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
<CoverageEligibilityResponse xmlns="http://hl7.org/fhir">
<id value="14916"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/eligibility-response|0.3.0"/>
</meta>
<text>
<status value="extensions"/>
<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><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>
</text>
<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"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system
value="http://sni.com.sa/identifiers/coverageeligibilityresponse"/>
<value value="Elig_10551202772262"/>
</identifier>
<status value="active"/>
<purpose value="validation"/>
<purpose value="benefits"/>
<patient>🔗
<reference value="Patient/123454186"/>
</patient>
<servicedPeriod>
<start value="2023-07-15"/>
<end value="2023-07-16"/>
</servicedPeriod>
<created value="2023-12-19T08:20:29.933+00:00"/>
<request>
<identifier>
<system
value="http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest"/>
<value value="req_161959"/>
</identifier>
</request>
<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"/>
</coding>
</valueCodeableConcept>
</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>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
<code value="in"/>
</coding>
</network>
<unit>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
<code value="individual"/>
</coding>
</unit>
<term>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
<code value="annual"/>
</coding>
</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>
</item>
</insurance>
</CoverageEligibilityResponse>