Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
: Message: Coverage Eligibility #1 Response - JSON Representation
{
"resourceType" : "Bundle",
"id" : "43c68545-8e37-4744-b8ea-9a1e3c1ada84",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle"
]
},
"type" : "message",
"timestamp" : "2023-12-19T08:20:29.929+00:00",
"entry" : [
{
"fullUrl" : "http://sni.com.sa/MessageHeader/152a949f-4e1b-4db0-900e-85472517f007",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "152a949f-4e1b-4db0-900e-85472517f007",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_152a949f-4e1b-4db0-900e-85472517f007\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 152a949f-4e1b-4db0-900e-85472517f007</b></p><a name=\"152a949f-4e1b-4db0-900e-85472517f007\"> </a><a name=\"hc152a949f-4e1b-4db0-900e-85472517f007\"> </a><a name=\"152a949f-4e1b-4db0-900e-85472517f007-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-message-header.html\">Nphies MessageHeader</a></p></div><p><b>event</b>: <a href=\"CodeSystem-ksa-message-events.html#ksa-message-events-eligibility-response\">KSA Message Events eligibility-response</a>: Eligibility Response</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://10.73.91.79\">http://10.73.91.79</a></td><td>Identifier: <code>http://nphies.sa/license/provider-license</code>/PR-FHIR</td></tr></table><p><b>sender</b>: Identifier: <code>http://nphies.sa/license/payer-license</code>/INS-FHIR</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://sni.com.sa\">http://sni.com.sa</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>c19c71dc-cfad-4401-b5b0-c0f20e8f1491</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-43c68545-8e37-4744-b8ea-9a1e3c1ada84.html#http-//sni.com.sa/CoverageEligibilityResponse/14916\">Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000</a></p></div>"
},
"eventCoding" : {
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
"code" : "eligibility-response"
},
"destination" : [
{
"endpoint" : "http://10.73.91.79",
"receiver" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
}
}
],
"sender" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/payer-license",
"value" : "INS-FHIR"
}
},
"source" : {
"endpoint" : "http://sni.com.sa"
},
"response" : {
"identifier" : "c19c71dc-cfad-4401-b5b0-c0f20e8f1491",
"code" : "ok"
},
"focus" : [
{
"reference" : "http://sni.com.sa/CoverageEligibilityResponse/14916"
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/CoverageEligibilityResponse/14916",
"resource" : {
"resourceType" : "CoverageEligibilityResponse",
"id" : "14916",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/eligibility-response"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_14916\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse 14916</b></p><a name=\"14916\"> </a><a name=\"hc14916\"> </a><a name=\"14916-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-eligibility-response.html\">Nphies CoverageEligibilityResponse</a></p></div><p><b>Site Eligibility</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/siteEligibility eligible}\">Eligible</span></p><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/coverageeligibilityresponse</code>/Elig_10551202772262</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage Validation, Coverage benefits</p><p><b>patient</b>: <a href=\"Patient-123454186.html\">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>serviced</b>: 2023-07-15 --> 2023-07-16</p><p><b>created</b>: 2023-12-19 08:20:29+0000</p><p><b>request</b>: Identifier: <code>http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest</code>/req_161959</p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Coverage is in-force</p><p><b>insurer</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135db.html\">Organization Saudi National Insurance</a></p><blockquote><p><b>insurance</b></p><p><b>Site Eligibility</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/siteEligibility eligible}\">Eligible</span></p><p><b>coverage</b>: <a href=\"Coverage-1333.html\">Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000001; status = active; type = extended healthcare; dependent = 01; relationship = Self; network = Golden C</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/benefit-category 1}\">Medical Care</span></p><p><b>excluded</b>: false</p><p><b>name</b>: Health Benefit Plan Coverage</p><p><b>description</b>: Policy Maximum Annual Limit and Approval limit</p><p><b>network</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-network in}\">In Network</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/benefit-type benefit}\">Benefit</span></td><td><span title=\"Saudi Riyal\">SAR50,000.00</span> (SAR)</td><td><span title=\"Saudi Riyal\">SAR20,000.00</span> (SAR)</td></tr></table></blockquote></blockquote></div>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/siteEligibility",
"code" : "eligible"
}
]
}
}
],
"identifier" : [
{
"system" : "http://sni.com.sa/identifiers/coverageeligibilityresponse",
"value" : "Elig_10551202772262"
}
],
"status" : "active",
"purpose" : [
"validation",
"benefits"
],
"patient" : {
🔗 "reference" : "Patient/123454186"
},
"servicedPeriod" : {
"start" : "2023-07-15",
"end" : "2023-07-16"
},
"created" : "2023-12-19T08:20:29.933+00:00",
"request" : {
"identifier" : {
"system" : "http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest",
"value" : "req_161959"
}
},
"outcome" : "complete",
"disposition" : "Coverage is in-force",
"insurer" : {
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
},
"insurance" : [
{
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/siteEligibility",
"code" : "eligible"
}
]
}
}
],
"coverage" : {
🔗 "reference" : "Coverage/1333"
},
"inforce" : true,
"item" : [
{
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/benefit-category",
"code" : "1"
}
]
},
"excluded" : false,
"name" : "Health Benefit Plan Coverage",
"description" : "Policy Maximum Annual Limit and Approval limit",
"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://nphies.sa/terminology/CodeSystem/benefit-type",
"code" : "benefit"
}
]
},
"allowedMoney" : {
"value" : 50000,
"currency" : "SAR"
