Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
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
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<type value="message"/>
<timestamp value="2023-12-19T08:20:29.929+00:00"/>
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<profile
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<text>
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<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><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 MessageHeaderversion: null0.3.0)</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>
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<eventCoding>
<system
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<code value="eligibility-response"/>
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<destination>
<endpoint value="http://10.73.91.79"/>
<receiver>
<type value="Organization"/>
<identifier>
<system value="http://nphies.sa/license/provider-license"/>
<value value="PR-FHIR"/>
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<sender>
<type value="Organization"/>
<identifier>
<system value="http://nphies.sa/license/payer-license"/>
<value value="INS-FHIR"/>
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<source>
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<response>
<identifier value="c19c71dc-cfad-4401-b5b0-c0f20e8f1491"/>
<code value="ok"/>
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<focus>
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<entry>
<fullUrl value="http://sni.com.sa/CoverageEligibilityResponse/14916"/>
<resource>
<CoverageEligibilityResponse>
<id value="14916"/>
<meta>
<profile
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<text>
<status value="extensions"/>
<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><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 CoverageEligibilityResponseversion: null0.3.0)</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>
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<coding>
<system
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<code value="eligible"/>
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<identifier>
<system
value="http://sni.com.sa/identifiers/coverageeligibilityresponse"/>
<value value="Elig_10551202772262"/>
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<status value="active"/>
<purpose value="validation"/>
<purpose value="benefits"/>
<patient>🔗
<reference value="Patient/123454186"/>
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<servicedPeriod>
<start value="2023-07-15"/>
<end value="2023-07-16"/>
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<created value="2023-12-19T08:20:29.933+00:00"/>
<request>
<identifier>
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<value value="req_161959"/>
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<outcome value="complete"/>
<disposition value="Coverage is in-force"/>
<insurer>🔗
<reference value="Organization/bff3aa1fbd3648619ac082357bf135db"/>
</insurer>
<insurance>
<extension
url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-siteEligibility">
<valueCodeableConcept>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/siteEligibility"/>
<code value="eligible"/>
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</extension>
<coverage>🔗
<reference value="Coverage/1333"/>
</coverage>
<inforce value="true"/>
<item>
<category>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/benefit-category"/>
<code value="1"/>
</coding>
</category>
<excluded value="false"/>
<name value="Health Benefit Plan Coverage"/>
<description
value="Policy Maximum Annual Limit and Approval limit"/>
<network>
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<code value="in"/>
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<code value="individual"/>
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<term>
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<system
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<code value="annual"/>
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</term>
<benefit>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/benefit-type"/>
<code value="benefit"/>
</coding>
</type>
<allowedMoney>
<value value="50000"/>
<currency value="SAR"/>
</allowedMoney>
<usedMoney>
<value value="20000"/>
<currency value="SAR"/>
</usedMoney>
</benefit>
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</insurance>
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</entry>
<entry>
<fullUrl value="http://sni.com.sa/Patient/123454186"/>
<resource>
<Patient>
<id value="123454186"/>
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<text>
<status value="generated"/>
<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><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 Patientversion: null0.3.0)</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>
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<valueCodeableConcept>
<coding>
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<code value="business"/>
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<valueCodeableConcept>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="SAU"/>
<display value="Saudi Arabia"/>
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<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PPN"/>
<display value="Passport Number"/>
</coding>
</type>
<system value="http://nphies.sa/identifier/passportnumber"/>
<value value="G12345678"/>
</identifier>
<active value="true"/>
<name>
<use value="official"/>
<text value="Ahmad Khaled Abbas"/>
<family value="Ahmad"/>
<given value="Khaled"/>
<given value="Abbas"/>
</name>
<telecom>
<system value="phone"/>
<value value="+966512345691"/>
</telecom>
<gender value="male">
<extension
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<valueCodeableConcept>
<coding>
<system
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<code value="male"/>
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</gender>
<birthDate value="1984-12-25"/>
<deceasedBoolean value="false"/>
<address>
<use value="home"/>
<text value="Salamah Street, Building 25, Suite 2, Saudi Arabia"/>
<line value="Salamah Street, Building 25, Suite 2"/>
<line value="Al Malga District"/>
<city value="Riyadh"/>
<country value="Saudi Arabia"/>
</address>
<maritalStatus>
<coding>
<system
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<code value="M"/>
</coding>
</maritalStatus>
</Patient>
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</entry>
<entry>
<fullUrl
value="http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db"/>
<resource>
<Organization>
<id value="bff3aa1fbd3648619ac082357bf135db"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<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><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 Organizationversion: null0.3.0)</a></p></div><p><b>identifier</b>: National Insurance Organization Identifier/INS-FHIR (use: official, )</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>
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<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NII"/>
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<system value="http://nphies.sa/license/payer-license"/>
<value value="INS-FHIR"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Saudi National Insurance"/>
<address>
<use value="work"/>
<text value="Olaya Street, Building 70, Riyadh Saudi Arabia"/>
<line value="Olaya Street, Building 70"/>
<line value="Al Olaya District"/>
<city value="Riyadh"/>
<country value="Saudi Arabia"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="http://sni.com.sa/Coverage/1333"/>
<resource>
<Coverage>
<id value="1333"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<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><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 Coverageversion: null0.3.0)</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>
</text>
<identifier>
<system value="http://sni.com.sa/identifiers/memberid"/>
<value value="0000000001"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/coverage-type"/>
<code value="EHCPOL"/>
<display value="extended healthcare"/>
</coding>
</type>
<policyHolder>🔗
<reference value="Organization/13"/>
</policyHolder>
<subscriber>🔗
<reference value="Patient/123454186"/>
</subscriber>
<beneficiary>🔗
<reference value="Patient/123454186"/>
</beneficiary>
<dependent value="01"/>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
<display value="Self"/>
</coding>
</relationship>
<payor>🔗
<reference value="Organization/bff3aa1fbd3648619ac082357bf135db"/>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
</coding>
</type>
<value value="CB135"/>
<name value="Insurance Plan A"/>
</class>
<network value="Golden C"/>
</Coverage>
</resource>
</entry>
<entry>
<fullUrl value="http://sni.com.sa/Organization/13"/>
<resource>
<Organization>
<id value="13"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<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><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 Organizationversion: null0.3.0)</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>
</text>
<identifier>
<system value="http://nphies.sa/identifiers/organization"/>
<value value="5009"/>
</identifier>
<active value="true"/>
<name value="Policy Holder Organization"/>
</Organization>
</resource>
</entry>
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