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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"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update"
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"type" : "message",
"timestamp" : "2020-03-11T08:10:13-05:00",
"entry" : [
{
"fullUrl" : "urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa</b></p><a name=\"5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa\"> </a><a name=\"hc5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa\"> </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-messageheader.html\">UAPI MessageHeader</a></p></div><p><b>event</b>: uapi-event-type status-update: status-update</p><p><b>sender</b>: <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></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-PACT</td><td><a href=\"https://genentech-pps.my.salesforce.com\">https://genentech-pps.my.salesforce.com</a></td></tr></table><p><b>focus</b>: <a href=\"Bundle-7c8f5054-015b-4bce-99f5-4160a82a4225.html#urn-uuid-8e055260-dd74-4c89-9ccf-3d2f47135ee0\">Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p></div>"
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"eventCoding" : {
"system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type",
"code" : "status-update"
},
"sender" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
},
"source" : {
"name" : "Genentech-PACT",
"endpoint" : "https://genentech-pps.my.salesforce.com"
},
"focus" : [
{
"reference" : "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"type" : "List"
}
]
}
},
{
"fullUrl" : "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"resource" : {
"resourceType" : "List",
"id" : "8e055260-dd74-4c89-9ccf-3d2f47135ee0",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"List_8e055260-dd74-4c89-9ccf-3d2f47135ee0\"> </a><p class=\"res-header-id\"><b>Generated Narrative: List 8e055260-dd74-4c89-9ccf-3d2f47135ee0</b></p><a name=\"8e055260-dd74-4c89-9ccf-3d2f47135ee0\"> </a><a name=\"hc8e055260-dd74-4c89-9ccf-3d2f47135ee0\"> </a><h2>messageContext</h2><table class=\"clstu\"><tr><td>Mode: Change List </td><td>Status: Current </td></tr><tr><td/></tr></table><table class=\"grid\"><tr style=\"backgound-color: #eeeeee\"><td><b>Items</b></td></tr><tr><td><a href=\"Bundle-uapi-query-response-1-gpf.html#urn-uuid-b3d46ea3-62e6-4171-b818-d64712edfe55\">Bundle: type = message; timestamp = 2020-03-11 08:10:17-0500</a></td></tr><tr><td><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></td></tr><tr><td><a href=\"Bundle-uapi-status-update-3.html#urn-uuid-a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\">Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-uapi-status-update-3.html#urn-uuid-e89b0285-4582-4b1b-a448-f2cc467664f4\">Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr></table></div>"
},
"status" : "current",
"mode" : "changes",
"title" : "messageContext",
"entry" : [
{
"item" : {
"reference" : "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55",
"type" : "Patient"
}
},
{
"item" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
}
},
{
"item" : {
"reference" : "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"type" : "CoverageEligibilityRequest"
}
},
{
"item" : {
"reference" : "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4",
"type" : "CoverageEligibilityResponse"
}
}
]
}
},
{
"fullUrl" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"resource" : {
"resourceType" : "Organization",
"id" : "01c31a2f-321d-4c6e-8349-206af8a88088",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_01c31a2f-321d-4c6e-8349-206af8a88088\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 01c31a2f-321d-4c6e-8349-206af8a88088</b></p><a name=\"01c31a2f-321d-4c6e-8349-206af8a88088\"> </a><a name=\"hc01c31a2f-321d-4c6e-8349-206af8a88088\"> </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-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: <code>http://vendor.com/ab</code>/HOSP-12345\u00a0(use:\u00a0usual,\u00a0), <code>http://dev.gene.com/fhir/mulesoft</code>/Vendor_AB_HOSP-12345\u00a0(use:\u00a0official,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: Mid Atlantic Retina</p><p><b>telecom</b>: ph: -unknown-</p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p><blockquote><p><b>contact</b></p><p><b>name</b>: Venus Yardav (Official)</p><p><b>telecom</b>: ph: 8882704882(Work), fax: 8179974042(Work)</p></blockquote></div>"
},
"identifier" : [
{
"use" : "usual",
"system" : "http://vendor.com/ab",
