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
<Bundle xmlns="http://hl7.org/fhir">
<id value="uapi-copay-response-2"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-query-response"/>
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<identifier>
<use value="usual"/>
<system value="http://connectiverx.com/requestId"/>
<value value="86a42a99-663b-48b8-8fd9-c1afdbca5b98"/>
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<type value="message"/>
<timestamp value="2023-01-11T08:10:17-05:00"/>
<entry>
<fullUrl value="urn:uuid:410f399f-e309-4bc9-be19-8ab330e40397"/>
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<id value="410f399f-e309-4bc9-be19-8ab330e40397"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_410f399f-e309-4bc9-be19-8ab330e40397"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader 410f399f-e309-4bc9-be19-8ab330e40397</b></p><a name="410f399f-e309-4bc9-be19-8ab330e40397"> </a><a name="hc410f399f-e309-4bc9-be19-8ab330e40397"> </a><p><b>event</b>: uapi-event-type enrollment-response: Enrollment Response</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>Genentech-FHIR-DEV</td><td><a href="https://fhir.developer.gene.com/$process-message">https://fhir.developer.gene.com/$process-message</a></td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td>1-63c61a26-4965b3a156f488da6e0800ed</td><td>OK</td></tr></table><p><b>focus</b>: <a href="Bundle-uapi-copay-response-1.html#urn-uuid-09cdac62-7c6b-48e6-8738-00f270280ba1">Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500</a></p></div>
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<eventCoding>
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value="http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type"/>
<code value="enrollment-response"/>
<display value="Enrollment Response"/>
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<source>
<name value="Genentech-FHIR-DEV"/>
<endpoint value="https://fhir.developer.gene.com/$process-message"/>
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<response>
<identifier value="1-63c61a26-4965b3a156f488da6e0800ed"/>
<code value="ok"/>
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<focus>
<reference value="urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1"/>
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<entry>
<fullUrl value="urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1"/>
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<Parameters>
<id value="09cdac62-7c6b-48e6-8738-00f270280ba1"/>
<parameter>
<name value="responder-patient"/>
<valueReference>
<reference value="urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55"/>
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</parameter>
<parameter>
<name value="search-result"/>
<valueReference>
<reference value="urn:uuid:aecbb129-9a73-4b59-9d66-ff5cdb3f3164"/>
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<entry>
<fullUrl value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<resource>
<Patient>
<id value="2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-patient"/>
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<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"> </a><p class="res-header-id"><b>Generated Narrative: Patient 2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9</b></p><a name="2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"> </a><a name="hc2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"> </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-uapi-patient.html">UAPI Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 8132413049 (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Other Id (see the one above)">Other Id:</td><td colspan="3">Patient internal identifier/ca3c6274-e70b-45cf-a65a-30e8386d50bb (use: usual, )</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li>ph: 1231231234(Home)</li><li>ph: 1234561234(Mobile)</li><li><a href="mailto:bobster83@example.com">bobster83@example.com</a></li><li>1234 Main St San Francisco CA 94105 US </li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Language spoken">Language:</td><td colspan="3"><span title="Codes:{urn:ietf:bcp:47 en}">English</span> (preferred)</td></tr><tr><td style="background-color: #f3f5da" title="Patient Links">Links:</td><td colspan="3"><ul><li>Managing Organization: <a href="Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-01c31a2f-321d-4c6e-8349-206af8a88088">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></li></ul></td></tr></table></div>
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<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PI"/>
<display value="Patient internal identifier"/>
</coding>
</type>
<system value="http://gene.com/patientmaster"/>
<value value="ca3c6274-e70b-45cf-a65a-30e8386d50bb"/>
<assigner>
