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Source1

{
  "resourceType": "Coverage",
  "id": "full",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-CoverageDavinciWellknownLocation",
      "valueUri": "http://somepayer.org/.well-known/davinci-configuration"
    }
  ],
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MB"
          }
        ]
      },
      "system": "http://example.org/new-payer/identifiers/coverage",
      "value": "234567"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "https://nahdo.org/sopt",
        "code": "2",
        "display": "MEDICAID"
      }
    ]
  },
  "subscriberId": "97531",
  "beneficiary": {
    "reference": "http://example.org/new-payer/fhir/Patient/pat1"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self"
      }
    ]
  },
  "period": {
    "start": "2021-01-01",
    "end": "2021-12-31"
  },
  "payor": [
    {
      "reference": "Organization/full"
    }
  ]
}