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Packagendhm.in
Resource TypeCoverageEligibilityResponse
IdCoverageEligibilityResponse-auth-requirements-example-01.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CoverageEligibilityResponse auth-requirements-example-01

Language: en

Profile: CoverageEligibilityResponse

status: Active

purpose: Coverage auth-requirements

patient: ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)

created: 2023-09-07

requestor: Practitioner Dr. DEF

request: CoverageEligibilityRequest: identifier = 7612345; status = active; priority = Normal; purpose = auth-requirements; created = 2023-09-07 11:01:00+0500

outcome: Processing Complete

disposition: Policy is currently in-force.

insurer: Organization XYZ Insurance Co. Ltd.

insurance

coverage: Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --> 2026-03-17

inforce: true

benefitPeriod: 2023-09-07 --> 2026-08-07

item

productOrService: Consultant

item

productOrService: Metformin hydrochloride 500 mg prolonged-release oral tablet

Source1

{
  "resourceType": "CoverageEligibilityResponse",
  "id": "auth-requirements-example-01",
  "meta": {
    "profile": [
      "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"
    ]
  },
  "language": "en",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "purpose": [
    "auth-requirements"
  ],
  "patient": {
    "reference": "Patient/example-01"
  },
  "created": "2023-09-07",
  "requestor": {
    "reference": "Practitioner/example-01"
  },
  "request": {
    "reference": "CoverageEligibilityRequest/auth-requirement-example-01"
  },
  "outcome": "complete",
  "disposition": "Policy is currently in-force.",
  "insurer": {
    "reference": "Organization/example-02"
  },
  "insurance": [
    {
      "coverage": {
        "reference": "Coverage/example-01"
      },
      "inforce": true,
      "benefitPeriod": {
        "start": "2023-09-07",
        "end": "2026-08-07"
      },
      "item": [
        {
          "productOrService": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "768839008",
                "display": "Consultant"
              }
            ]
          }
        },
        {
          "productOrService": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "765507008",
                "display": "Metformin hydrochloride 500 mg prolonged-release oral tablet"
              }
            ]
          }
        }
      ]
    }
  ]
}