<display value="Genentech Patient Master"/>
</assigner>
</identifier>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PI"/>
<display value="Patient internal identifier"/>
</coding>
</type>
<system value="http://connectiverx.com/confirmationId"/>
<value value="8132413049"/>
<assigner>
<display value="CRX"/>
</assigner>
</identifier>
<name>
<use value="official"/>
<family value="Michaelson"/>
<given value="Ryan"/>
</name>
<telecom>
<system value="phone"/>
<value value="1231231234"/>
<use value="home"/>
<rank value="1"/>
</telecom>
<telecom>
<system value="phone"/>
<value value="1234561234"/>
<use value="mobile"/>
<rank value="2"/>
</telecom>
<telecom>
<system value="email"/>
<value value="bobster83@example.com"/>
<use value="home"/>
<rank value="3"/>
</telecom>
<gender value="male"/>
<birthDate value="1972-10-29"/>
<address>
<line value="1234 Main St"/>
<city value="San Francisco"/>
<state value="CA"/>
<postalCode value="94105"/>
<country value="US"/>
</address>
<communication>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="English"/>
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</language>
<preferred value="true"/>
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<managingOrganization>
<reference value="urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088"/>
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<entry>
<fullUrl value="urn:uuid:b1fc009a-3710-49d8-81ad-cfa8e4a979fb"/>
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<Bundle>
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<profile
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</meta>
<type value="searchset"/>
<total value="2"/>
<link>
<relation value="self"/>
<url
value="ExplanationOfBenefit?patient=xyz&_include=ExplanationOfBenefit:coverage"/>
</link>
<entry>
<fullUrl value="urn:uuid:4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d"/>
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<ExplanationOfBenefit>
<id value="4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d"/>
<contained>
<Organization>
<id value="d02db104-a75c-433f-8764-9778c2e20626"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
</meta>
<identifier>
<use value="usual"/>
<system value="http://gene.com"/>
<value value="ORG-00002"/>
<assigner>
<display value="Genentech"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Copay Organization - CRX"/>
<telecom>
<system value="phone"/>
<value value="1800654332211"/>
<use value="work"/>
<rank value="1"/>
</telecom>
</Organization>
</contained>
<identifier>
<use value="usual"/>
<system value="http://connectiverx.com/enrollmentId"/>
<value value="45d1b98c-587c-ed11-8279-d6b6a2da4722"/>
</identifier>
<status value="active"/>
<type>
<coding>
<code value="pharmacy"/>
</coding>
</type>
<use value="predetermination"/>
<patient>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
</patient>
<created value="2023-02-07T08:10:13-05:00"/>
<insurer>
<reference
value="urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"/>
</insurer>
<provider>
<reference
value="urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"/>
</provider>
<outcome value="complete"/>
<insurance>
<focal value="true"/>
<coverage>
<reference
value="urn:uuid:597540c9-6248-466e-81e0-58e78f15454e"/>
</coverage>
</insurance>
</ExplanationOfBenefit>
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<search>
<mode value="match"/>
</search>
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<entry>
<fullUrl value="urn:uuid:597540c9-6248-466e-81e0-58e78f15454e"/>
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<Coverage>
<id value="597540c9-6248-466e-81e0-58e78f15454e"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"/>
</meta>
<contained>
<Organization>
<id value="d02db104-a75c-433f-8764-9778c2e20626"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
</meta>
<identifier>
<use value="usual"/>
<system value="http://gene.com"/>
<value value="ORG-00002"/>
<assigner>
<display value="Genentech"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Copay Organization - CRX"/>
<telecom>
<system value="phone"/>
<value value="1800654332211"/>
<use value="work"/>
<rank value="1"/>
</telecom>
</Organization>
</contained>
<extension
url="https://fhir.developer.gene.com/StructureDefinition/IssuedDate">
<valueDate value="2023-01-01"/>
</extension>
<status value="active"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="pay"/>
<display value="Pay"/>
</coding>
</type>
<subscriber>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<type value="Patient"/>
</subscriber>
<subscriberId value="EYE00044117"/>
<beneficiary>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<type value="Patient"/>
</beneficiary>
<period>
<start value="2023-01-01"/>
<end value="2023-12-31"/>
</period>
<payor>
<reference