"value" : "HOSP-12345",
"assigner" : {
"display" : "AB Vendor"
}
},
{
"use" : "official",
"system" : "http://dev.gene.com/fhir/mulesoft",
"value" : "Vendor_AB_HOSP-12345",
"assigner" : {
"display" : "UAPI Process API Mulesoft"
}
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "prov",
"display" : "Healthcare Provider"
}
]
}
],
"name" : "Mid Atlantic Retina",
"telecom" : [
{
"system" : "phone"
}
],
"address" : [
{
"line" : [
"8 Ranoldo Terrace"
],
"city" : "Cherry Hill",
"state" : "NJ",
"postalCode" : "08034",
"country" : "US"
}
],
"contact" : [
{
"name" : {
"use" : "official",
"family" : "Yardav",
"given" : [
"Venus"
]
},
"telecom" : [
{
"system" : "phone",
"value" : "8882704882",
"use" : "work",
"rank" : 1
},
{
"system" : "fax",
"value" : "8179974042",
"use" : "work",
"rank" : 2
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2",
"resource" : {
"resourceType" : "Patient",
"id" : "7c0c0017-e08d-4a14-9889-9eea26303ff2",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-patient"
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"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_7c0c0017-e08d-4a14-9889-9eea26303ff2\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient 7c0c0017-e08d-4a14-9889-9eea26303ff2</b></p><a name=\"7c0c0017-e08d-4a14-9889-9eea26303ff2\"> </a><a name=\"hc7c0c0017-e08d-4a14-9889-9eea26303ff2\"> </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: MPAT-000123\u00a0(use:\u00a0usual,\u00a0))</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/540002\u00a0(use:\u00a0official,\u00a0)</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>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
]
},
"system" : "http://vendor.com/ab",
"value" : "540002",
"assigner" : {
"display" : "AB Vendor"
}
},
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
]
},
"system" : "http://dev.gene.com/patientmaster",
"value" : "MPAT-000123",
"assigner" : {
"display" : "Genentech Patient Master"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Michaelson",
"given" : [
"Ryan"
]
}
],
"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" : [
"1234 Main St"
],
"city" : "San Francisco",
"state" : "CA",
"postalCode" : "94105",
"country" : "US"
}
],
"communication" : [
{
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en",
"display" : "English"
}
]
},
"preferred" : true
}
],
"managingOrganization" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088"
}
}
},
{
"fullUrl" : "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"resource" : {
"resourceType" : "CoverageEligibilityRequest",
"id" : "a0e6a72c-a35b-4e1c-890e-6d34ed51d4de",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityRequest_a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest a0e6a72c-a35b-4e1c-890e-6d34ed51d4de</b></p><a name=\"a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\"> </a><a name=\"hca0e6a72c-a35b-4e1c-890e-6d34ed51d4de\"> </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-coverage-eligibility-request.html\">UAPI CoverageEligibilityRequest</a></p></div><p><b>UAPI CoverageEligibilityRequest ServiceRequestType</b>: <span title=\"Codes:{https://fhir.developer.gene.com/CodeSystem/uapi-sr-type bipa}\">Benefit Investigation / Prior Authorization</span></p><p><b>UAPI CoverageEligibilityRequest Product</b>: <span title=\"Codes:{https://fhir.developer.gene.com/CodeSystem/uapi-product-name lucentis}\">Lucentis</span></p><p><b>identifier</b>: <code>https://fhir.developer.gene.com/enrollment/bundle-enrollment-id</code>/c78bde64-95e8-41f9-8a37-b2ac9aaf33d6\u00a0(use:\u00a0old,\u00a0), <code>https://fhir.developer.gene.com/enrollment/Case</code>/05971219\u00a0(use:\u00a0old,\u00a0), <code>https://genentech-pps.my.salesforce.com/ProductCoverageID</code>/PC-4856067\u00a0(use:\u00a0official,\u00a0)</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Bundle-uapi-status-update-1.html#urn-uuid-7c0c0017-e08d-4a14-9889-9eea26303ff2\">Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>created</b>: 2021-05-27 08:10:13-0500</p><p><b>provider</b>: <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></p><p><b>insurer</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"#hca0e6a72c-a35b-4e1c-890e-6d34ed51d4de/42b41bdb-1781-49aa-a091-78cdd92129df\">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</a></td></tr></table><blockquote><p><b>item</b></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm E11.3513}\">Type 2 diab with prolif diab rtnop with macular