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Narrative

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Source1

{
  "resourceType": "CoverageEligibilityResponse",
  "id": "NgCoverageEligibilityResponse-ChikaXrayApproved",
  "meta": {
    "profile": [
      "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-response"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id",
      "value": "ELAPPROVE02"
    }
  ],
  "status": "active",
  "purpose": [
    "validation"
  ],
  "patient": {
    "reference": "Patient/Patient-Chika-Okafor",
    "display": "Chika Okafor"
  },
  "created": "2025-11-07T00:09:00+01:00",
  "requestor": {
    "reference": "Organization/Organization-PortHarcourt-Hospital",
    "display": "Port Harcourt Emergency Hospital"
  },
  "request": {
    "reference": "CoverageEligibilityRequest/NgCoverageEligibilityRequest-ChikaEmergency"
  },
  "outcome": "complete",
  "disposition": "Pre-authorization APPROVED. Approved amount: ₦15,000. Patient copay: ₦1,500. Authorization code: PA-2025-8847. Valid until: 10-Nov-2025.",
  "insurer": {
    "reference": "Organization/Organization-Truth-HMO",
    "display": "Truth HMO"
  },
  "insurance": [
    {
      "coverage": {
        "reference": "Coverage/Coverage-Chika-TruthHMO",
        "display": "Truth HMO Policy - Chika Okafor"
      },
      "inforce": true,
      "item": [
        {
          "productOrService": {
            "coding": [
              {
                "system": "http://www.ama-assn.org/go/cpt",
                "code": "73610",
                "display": "Radiologic examination, ankle; complete, minimum of 3 views"
              }
            ],
            "text": "Ankle X-ray - Right ankle sprain (ICD-10: S93.4)"
          },
          "description": "Pre-authorization approved for emergency ankle X-ray. Valid until 10-Nov-2025.",
          "benefit": [
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code": "benefit",
                    "display": "Benefit"
                  }
                ]
              },
              "allowedMoney": {
                "value": 15000,
                "currency": "NGN"
              },
              "usedMoney": {
                "value": 0,
                "currency": "NGN"
              }
            },
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code": "copay",
                    "display": "Copayment per service"
                  }
                ]
              },
              "allowedMoney": {
                "value": 1500,
                "currency": "NGN"
              }
            },
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code": "room",
                    "display": "Room"
                  }
                ],
                "text": "HMO Coverage Amount"
              },
              "allowedMoney": {
                "value": 13500,
                "currency": "NGN"
              }
            }
          ],
          "authorizationRequired": true,
          "authorizationSupporting": [
            {
              "text": "Emergency presentation with suspected fracture"
            }
          ],
          "authorizationUrl": "https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id#PA-2025-8847"
        }
      ]
    }
  ],
  "preAuthRef": "PA-2025-8847"
}