Universal API Implementation Guide
1.1.20 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
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"id" : "uapi-bundle-copay-claim-upsert",
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"system" : "http://risrx.com/claimbundleid",
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},
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{
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"valueString" : "J2357"
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}
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{
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}
]
},
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"coding" : [
{
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"code" : "approved"
}
]
}
}
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{
"category" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-payment-type",
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{
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"code" : "paid"
}
]
},
"date" : "2024-06-06",
"identifier" : {
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"value" : "123456"
}
}
}
},
{
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"resource" : {
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"id" : "3fd08ef2-34a2-4191-ad04-44353c2f133a",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-patient"
]
},
"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
]
},
"system" : "http://risrx.com/masterpatientcardid",
"value" : "12220c4c-b03b-4ebc-9bb7-1c5ddafbb30c",
"assigner" : {
"display" : "RisRx"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Michaelson",
"given" : [
"Ryan",
"Tom"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "1231231234",
"use" : "home",
"rank" : 1
},
{
"system" : "phone",
"value" : "1234561234",
"use" : "mobile",
"rank" : 2
},
{
"system" : "email",
"value" : "bobster83@example.com",
"use" : "home",
"rank" : 3
}
],
"gender" : "male",
"birthDate" : "1972-10-29",
"address" : [
{
"line" : [
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],
"city" : "San Francisco",
"state" : "CA",
"postalCode" : "94105",
"country" : "US"
}
],
"communication" : [
{
"language" : {
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},
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"id" : "695d0991-5e03-46df-934a-85a28acd95c1",
"meta" : {
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"display" : "Provider number"
}
]
},
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1922071448",
"assigner" : {
"display" : "Centers for Medicare & Medicaid Services"
}
},
{
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"type" : {
"coding" : [
{
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"code" : "TAX",
"display" : "Tax ID number"
}
]
},
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "00000000"
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{
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"type" : {
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"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1639285034"
}
],
"name" : [
{
"use" : "official",
"family" : "CRUZ",
"given" : [
"MARISSA"
]
}
]
}
},
{
"fullUrl" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
"resource" : {
"resourceType" : "RelatedPerson",
"id" : "4db51d32-65c3-4f8c-959e-0155c6d14545",
"meta" : {
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]
},
"patient" : {
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"type" : "Patient"
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"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code" : "SIGOTHR",
"display" : "significant other"
}
]
}
],
"name" : [
{
"use" : "official",
"family" : "Smith",
"given" : [
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]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "1234567890",
"use" : "mobile"
}
],
"birthDate" : "1972-10-29"
}
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{
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"id" : "b0574bf9-d016-4af7-a895-269abd739db3",
"meta" : {
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]
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"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/IssuedDate",
"valueDate" : "2023-02-26"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "pay",
"display" : "Pay"
}
]
},
"subscriber" : {
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"type" : "Patient"
},
"subscriberId" : "EYE00044137",
"beneficiary" : {
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"type" : "Patient"
},
"period" : {
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"end" : "2199-12-31"
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"payor" : [
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"type" : "Organization"
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}
]
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"name" : "BIN"
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{
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"value" : "54",
"name" : "PCN"
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{
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"display" : "Group"
}
]
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"name" : "Group Number"
},
{
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{
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"code" : "plan",
"display" : "Plan"
}
]
},
"value" : "Xolair-Admin",
"name" : "Xolair Co Pay program"
}
],
"order" : 1,
"network" : "Genentech"
}
}
]
}
},
{
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{
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"type" : {
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{
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},
{
"code" : "uc"
}
]
},
"system" : "http://risrx.com/claimid",
"value" : "123456"
}
],
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"type" : {
"coding" : [
{
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}
]
},
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},
"created" : "2024-06-06T21:01:11.230Z",
"insurer" : {
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},
"provider" : {
"reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"
},
"payee" : {
"party" : {
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}
},
"outcome" : "complete",
"supportingInfo" : [
{
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"category" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
"code" : "eobdate"
}
]
},
"valueString" : "2024-06-07"
},
{
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"category" : {
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{
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"code" : "ndc"
}
]
},
"valueString" : "50242021501"
},
{
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"category" : {
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{
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"code" : "claimrequesteddate"
}
]
},
"valueString" : "2024-06-01"
},
{
"sequence" : 4,
"category" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
"code" : "claimapproveddate"
}
]
},
"valueString" : "2024-06-03"
},
{
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{
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"code" : "jcode"
}
]
},
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}
],
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}
],
"item" : [
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"code" : "96401"
}
]
},
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"adjudication" : [
{
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}
]
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"amount" : {