edema, bi</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #d3637025-883d-4678-9e0a-1d243a338f9f</b></p><a name=\"a0e6a72c-a35b-4e1c-890e-6d34ed51d4de/d3637025-883d-4678-9e0a-1d243a338f9f\"> </a><a name=\"hca0e6a72c-a35b-4e1c-890e-6d34ed51d4de/d3637025-883d-4678-9e0a-1d243a338f9f\"> </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-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: <code>http://vendor.com/ab</code>/PAY-111\u00a0(use:\u00a0usual,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: Dakotacare</p><p><b>telecom</b>: ph: 8778472862(Work)</p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Coverage #42b41bdb-1781-49aa-a091-78cdd92129df</b></p><a name=\"a0e6a72c-a35b-4e1c-890e-6d34ed51d4de/42b41bdb-1781-49aa-a091-78cdd92129df\"> </a><a name=\"hca0e6a72c-a35b-4e1c-890e-6d34ed51d4de/42b41bdb-1781-49aa-a091-78cdd92129df\"> </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-coverage.html\">UAPI Coverage</a></p></div><p><b>UAPI Coverage Plan Year</b>: Calendar Year</p><p><b>UAPI Coverage Reference Number</b>: jhgfdsd56e5r76</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-4db51d32-65c3-4f8c-959e-0155c6d14545\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>subscriberId</b>: 4353</p><p><b>beneficiary</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>period</b>: 2021-08-31 --> 2021-09-07</p><p><b>payor</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class subplan}\">SubPlan</span></p><p><b>value</b>: CHAMPVA</p><p><b>name</b>: SubPlan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: Miltary</p><p><b>name</b>: Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: 12344frgr</p><p><b>name</b>: Group</p></blockquote><p><b>order</b>: 1</p><p><b>network</b>: Dakotacare</p></blockquote></div>"
},
"contained" : [
{
"resourceType" : "Organization",
"id" : "d3637025-883d-4678-9e0a-1d243a338f9f",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
]
},
"identifier" : [
{
"use" : "usual",
"system" : "http://vendor.com/ab",
"value" : "PAY-111",
"assigner" : {
"display" : "AB Vendor"
}
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins"
}
]
}
],
"name" : "Dakotacare",
"telecom" : [
{
"system" : "phone",
"value" : "8778472862",
"use" : "work",
"rank" : 1
}
]
},
{
"resourceType" : "Coverage",
"id" : "42b41bdb-1781-49aa-a091-78cdd92129df",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"
]
},
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/PlanYear",
"valueString" : "Calendar Year"
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber",
"valueString" : "jhgfdsd56e5r76"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "HIP",
"display" : "health insurance plan policy"
}
]
},
"subscriber" : {
"reference" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
"type" : "RelatedPerson"
},
"subscriberId" : "4353",
"beneficiary" : {
"reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
"type" : "Patient"
},
"period" : {
"start" : "2021-08-31",
"end" : "2021-09-07"
},
"payor" : [
{
"reference" : "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f",
"type" : "Organization"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan",
"display" : "SubPlan"
}
]
},
"value" : "CHAMPVA",
"name" : "SubPlan"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan",
"display" : "Plan"
}
]
},
"value" : "Miltary",
"name" : "Plan"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group",
"display" : "Group"
}
]
},
"value" : "12344frgr",
"name" : "Group"
}
],
"order" : 1,
"network" : "Dakotacare"
}
],
"extension" : [
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/SRType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type",
"code" : "bipa",
"display" : "Benefit Investigation / Prior Authorization"
}
]
}
},
{
"url" : "https://fhir.developer.gene.com/StructureDefinition/Product",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.developer.gene.com/CodeSystem/uapi-product-name",
"code" : "lucentis",
"display" : "Lucentis"
}
]
}
}
],
"identifier" : [
{
"use" : "old",
"system" : "https://fhir.developer.gene.com/enrollment/bundle-enrollment-id",
"value" : "c78bde64-95e8-41f9-8a37-b2ac9aaf33d6"
},
{
"use" : "old",
"system" : "https://fhir.developer.gene.com/enrollment/Case",
"value" : "05971219"
},
{
"use" : "official",
"system" : "https://genentech-pps.my.salesforce.com/ProductCoverageID",
"value" : "PC-4856067"
}
],
"status" : "active",
"purpose" : [
"benefits"
],
"patient" : {
"reference" : "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2",
"type" : "Patient"
},