},
"usedMoney" : {
"value" : 20000,
"currency" : "SAR"
}
}
]
}
]
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/Patient/123454186",
"resource" : {
"resourceType" : "Patient",
"id" : "123454186",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_123454186\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient 123454186</b></p><a name=\"123454186\"> </a><a name=\"hc123454186\"> </a><a name=\"123454186-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-patient.html\">Nphies Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td>true</td><td style=\"background-color: #f3f5da\" title=\"Known status of Patient\">Deceased:</td><td>false</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}\">Married</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><ul><li><a href=\"tel:+966512345691\">+966512345691</a></li><li>Salamah Street, Building 25, Suite 2, Saudi Arabia(home)</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Patient occupation as per the nphies adopted list of occupations.\"><a href=\"StructureDefinition-extension-occupation.html\">Patient Occupation</a></td><td colspan=\"3\"><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/occupation business}\">Business</span></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/occupation",
"code" : "business"
}
]
}
}
],
"identifier" : [
{
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-identifier-country",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "SAU",
"display" : "Saudi Arabia"
}
]
}
}
],
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PPN",
"display" : "Passport Number"
}
]
},
"system" : "http://nphies.sa/identifier/passport",
"value" : "G12345678"
}
],
"active" : true,
"name" : [
{
"use" : "official",
"text" : "Ahmad Khaled Abbas",
"family" : "Ahmad",
"given" : [
"Khaled",
"Abbas"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "+966512345691"
}
],
"gender" : "male",
"_gender" : {
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code" : "male"
}
]
}
}
]
},
"birthDate" : "1984-12-25",
"deceasedBoolean" : false,
"address" : [
{
"use" : "home",
"text" : "Salamah Street, Building 25, Suite 2, Saudi Arabia",
"line" : [
"Salamah Street, Building 25, Suite 2",
"Al Malga District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
],
"maritalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code" : "M"
}
]
}
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db",
"resource" : {
"resourceType" : "Organization",
"id" : "bff3aa1fbd3648619ac082357bf135db",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_bff3aa1fbd3648619ac082357bf135db\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db</b></p><a name=\"bff3aa1fbd3648619ac082357bf135db\"> </a><a name=\"hcbff3aa1fbd3648619ac082357bf135db\"> </a><a name=\"bff3aa1fbd3648619ac082357bf135db-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-insurer-organization.html\">Nphies Insurer Organization</a></p></div><p><b>identifier</b>: National Insurance Organization Identifier/INS-FHIR\u00a0(use:\u00a0official,\u00a0)</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: Saudi National Insurance</p><p><b>address</b>: Olaya Street, Building 70, Riyadh Saudi Arabia(work)</p></div>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "NII"
}
]
},
"system" : "http://nphies.sa/license/payer-license",
"value" : "INS-FHIR"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/organization-type",
"code" : "ins"
}
]
}
],
"name" : "Saudi National Insurance",
"address" : [
{
"use" : "work",
"text" : "Olaya Street, Building 70, Riyadh Saudi Arabia",
"line" : [
"Olaya Street, Building 70",
"Al Olaya District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/Coverage/1333",
"resource" : {
"resourceType" : "Coverage",
"id" : "1333",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_1333\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 1333</b></p><a name=\"1333\"> </a><a name=\"hc1333\"> </a><a name=\"1333-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-coverage.html\">Nphies Coverage</a></p></div><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/memberid</code>/0000000001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/coverage-type EHCPOL}\">extended healthcare</span></p><p><b>policyHolder</b>: <a href=\"Organization-13.html\">Organization Policy Holder Organization</a></p><p><b>subscriber</b>: <a href=\"Patient-123454186.html\">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>beneficiary</b>: <a href=\"Patient-123454186.html\">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>payor</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135db.html\">Organization Saudi National Insurance</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></td><td>CB135</td><td>Insurance Plan A</td></tr></table><p><b>network</b>: Golden C</p></div>"
},
"identifier" : [
{
"system" : "http://sni.com.sa/identifiers/memberid",
"value" : "0000000001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"policyHolder" : {
🔗 "reference" : "Organization/13"
},
"subscriber" : {
🔗 "reference" : "Patient/123454186"
},
"beneficiary" : {
🔗 "reference" : "Patient/123454186"
},
"dependent" : "01",
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self",
"display" : "Self"
}
]
},
"payor" : [
{
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "CB135",
"name" : "Insurance Plan A"
}
],
"network" : "Golden C"
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/13",
"resource" : {
"resourceType" : "Organization",
"id" : "13",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_13\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 13</b></p><a name=\"13\"> </a><a name=\"hc13\"> </a><a name=\"13-en-US\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-policyholder-organization.html\">Nphies Policy Holder Organization</a></p></div><p><b>identifier</b>: <code>http://nphies.sa/identifiers/organization</code>/5009</p><p><b>active</b>: true</p><p><b>name</b>: Policy Holder Organization</p></div>"
},
"identifier" : [
{
"system" : "http://nphies.sa/identifiers/organization",
"value" : "5009"
}
],
"active" : true,
"name" : "Policy Holder Organization"
}
}
]
}