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}
},
{
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}
},
{
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}
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}
},
{
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}
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"amount" : {
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}
},
{
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{
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}
]
},
"amount" : {
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}
},
{
"category" : {
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{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
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}
]
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}
},
{
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{
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"code" : "patienttotalresponsibility"
}
]
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}
}
]
}
],
"adjudication" : [
{
"category" : {
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{
"system" : "http://terminology.gene.com/fhir/usix/uapi/ValueSet/uapi-copay-adjudication-category-discriminator",
"code" : "claimstatus"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-status",
"code" : "approved"
}
]
}
}
],
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{
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{
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-payment-type",
"code" : "check"
}
]
},
"amount" : {
"value" : 5.01
}
},
{
"category" : {
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{
"system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
"code" : "paidbypatient"
}
]
},
"amount" : {
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}
},
{
"category" : {
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{
"system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
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}
]
},
"amount" : {
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}
}
],
"payment" : {
"type" : {
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{
"system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code" : "paid"
}
]
},
"date" : "2024-06-06",
"identifier" : {
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"value" : "123456"
}
}
}
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{
"fullUrl" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
"resource" : {
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"id" : "3fd08ef2-34a2-4191-ad04-44353c2f133a",
"meta" : {
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"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
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"value" : "12220c4c-b03b-4ebc-9bb7-1c5ddafbb30c",
"assigner" : {
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"name" : [
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"family" : "Michaelson",
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"Tom"
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"telecom" : [
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"use" : "home",
"rank" : 1
},
{
"system" : "phone",
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"use" : "mobile",
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{
"system" : "email",
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}
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"gender" : "male",
"birthDate" : "1972-10-29",
"address" : [
{
"line" : [
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"city" : "San Francisco",
"state" : "CA",
"postalCode" : "94105",
"country" : "US"
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"communication" : [
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"language" : {
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},
{
"fullUrl" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1",
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"id" : "695d0991-5e03-46df-934a-85a28acd95c1",
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"identifier" : [
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"type" : {
"coding" : [
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"code" : "PRN",
"display" : "Provider number"
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"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1922071448",
"assigner" : {
"display" : "Centers for Medicare & Medicaid Services"
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{
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"type" : {
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"code" : "TAX",
"display" : "Tax ID number"
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"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "00000000"
},
{
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"type" : {
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{
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"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1639285034"
}
],
"name" : [
{
"use" : "official",
"family" : "CRUZ",
"given" : [
"MARISSA"
]
}
]
}
},
{
"fullUrl" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
"resource" : {
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"id" : "4db51d32-65c3-4f8c-959e-0155c6d14545",
"meta" : {
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"patient" : {
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"relationship" : [
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"coding" : [
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"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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"display" : "significant other"
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"name" : [
{
"use" : "official",
"family" : "Smith",
"given" : [
"Bob Paul"
]
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],
"telecom" : [
{
"system" : "phone",
"value" : "1234567890",
"use" : "mobile"
}
],
"birthDate" : "1972-10-29"
}
},
{
"fullUrl" : "urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e",
"resource" : {
"resourceType" : "Coverage",
"id" : "b0574bf9-d016-4af7-a895-269abd739db3",
"meta" : {
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🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"
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},
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/IssuedDate",
"valueDate" : "2023-02-26"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "pay",
"display" : "Pay"
}
]
},
"subscriber" : {
"reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
"type" : "Patient"
},
"subscriberId" : "EYE00044137",
"beneficiary" : {
"reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
"type" : "Patient"
},
"period" : {
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"end" : "2199-12-31"
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"payor" : [
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"type" : "Organization"
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"class" : [
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"display" : "RX BIN"
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"value" : "600426",
"name" : "BIN"
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{
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"value" : "54",
"name" : "PCN"
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{
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"value" : "EC38532005",
"name" : "Group Number"
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},
"value" : "Xolair-Admin",
"name" : "Xolair Co Pay program"
}
],
"order" : 1,
"network" : "Genentech"
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}
]
}
}
]
}