Internal - UAPI Status Update C&R - Universal API Implementation Guide v1.1.20

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

Example Bundle: Internal - UAPI Status Update C&R

Profile: UAPI Bundle - Status Update

Bundle uapi-status-update-3 of type message

Entry 1 - fullUrl = urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa

Resource MessageHeader:

Generated Narrative: MessageHeader 5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa

Profile: UAPI MessageHeader
event: uapi-event-type status-update: status-update
sender: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Sources
- Name Endpoint
* Genentech-PACT https://genentech-pps.my.salesforce.com
focus: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500

Entry 2 - fullUrl = urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0

Resource List:

Generated Narrative: List 8e055260-dd74-4c89-9ccf-3d2f47135ee0

messageContext
Mode: Change List Status: Current
Items
Bundle: type = message; timestamp = 2020-03-11 08:10:17-0500
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500

Entry 3 - fullUrl = urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088

Resource Organization:

Generated Narrative: Organization 01c31a2f-321d-4c6e-8349-206af8a88088

Profile: UAPI Organization
identifier: http://vendor.com/ab/HOSP-12345 (use: usual, ), http://dev.gene.com/fhir/mulesoft/Vendor_AB_HOSP-12345 (use: official, )
type: Healthcare Provider
name: Mid Atlantic Retina
telecom: ph: -unknown-
address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US
contact
name: Venus Yardav (Official)
telecom: ph: 8882704882(Work), fax: 8179974042(Work)

Entry 4 - fullUrl = urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2

Resource Patient:

Generated Narrative: Patient 7c0c0017-e08d-4a14-9889-9eea26303ff2

Profile: UAPI Patient
Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: MPAT-000123 (use: usual, ))
Other Id: Patient internal identifier/540002 (use: official, )
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 5 - fullUrl = urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de

Resource CoverageEligibilityRequest:

Generated Narrative: CoverageEligibilityRequest a0e6a72c-a35b-4e1c-890e-6d34ed51d4de

Profile: UAPI CoverageEligibilityRequest
UAPI CoverageEligibilityRequest ServiceRequestType: Benefit Investigation / Prior Authorization
UAPI CoverageEligibilityRequest Product: Lucentis
identifier: https://fhir.developer.gene.com/enrollment/bundle-enrollment-id/c78bde64-95e8-41f9-8a37-b2ac9aaf33d6 (use: old, ), https://fhir.developer.gene.com/enrollment/Case/05971219 (use: old, ), https://genentech-pps.my.salesforce.com/ProductCoverageID/PC-4856067 (use: official, )
status: Active
purpose: Coverage benefits
patient: Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500
created: 2021-05-27 08:10:13-0500
provider: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
insurer: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Insurances
- Coverage
* Coverage: extension = Calendar Year,jhgfdsd56e5r76; status = active; type = health insurance plan policy; subscriberId = 4353; period = 2021-08-31 --> 2021-09-07; order = 1; network = Dakotacare
item
Diagnoses
- Diagnosis[x]
* Type 2 diab with prolif diab rtnop with macular edema, bi
Generated Narrative: Organization #d3637025-883d-4678-9e0a-1d243a338f9f

Profile: UAPI Organization
identifier: http://vendor.com/ab/PAY-111 (use: usual, )
type: Insurance Company
name: Dakotacare
telecom: ph: 8778472862(Work)
Generated Narrative: Coverage #42b41bdb-1781-49aa-a091-78cdd92129df

Profile: UAPI Coverage
UAPI Coverage Plan Year: Calendar Year
UAPI Coverage Reference Number: jhgfdsd56e5r76
status: Active
type: health insurance plan policy
subscriber: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
subscriberId: 4353
beneficiary: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
period: 2021-08-31 --> 2021-09-07
payor: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
class
type: SubPlan
value: CHAMPVA
name: SubPlan
class
type: Plan
value: Miltary
name: Plan
class
type: Group
value: 12344frgr
name: Group
order: 1
network: Dakotacare

Entry 6 - fullUrl = urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4

Resource CoverageEligibilityResponse:

Generated Narrative: CoverageEligibilityResponse e89b0285-4582-4b1b-a448-f2cc467664f4

