Bundle uapi-copay-response-rejected-1 of type message

Entry 1 - fullUrl = urn:uuid:410f399f-e309-4bc9-be19-8ab330e40397

Resource MessageHeader:

event: uapi-event-type enrollment-response: Enrollment Response

Sources

-	Name
*	Genentech-FHIR-DEV

Responses

-	Identifier	Code
*	1-63c61a26-4965b3a156f488da6e0800ed	OK

focus: Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500

Entry 2 - fullUrl = urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1

Resource Parameters:

Parameters

responder-patient	Bundle: type = message; timestamp = 2020-03-11 08:10:17-0500
search-result	Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500

Entry 3 - fullUrl = urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9

Resource Patient:

Profile: UAPI Patient

Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: ca3c6274-e70b-45cf-a65a-30e8386d50bb (use: usual, ))

---

Other Id:	Patient internal identifier/8132413049 (use: usual, )
Contact Detail	ph: 1231231234(Home) ph: 1234561234(Mobile) bobster83@example.com 1234 Main St San Francisco CA 94105 US
Language:	English (preferred)
Links:	Managing Organization: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500

Entry 4 - fullUrl = urn:uuid:b1fc009a-3710-49d8-81ad-cfa8e4a979fb

Resource Bundle:

Profile: UAPI Bundle - Search Result

Bundle b1fc009a-3710-49d8-81ad-cfa8e4a979fb of type searchset

---

Entry 1 - fullUrl = urn:uuid:e344813d-eb60-466e-806b-ebd35c988293

Search:Mode = match

Resource ExplanationOfBenefit:

identifier: http://connectiverx.com/enrollmentId/ad44f19a-42b6-ed11-827c-9e11af077484 (use: usual, )

status: Cancelled

type: institutional

use: Predetermination

patient: Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500

created: 2023-04-11 21:01:11+0000

insurer: Bundle: identifier = http://risrx.com/requestId#42c481a9-7e7e-4d14-ab37-f648e376802d (use: usual, ); type = message; timestamp = 2024-04-19 08:10:17-0500

provider: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500

outcome: error

Insurances

-	Focal	Coverage
*	false	Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500

---

Profile: UAPI Organization

identifier: http://gene.com/ORG-00002 (use: usual, )

type: Insurance Company

name: Copay Organization - CRX

Contacts

-	Telecom
*	ph: 1800654332211(Work)

---

Severity	Location	Code	Details	Diagnostics
Error		Processing Failure	Provided patient information does not meet minimum criteria for verification.

---

Entry 2 - fullUrl = urn:uuid:e6e8d8c6-a074-4ea5-be1a-a67cb8628a85

Search:Mode = include

Resource Coverage:

Profile: UAPI Coverage

status: Cancelled

type: Pay

subscriber: Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500

beneficiary: Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98 (use: usual, ); type = message; timestamp = 2023-01-11 08:10:17-0500

Classes

-	Type	Value	Name
*	Plan	Vabysmo-Drug	Ophthalmology Co Pay program

order: 1

network: Genentech

---

Profile: UAPI Organization

identifier: http://gene.com/ORG-00002 (use: usual, )

type: Insurance Company

name: Copay Organization - CRX

Contacts

-	Telecom
*	ph: 1800654332211(Work)