value="urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"/>
<type value="Organization"/>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxbin"/>
<display value="RX BIN"/>
</coding>
</type>
<value value="600426"/>
<name value="BIN"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxpcn"/>
<display value="RX PCN"/>
</coding>
</type>
<value value="54"/>
<name value="PCN"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="group"/>
<display value="Group"/>
</coding>
</type>
<value value="EC38517002"/>
<name value="Group Number"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
<display value="Plan"/>
</coding>
</type>
<value value="Vabysmo-Drug"/>
<name value="Ophthalmology Co Pay program"/>
</class>
<order value="1"/>
<network value="Genentech"/>
</Coverage>
</resource>
<search>
<mode value="include"/>
</search>
</entry>
<entry>
<fullUrl value="urn:uuid:d9acfd1d-addc-4e0d-b7a6-ff921bde9236"/>
<resource>
<ExplanationOfBenefit>
<id value="d9acfd1d-addc-4e0d-b7a6-ff921bde9236"/>
<contained>
<Organization>
<id value="d02db104-a75c-433f-8764-9778c2e20626"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
</meta>
<identifier>
<use value="usual"/>
<system value="http://gene.com"/>
<value value="ORG-00002"/>
<assigner>
<display value="Genentech"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Copay Organization - CRX"/>
<telecom>
<system value="phone"/>
<value value="1800654332211"/>
<use value="work"/>
<rank value="1"/>
</telecom>
</Organization>
</contained>
<identifier>
<use value="usual"/>
<system value="http://connectiverx.com/enrollmentId"/>
<value value="ad44f19a-42b6-ed11-827c-9e11af077484"/>
</identifier>
<status value="active"/>
<type>
<coding>
<code value="institutional"/>
</coding>
</type>
<use value="predetermination"/>
<patient>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
</patient>
<created value="2023-02-26T21:01:11.230Z"/>
<insurer>
<reference
value="urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"/>
</insurer>
<provider>
<reference
value="urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"/>
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<outcome value="complete"/>
<insurance>
<focal value="true"/>
<coverage>
<reference
value="urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e"/>
</coverage>
</insurance>
</ExplanationOfBenefit>
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<mode value="match"/>
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<Coverage>
<id value="5c2e19ac-8227-4de5-a893-069dec07448e"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"/>
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<contained>
<Organization>
<id value="d02db104-a75c-433f-8764-9778c2e20626"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
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<identifier>
<use value="usual"/>
<system value="http://gene.com"/>
<value value="ORG-00002"/>
<assigner>
<display value="Genentech"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
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<name value="Copay Organization - CRX"/>
<telecom>
<system value="phone"/>
<value value="1800654332211"/>
<use value="work"/>
<rank value="1"/>
</telecom>
</Organization>
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<extension
url="https://fhir.developer.gene.com/StructureDefinition/IssuedDate">
<valueDate value="2023-02-26"/>
</extension>
<status value="active"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="pay"/>
<display value="Pay"/>
</coding>
</type>
<subscriber>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<type value="Patient"/>
</subscriber>
<subscriberId value="EYE00044137"/>
<beneficiary>
<reference
value="urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"/>
<type value="Patient"/>
</beneficiary>
<period>
<start value="2023-02-08"/>
<end value="2199-12-31"/>
</period>
<payor>
<reference
value="urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"/>
<type value="Organization"/>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxbin"/>
<display value="RX BIN"/>
</coding>
</type>
<value value="600426"/>
<name value="BIN"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxpcn"/>
<display value="RX PCN"/>
</coding>
</type>
<value value="54"/>
<name value="PCN"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="group"/>
<display value="Group"/>
</coding>
</type>
<value value="EC38532005"/>
<name value="Group Number"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
<display value="Plan"/>
</coding>
</type>
<value value="Ophtha Administration"/>
<name value="Ophthalmology Co Pay program"/>
</class>
<order value="1"/>
<network value="Genentech"/>
</Coverage>
</resource>
<search>
<mode value="include"/>
</search>
</entry>
</Bundle>
</resource>
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</Bundle>