>
</extension>
</extension>
<extension
url="https://hcx-base-url/StructureDefinition/HCXQuestionnairesExtension">
<extension url="Questionnaire">
<valueReference>
<reference value="Questionnnaire/1"/>
</valueReference>
</extension>
<extension url="QuestionnaireRequiredFlag">
<valueBoolean value="true"/>
</extension>
<extension url="QuestionnaireClaimUse">
<valueCode value="claim"/>
</extension>
<extension url="DocumentationUrl">
<valueUrl value="http://documentation-url"/>
</extension>
</extension>
<type>
<coding>
<system value="http://terminologyServer/ValueSets/packages"/>
<code value="HBP_PACKAGE_00003"/>
<display value="Microlaryngoscopic Surgery"/>
</coding>
</type>
<cost>
<type>
<coding>
<system
value="http://terminologyServer/ValueSets/pacakgeCostTypes"/>
<code value="hospitalization"/>
</coding>
</type>
<applicability>
<coding>
<system
value="http://terminologyServer/ValueSets/applicabilityCodes"/>
<code value="in-network"/>
<display value="Gujarat SHA empaneled hospitals"/>
</coding>
</applicability>
<qualifiers>
<coding>
<system
value="http://terminologyServer/ValueSets/stratificationTypes"/>
<code value="STRAT002"/>
</coding>
</qualifiers>
<qualifiers>
<coding>
<system
value="http://terminologyServer/ValueSets/implantCodes"/>
<code value="IMP0005"/>
</coding>
</qualifiers>
<value>
<value value="18500"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
</InsurancePlan>
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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