"created" : "2021-05-27T08:10:13-05:00",
"provider" : {
"reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088",
"type" : "Organization"
},
"insurer" : {
"reference" : "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f",
"type" : "Organization"
},
"insurance" : [
{
"coverage" : {
"reference" : "#42b41bdb-1781-49aa-a091-78cdd92129df"
}
}
],
"item" : [
{
"diagnosis" : [
{
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "E11.3513"
}
]
}
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4",
"resource" : {
"resourceType" : "CoverageEligibilityResponse",
"id" : "e89b0285-4582-4b1b-a448-f2cc467664f4",
"meta" : {
"profile" : [
🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_e89b0285-4582-4b1b-a448-f2cc467664f4\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse e89b0285-4582-4b1b-a448-f2cc467664f4</b></p><a name=\"e89b0285-4582-4b1b-a448-f2cc467664f4\"> </a><a name=\"hce89b0285-4582-4b1b-a448-f2cc467664f4\"> </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-coverage-eligibility-response.html\">UAPI CoverageEligibilityResponse</a></p></div><p><b>UAPI CoverageEligibilityResponse Status</b>: <span title=\"Codes:{https://fhir.developer.gene.com/CodeSystem/uapi-coverage-outcome approved}\">Approved</span></p><p><b>UAPI PreD Est. TAT</b>: 5-7 Business Days</p><p><b>UAPI PCP Referral Required?</b>: No</p><p><b>UAPI PCP Referral Effective Date</b>: 2022-05-14</p><p><b>UAPI PCP Referral On-file?</b>: Yes</p><p><b>UAPI PCP Referral Recertification Date</b>: 2022-05-14</p><p><b>UAPI Spend Down Frequency</b>: 6</p><p><b>UAPI Peer to Peer Available</b>: Yes</p><p><b>UAPI # of Appeals Allowed</b>: 2</p><p><b>UAPI Appeal Submission Deadline</b>: 2022-05-14</p><p><b>UAPI Additional Documents Required</b>: Denial Letter</p><p><b>UAPI Estimated Appeal TAT</b>: 4</p><p><b>identifier</b>: <code>https://fhir.developer.gene.com/enrollment/bundle-enrollment-id</code>/c78bde64-95e8-41f9-8a37-b2ac9aaf33d6\u00a0(use:\u00a0old,\u00a0), <code>https://fhir.developer.gene.com/enrollment/Case</code>/05971219\u00a0(use:\u00a0old,\u00a0), <code>https://genentech-pps.my.salesforce.com/ProductCoverageID</code>/PC-4856067\u00a0(use:\u00a0official,\u00a0)</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Bundle-uapi-status-update-1.html#urn-uuid-7c0c0017-e08d-4a14-9889-9eea26303ff2\">Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>serviced</b>: 2021-06-01</p><p><b>created</b>: 2021-05-27 08:10:13-0500</p><p><b>request</b>: <a href=\"Bundle-uapi-status-update-3.html#urn-uuid-a0e6a72c-a35b-4e1c-890e-6d34ed51d4de\">Bundle: type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>outcome</b>: Complete</p><p><b>disposition</b>: Yes, if medically necessary</p><p><b>insurer</b>: <a href=\"#hce89b0285-4582-4b1b-a448-f2cc467664f4/d3637025-883d-4678-9e0a-1d243a338f9f\">Organization Dakotacare</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"#hce89b0285-4582-4b1b-a448-f2cc467664f4/42b41bdb-1781-49aa-a091-78cdd92129df\">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</a></p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service billing}\">Billing Code</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type fullBI}\">Full BI</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DeductibleApply}\">Does Deductible Apply?</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type doesIndDedApplyFamily}\">does ind ded apply to family</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type FamDedMetBefore}\">Must Fam Ded Be Met Before Bene Cov</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type OOPApply}\">Does OOP Apply</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type IndividualOOPFamily}\">Does Individual OOP Apply to Family</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type 100%Cov}\">100% Cov only if Family OOP Met</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type InsurerCostShare}\">Insurer Cost Share %</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type PatientCostShare}\">Patient Cost Share %</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type BuyBill}\">Buy and Bill</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DrugTierLevel}\">Drug Tier Level</span></p><p><b>allowed</b>: Yes</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type PatientCostInitial}\">Patient Cost Share % **Initial Coverage Stage</span></p><p><b>allowed</b>: 25</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DaysSupplyInitial}\">Day Supply **Initial Coverage