FHIR Implementation Guide for HCX
0.9.0 - CI Build
FHIR Implementation Guide for HCX
0.9.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.9.0). See the Directory of published versions
{
"resourceType" : "CoverageEligibilityResponse",
"id" : "example-01",
"text" : {
"status" : "generated",
"div" : "<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:\u00a0urn: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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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/5.3.0/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>"
},
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuiad:581da6a9"
}
],
"status" : "active",
"purpose" : [
"discovery",
"benefits"
],
"patient" : {
"id" : "RVH1003",
"identifier" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "SN",
"display" : "Subscriber Number"
}
]
},
"system" : "http://gicofIndia.com/beneficiaries",
"value" : "BEN-101"
}
},
"servicedPeriod" : {
"start" : "2021-12-22",
"end" : "2021-12-25"
},
"created" : "2021-12-22",
"requestor" : {
"id" : "NPR-6897",
"identifier" : {
"system" : "https://ndhm.gov.in/npr",
"value" : "NPR-6897"
}
},
"request" : {
"id" : "example-01",
"identifier" : {
"system" : "https://www.tmh.in/coverage-eligibility-request",
"value" : "dc82673b-8c71-48c2-8a17-16dcb3b035f6"
}
},
"outcome" : "complete",
"insurer" : {
"id" : "GICOFINDIA",
"identifier" : {
"system" : "http://irdai.gov.in/insurers",
"value" : "112"
}
},
"insurance" : [
{
"coverage" : {
"id" : "dadde132-ad64-4d18-8c18-1d52d7e86abc",
"identifier" : {
"system" : "https://www.gicofIndia.in/policies",
"value" : "policy-RVH1003"
}
},
"inforce" : true,
"item" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "30",
"display" : "Health Benefit Plan Coverage"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}
]
},
"term" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 500000,
"currency" : "INR"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "copay-maximum"
}
]
},
"allowedMoney" : {
"value" : 100,
"currency" : "INR"
}
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "copay-percent"
}
]
},
"allowedUnsignedInt" : 20
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "69",
"display" : "Maternity"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}
]
},
"term" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 15000,
"currency" : "INR"
}
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F3",
"display" : "Dental Coverage"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}
]
},
"term" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 2000,
"currency" : "INR"
}
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F6",
"display" : "Vision Coverage"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}
]
},
"term" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 400,
"currency" : "INR"
}
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "49",
"display" : "Hospital Room and Board"
}
]
},
"network" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}
]
},
"unit" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}
]
},
"term" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "day"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "room"
}
]
},
"allowedString" : "shared"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 600,
"currency" : "INR"
}
}
]
}
]
}
]
}
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.9.0 based on FHIR 4.0.1. Generated 2023-12-14
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