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
: Coverage Eligibility Response #1 - JSON Representation
{
"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\"><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"
}
}
]
}
]
}
]
}