Stage</span></p><p><b>allowed</b>: 30 day supply</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DrugCopayInitial}\">Drug Copay **Initial Coverage Stage</span></p><p><b>allowed</b>: 30.00</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type PatientCostCatastrophic}\">Patient Cost Share % **Catastrophic Coverage Stage</span></p><p><b>allowed</b>: 15</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DrugCopayCatastrophic}\">Drug Co-pay **Catastrophic Coverage Stage</span></p><p><b>allowed</b>: 10</p></blockquote><p><b>authorizationRequired</b>: true</p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service admin}\">Admin Code</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit indivitual}\">Indivitual</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type deductible}\">deductible</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type OOPMax}\">OOP MAx</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type MaxBenefit/Year}\">Max Benefit/Year</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type MaxLifetimeAmount}\">Max Lifetime Amount</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type SpentDownAmount}\">Spent Down Amount</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type CoverageGap}\">Coverage Gap</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><p><b>authorizationRequired</b>: true</p><p><b>authorizationSupporting</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting form}\">Form</span></p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service billing}\">Billing Code</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit family}\">Family</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type deductible}\">deductible</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type OOPMax}\">OOP Max</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type MaxBenefit/Year}\">Max Benefit/Year</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p><p><b>used</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service billing}\">Billing Code</span></p><p><b>network</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-network in}\">In Network</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DrugCo-Pay}\">Drug Co-Pay</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type SpecialistCo-Pay}\">Specialist Co-Pay</span></p><p><b>allowed</b>: <span title=\"US Dollar\">$25.00</span> (USD)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type DeductibleApplyOOP}\">Does Deductible Apply to OOP</span></p><p><b>allowed</b>: Yes</p></blockquote></blockquote></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #d3637025-883d-4678-9e0a-1d243a338f9f</b></p><a name=\"e89b0285-4582-4b1b-a448-f2cc467664f4/d3637025-883d-4678-9e0a-1d243a338f9f\"> </a><a name=\"hce89b0285-4582-4b1b-a448-f2cc467664f4/d3637025-883d-4678-9e0a-1d243a338f9f\"> </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-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: <code>http://vendor.com/ab</code>/PAY-111\u00a0(use:\u00a0usual,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: Dakotacare</p><p><b>telecom</b>: ph: 8778472862(Work)</p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Coverage #42b41bdb-1781-49aa-a091-78cdd92129df</b></p><a name=\"e89b0285-4582-4b1b-a448-f2cc467664f4/42b41bdb-1781-49aa-a091-78cdd92129df\"> </a><a name=\"hce89b0285-4582-4b1b-a448-f2cc467664f4/42b41bdb-1781-49aa-a091-78cdd92129df\"> </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-coverage.html\">UAPI Coverage</a></p></div><p><b>UAPI Coverage Plan Year</b>: Calendar Year</p><p><b>UAPI Coverage Reference Number</b>: jhgfdsd56e5r76</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-4db51d32-65c3-4f8c-959e-0155c6d14545\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>subscriberId</b>: 4353</p><p><b>beneficiary</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>period</b>: 2021-08-31 --> 2021-09-07</p><p><b>payor</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-d3637025-883d-4678-9e0a-1d243a338f9f\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class subplan}\">SubPlan</span></p><p><b>value</b>: CHAMPVA</p><p><b>name</b>: SubPlan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: Miltary</p><p><b>name</b>: Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: 12344frgr</p><p><b>name</b>: Group</p></blockquote><p><b>order</b>: 1</p><p><b>network</b>: Dakotacare</p></blockquote></div>"
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