Profile: UAPI CoverageEligibilityResponse
UAPI CoverageEligibilityResponse Status: Approved
UAPI PreD Est. TAT: 5-7 Business Days
UAPI PCP Referral Required?: No
UAPI PCP Referral Effective Date: 2022-05-14
UAPI PCP Referral On-file?: Yes
UAPI PCP Referral Recertification Date: 2022-05-14
UAPI Spend Down Frequency: 6
UAPI Peer to Peer Available: Yes
UAPI # of Appeals Allowed: 2
UAPI Appeal Submission Deadline: 2022-05-14
UAPI Additional Documents Required: Denial Letter
UAPI Estimated Appeal TAT: 4
identifier: https://fhir.developer.gene.com/enrollment/bundle-enrollment-id/c78bde64-95e8-41f9-8a37-b2ac9aaf33d6 (use: old, ), https://fhir.developer.gene.com/enrollment/Case/05971219 (use: old, ), https://genentech-pps.my.salesforce.com/ProductCoverageID/PC-4856067 (use: official, )
status: Active
purpose: Coverage benefits
patient: Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500
serviced: 2021-06-01
created: 2021-05-27 08:10:13-0500
request: Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500
outcome: Complete
disposition: Yes, if medically necessary
insurer: Organization Dakotacare
insurance
coverage: Coverage: extension = Calendar Year,jhgfdsd56e5r76; status = active; type = health insurance plan policy; subscriberId = 4353; period = 2021-08-31 --> 2021-09-07; order = 1; network = Dakotacare
item
productOrService: Billing Code
benefit
type: Full BI
benefit
type: Does Deductible Apply?
allowed: Yes
benefit
type: does ind ded apply to family
allowed: Yes
benefit
type: Must Fam Ded Be Met Before Bene Cov
allowed: Yes
benefit
type: Does OOP Apply
allowed: Yes
benefit
type: Does Individual OOP Apply to Family
allowed: Yes
benefit
type: 100% Cov only if Family OOP Met
allowed: Yes
benefit
type: Insurer Cost Share %
allowed: Yes
benefit
type: Patient Cost Share %
allowed: Yes
benefit
type: Buy and Bill
allowed: Yes
benefit
type: Drug Tier Level
allowed: Yes
benefit
type: Patient Cost Share % **Initial Coverage Stage
allowed: 25
benefit
type: Day Supply **Initial Coverage Stage
allowed: 30 day supply
benefit
type: Drug Copay **Initial Coverage Stage
allowed: 30.00
benefit
type: Patient Cost Share % **Catastrophic Coverage Stage
allowed: 15
benefit
type: Drug Co-pay **Catastrophic Coverage Stage
allowed: 10
authorizationRequired: true
item
productOrService: Admin Code
unit: Indivitual
benefit
type: deductible
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: OOP MAx
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: Max Benefit/Year
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: Max Lifetime Amount
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: Spent Down Amount
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: Coverage Gap
allowed: $25.00 (USD)
used: $25.00 (USD)
authorizationRequired: true
authorizationSupporting: Form
item
productOrService: Billing Code
unit: Family
benefit
type: deductible
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: OOP Max
allowed: $25.00 (USD)
used: $25.00 (USD)
benefit
type: Max Benefit/Year
allowed: $25.00 (USD)
used: $25.00 (USD)
item
productOrService: Billing Code
network: In Network
benefit
type: Drug Co-Pay
allowed: $25.00 (USD)
benefit
type: Specialist Co-Pay
allowed: $25.00 (USD)
benefit
type: Does Deductible Apply to OOP
allowed: Yes
Generated Narrative: Organization #d3637025-883d-4678-9e0a-1d243a338f9f

Profile: UAPI Organization
identifier: http://vendor.com/ab/PAY-111 (use: usual, )
type: Insurance Company
name: Dakotacare
telecom: ph: 8778472862(Work)
Generated Narrative: Coverage #42b41bdb-1781-49aa-a091-78cdd92129df

Profile: UAPI Coverage
UAPI Coverage Plan Year: Calendar Year
UAPI Coverage Reference Number: jhgfdsd56e5r76
status: Active
type: health insurance plan policy
subscriber: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
subscriberId: 4353
beneficiary: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
period: 2021-08-31 --> 2021-09-07
payor: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
class
type: SubPlan
value: CHAMPVA
name: SubPlan
class
type: Plan
value: Miltary
name: Plan
class
type: Group
value: 12344frgr
name: Group
order: 1
network: Dakotacare

IG © 2021+ . Package gene.com.fhir.uapi#1.1.20 based on FHIR 4.3.0. Generated 2025-06-25
Links: Table of Contents | QA Report