Generated Narrative: Bundle 43c68545-8e37-4744-b8ea-9a1e3c1ada84

Bundle 43c68545-8e37-4744-b8ea-9a1e3c1ada84 of type message

Entry 1 - fullUrl = http://sni.com.sa/MessageHeader/152a949f-4e1b-4db0-900e-85472517f007

Resource MessageHeader:

Generated Narrative: MessageHeader 152a949f-4e1b-4db0-900e-85472517f007

Profile: Nphies MessageHeader

event: KSA Message Events eligibility-response: Eligibility Response

Destinations

-	Endpoint	Receiver
*	http://10.73.91.79	Identifier: http://nphies.sa/license/provider-license/PR-FHIR

sender: Identifier: http://nphies.sa/license/payer-license/INS-FHIR

Sources

-	Endpoint
*	http://sni.com.sa

Responses

-	Identifier	Code
*	c19c71dc-cfad-4401-b5b0-c0f20e8f1491	OK

focus: Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000

Entry 2 - fullUrl = http://sni.com.sa/CoverageEligibilityResponse/14916

Resource CoverageEligibilityResponse:

Generated Narrative: CoverageEligibilityResponse 14916

Profile: Nphies CoverageEligibilityResponse

Site Eligibility: Eligible

identifier: http://sni.com.sa/identifiers/coverageeligibilityresponse/Elig_10551202772262

status: Active

purpose: Coverage Validation, Coverage benefits

patient: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)

serviced: 2023-07-15 --> 2023-07-16

created: 2023-12-19 08:20:29+0000

request: Identifier: http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest/req_161959

outcome: Processing Complete

disposition: Coverage is in-force

insurer: Organization Saudi National Insurance

insurance

Site Eligibility: Eligible

coverage: Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000001; status = active; type = extended healthcare; dependent = 01; relationship = Self; network = Golden C

inforce: true

item

category: Medical Care

excluded: false

name: Health Benefit Plan Coverage

description: Policy Maximum Annual Limit and Approval limit

network: In Network

unit: Individual

term: Annual

Benefits

-	Type	Allowed[x]	Used[x]
*	Benefit	SAR50,000.00 (SAR)	SAR20,000.00 (SAR)

Entry 3 - fullUrl = http://sni.com.sa/Patient/123454186

Resource Patient:

Generated Narrative: Patient 123454186

Profile: Nphies Patient

Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)

---

Active:	true	Deceased:	false
Marital Status:	Married
Contact Detail	+966512345691 Salamah Street, Building 25, Suite 2, Saudi Arabia(home)
Patient Occupation	Business

Entry 4 - fullUrl = http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db

Resource Organization:

Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db

Profile: Nphies Insurer Organization

identifier: National Insurance Organization Identifier/INS-FHIR (use: official, )

active: true

type: Insurance Company

name: Saudi National Insurance

address: Olaya Street, Building 70, Riyadh Saudi Arabia(work)

Entry 5 - fullUrl = http://sni.com.sa/Coverage/1333

Resource Coverage:

Generated Narrative: Coverage 1333

Profile: Nphies Coverage

identifier: http://sni.com.sa/identifiers/memberid/0000000001

status: Active

type: extended healthcare

policyHolder: Organization Policy Holder Organization

subscriber: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)

beneficiary: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)

dependent: 01

relationship: Self

payor: Organization Saudi National Insurance

Classes

-	Type	Value	Name
*	Plan	CB135	Insurance Plan A

network: Golden C

Entry 6 - fullUrl = http://sni.com.sa/Organization/13

Resource Organization:

Generated Narrative: Organization 13

Profile: Nphies Policy Holder Organization

identifier: http://nphies.sa/identifiers/organization/5009

active: true

name: Policy Holder Organization