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
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:Bundle ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "uapi-status-update-3"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-status-update> ] ) ] ; # fhir:type [ fhir:v "message"] ; # fhir:timestamp [ fhir:v "2020-03-11T08:10:13-05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa> ) ] [ fhir:fullUrl [ fhir:v "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0> ) ] [ fhir:fullUrl [ fhir:v "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088> ) ] [ fhir:fullUrl [ fhir:v "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2> ) ] [ fhir:fullUrl [ fhir:v "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de> ) ] [ fhir:fullUrl [ fhir:v "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4"^^xsd:anyURI ] ; ( fhir:resource <urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4> ) ] ) . # <urn:uuid:5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa> a fhir:MessageHeader ; fhir:id [ fhir:v "5c0cdcfa-4e39-4c4d-bff2-9d70a2f49eaa"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir: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>"^^rdf:XMLLiteral ] ; # fhir:event [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "status-update" ] ] ; # fhir:sender [ fhir:reference [ fhir:v "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ; # fhir:source [ fhir:name [ fhir:v "Genentech-PACT" ] ; fhir:endpoint [ fhir:v "https://genentech-pps.my.salesforce.com"^^xsd:anyURI ] ] ; # fhir:focus ( [ fhir:reference [ fhir:v "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0" ] ; fhir:type [ fhir:v "List"^^xsd:anyURI ] ] ) . # <urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0> a fhir:List ; fhir:id [ fhir:v "8e055260-dd74-4c89-9ccf-3d2f47135ee0"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir: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>"^^rdf:XMLLiteral ] ; # fhir:status [ fhir:v "current"] ; # fhir:mode [ fhir:v "changes"] ; # fhir:title [ fhir:v "messageContext"] ; # fhir:entry ( [ fhir:item [ fhir:reference [ fhir:v "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55" ] ; fhir:type [ fhir:v "Patient"^^xsd:anyURI ] ] ] [ fhir:item [ fhir:reference [ fhir:v "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ] [ fhir:item [ fhir:reference [ fhir:v "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de" ] ; fhir:type [ fhir:v "CoverageEligibilityRequest"^^xsd:anyURI ] ] ] [ fhir:item [ fhir:reference [ fhir:v "urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4" ] ; fhir:type [ fhir:v "CoverageEligibilityResponse"^^xsd:anyURI ] ] ] ) . # <urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088> a fhir:Organization ; fhir:id [ fhir:v "01c31a2f-321d-4c6e-8349-206af8a88088"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir: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 (use: usual, ), <code>http://dev.gene.com/fhir/mulesoft</code>/Vendor_AB_HOSP-12345 (use: official, )</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>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:use [ fhir:v "usual" ] ; fhir:system [ fhir:v "http://vendor.com/ab"^^xsd:anyURI ] ; fhir:value [ fhir:v "HOSP-12345" ] ; fhir:assigner [ fhir:display [ fhir:v "AB Vendor" ] ] ] [ fhir:use [ fhir:v "official" ] ; fhir:system [ fhir:v "http://dev.gene.com/fhir/mulesoft"^^xsd:anyURI ] ; fhir:value [ fhir:v "Vendor_AB_HOSP-12345" ] ; fhir:assigner [ fhir:display [ fhir:v "UAPI Process API Mulesoft" ] ] ] ) ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "prov" ] ; fhir:display [ fhir:v "Healthcare Provider" ] ] ) ] ) ; # fhir:name [ fhir:v "Mid Atlantic Retina"] ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ] ) ; # fhir:address ( [ ( fhir:line [ fhir:v "8 Ranoldo Terrace" ] ) ; fhir:city [ fhir:v "Cherry Hill" ] ; fhir:state [ fhir:v "NJ" ] ; fhir:postalCode [ fhir:v "08034" ] ; fhir:country [ fhir:v "US" ] ] ) ; # fhir:contact ( [ fhir:name [ fhir:use [ fhir:v "official" ] ; fhir:family [ fhir:v "Yardav" ] ; ( fhir:given [ fhir:v "Venus" ] ) ] ; ( fhir:telecom [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "8882704882" ] ; fhir:use [ fhir:v "work" ] ; fhir:rank [ fhir:v "1"^^xsd:positiveInteger ] ] [ fhir:system [ fhir:v "fax" ] ; fhir:value [ fhir:v "8179974042" ] ; fhir:use [ fhir:v "work" ] ; fhir:rank [ fhir:v "2"^^xsd:positiveInteger ] ] ) ] ) . # <urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2> a fhir:Patient ; fhir:id [ fhir:v "7c0c0017-e08d-4a14-9889-9eea26303ff2"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-patient"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-patient> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir: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 (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/540002 (use: official, )</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>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:use [ fhir:v "official" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PI" ] ; fhir:display [ fhir:v "Patient internal identifier" ] ] ) ] ; fhir:system [ fhir:v "http://vendor.com/ab"^^xsd:anyURI ] ; fhir:value [ fhir:v "540002" ] ; fhir:assigner [ fhir:display [ fhir:v "AB Vendor" ] ] ] [ fhir:use [ fhir:v "usual" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PI" ] ; fhir:display [ fhir:v "Patient internal identifier" ] ] ) ] ; fhir:system [ fhir:v "http://dev.gene.com/patientmaster"^^xsd:anyURI ] ; fhir:value [ fhir:v "MPAT-000123" ] ; fhir:assigner [ fhir:display [ fhir:v "Genentech Patient Master" ] ] ] ) ; # fhir:name ( [ fhir:use [ fhir:v "official" ] ; fhir:family [ fhir:v "Michaelson" ] ; ( fhir:given [ fhir:v "Ryan" ] ) ] ) ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "1231231234" ] ; fhir:use [ fhir:v "home" ] ; fhir:rank [ fhir:v "1"^^xsd:positiveInteger ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "1234561234" ] ; fhir:use [ fhir:v "mobile" ] ; fhir:rank [ fhir:v "2"^^xsd:positiveInteger ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "bobster83@example.com" ] ; fhir:use [ fhir:v "home" ] ; fhir:rank [ fhir:v "3"^^xsd:positiveInteger ] ] ) ; # fhir:gender [ fhir:v "male"] ; # fhir:birthDate [ fhir:v "1972-10-29"^^xsd:date] ; # fhir:address ( [ ( fhir:line [ fhir:v "1234 Main St" ] ) ; fhir:city [ fhir:v "San Francisco" ] ; fhir:state [ fhir:v "CA" ] ; fhir:postalCode [ fhir:v "94105" ] ; fhir:country [ fhir:v "US" ] ] ) ; # fhir:communication ( [ fhir:language [ ( fhir:coding [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en" ] ; fhir:display [ fhir:v "English" ] ] ) ] ; fhir:preferred [ fhir:v true ] ] ) ; # fhir:managingOrganization [ fhir:reference [ fhir:v "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ] ] . # <urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de> a fhir:CoverageEligibilityRequest ; fhir:id [ fhir:v "a0e6a72c-a35b-4e1c-890e-6d34ed51d4de"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir: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 (use: old, ), <code>https://fhir.developer.gene.com/enrollment/Case</code>/05971219 (use: old, ), <code>https://genentech-pps.my.salesforce.com/ProductCoverageID</code>/PC-4856067 (use: official, )</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 (use: usual, )</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>"^^rdf:XMLLiteral ] ; # fhir:contained ( [ a fhir:Organization ; fhir:id [ fhir:v "d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ] ) ] ; ( fhir:identifier [ fhir:use [ fhir:v "usual" ] ; fhir:system [ fhir:v "http://vendor.com/ab"^^xsd:anyURI ] ; fhir:value [ fhir:v "PAY-111" ] ; fhir:assigner [ fhir:display [ fhir:v "AB Vendor" ] ] ] ) ; ( fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "ins" ] ] ) ] ) ; fhir:name [ fhir:v "Dakotacare" ] ; ( fhir:telecom [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "8778472862" ] ; fhir:use [ fhir:v "work" ] ; fhir:rank [ fhir:v "1"^^xsd:positiveInteger ] ] ) ] [ a fhir:Coverage ; fhir:id [ fhir:v "42b41bdb-1781-49aa-a091-78cdd92129df" ] ; fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage> ] ) ] ; ( fhir:extension [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/PlanYear"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Calendar Year" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "jhgfdsd56e5r76" ] ] ) ; fhir:status [ fhir:v "active" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "HIP" ] ; fhir:display [ fhir:v "health insurance plan policy" ] ] ) ] ; fhir:subscriber [ fhir:reference [ fhir:v "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545" ] ; fhir:type [ fhir:v "RelatedPerson"^^xsd:anyURI ] ] ; fhir:subscriberId [ fhir:v "4353" ] ; fhir:beneficiary [ fhir:reference [ fhir:v "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ] ; fhir:type [ fhir:v "Patient"^^xsd:anyURI ] ] ; fhir:period [ fhir:start [ fhir:v "2021-08-31"^^xsd:date ] ; fhir:end [ fhir:v "2021-09-07"^^xsd:date ] ] ; ( fhir:payor [ fhir:reference [ fhir:v "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ) ; ( fhir:class [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subplan" ] ; fhir:display [ fhir:v "SubPlan" ] ] ) ] ; fhir:value [ fhir:v "CHAMPVA" ] ; fhir:name [ fhir:v "SubPlan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ; fhir:display [ fhir:v "Plan" ] ] ) ] ; fhir:value [ fhir:v "Miltary" ] ; fhir:name [ fhir:v "Plan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "group" ] ; fhir:display [ fhir:v "Group" ] ] ) ] ; fhir:value [ fhir:v "12344frgr" ] ; fhir:name [ fhir:v "Group" ] ] ) ; fhir:order [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:network [ fhir:v "Dakotacare" ] ] ) ; # fhir:extension ( [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/SRType"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "bipa" ] ; fhir:display [ fhir:v "Benefit Investigation / Prior Authorization" ] ] ) ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/Product"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://fhir.developer.gene.com/CodeSystem/uapi-product-name"^^xsd:anyURI ] ; fhir:code [ fhir:v "lucentis" ] ; fhir:display [ fhir:v "Lucentis" ] ] ) ] ] ) ; # fhir:identifier ( [ fhir:use [ fhir:v "old" ] ; fhir:system [ fhir:v "https://fhir.developer.gene.com/enrollment/bundle-enrollment-id"^^xsd:anyURI ] ; fhir:value [ fhir:v "c78bde64-95e8-41f9-8a37-b2ac9aaf33d6" ] ] [ fhir:use [ fhir:v "old" ] ; fhir:system [ fhir:v "https://fhir.developer.gene.com/enrollment/Case"^^xsd:anyURI ] ; fhir:value [ fhir:v "05971219" ] ] [ fhir:use [ fhir:v "official" ] ; fhir:system [ fhir:v "https://genentech-pps.my.salesforce.com/ProductCoverageID"^^xsd:anyURI ] ; fhir:value [ fhir:v "PC-4856067" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:purpose ( [ fhir:v "benefits"] ) ; # fhir:patient [ fhir:reference [ fhir:v "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2" ] ; fhir:type [ fhir:v "Patient"^^xsd:anyURI ] ] ; # fhir:created [ fhir:v "2021-05-27T08:10:13-05:00"^^xsd:dateTime] ; # fhir:provider [ fhir:reference [ fhir:v "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ; # fhir:insurer [ fhir:reference [ fhir:v "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ; # fhir:insurance ( [ fhir:coverage [ fhir:reference [ fhir:v "#42b41bdb-1781-49aa-a091-78cdd92129df" ] ] ] ) ; # fhir:item ( [ ( fhir:diagnosis [ fhir:diagnosis [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ; fhir:code [ fhir:v "E11.3513" ] ] ) ] ] ) ] ) . # <urn:uuid:e89b0285-4582-4b1b-a448-f2cc467664f4> a fhir:CoverageEligibilityResponse ; fhir:id [ fhir:v "e89b0285-4582-4b1b-a448-f2cc467664f4"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir: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 (use: old, ), <code>https://fhir.developer.gene.com/enrollment/Case</code>/05971219 (use: old, ), <code>https://genentech-pps.my.salesforce.com/ProductCoverageID</code>/PC-4856067 (use: official, )</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 (use: usual, )</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>"^^rdf:XMLLiteral ] ; # fhir:contained ( [ a fhir:Organization ; fhir:id [ fhir:v "d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ] ) ] ; ( fhir:identifier [ fhir:use [ fhir:v "usual" ] ; fhir:system [ fhir:v "http://vendor.com/ab"^^xsd:anyURI ] ; fhir:value [ fhir:v "PAY-111" ] ; fhir:assigner [ fhir:display [ fhir:v "AB Vendor" ] ] ] ) ; ( fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "ins" ] ] ) ] ) ; fhir:name [ fhir:v "Dakotacare" ] ; ( fhir:telecom [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "8778472862" ] ; fhir:use [ fhir:v "work" ] ; fhir:rank [ fhir:v "1"^^xsd:positiveInteger ] ] ) ] [ a fhir:Coverage ; fhir:id [ fhir:v "42b41bdb-1781-49aa-a091-78cdd92129df" ] ; fhir:meta [ ( fhir:profile [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"^^xsd:anyURI ; fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage> ] ) ] ; ( fhir:extension [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/PlanYear"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Calendar Year" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "jhgfdsd56e5r76" ] ] ) ; fhir:status [ fhir:v "active" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "HIP" ] ; fhir:display [ fhir:v "health insurance plan policy" ] ] ) ] ; fhir:subscriber [ fhir:reference [ fhir:v "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545" ] ; fhir:type [ fhir:v "RelatedPerson"^^xsd:anyURI ] ] ; fhir:subscriberId [ fhir:v "4353" ] ; fhir:beneficiary [ fhir:reference [ fhir:v "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ] ; fhir:type [ fhir:v "Patient"^^xsd:anyURI ] ] ; fhir:period [ fhir:start [ fhir:v "2021-08-31"^^xsd:date ] ; fhir:end [ fhir:v "2021-09-07"^^xsd:date ] ] ; ( fhir:payor [ fhir:reference [ fhir:v "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ) ; ( fhir:class [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subplan" ] ; fhir:display [ fhir:v "SubPlan" ] ] ) ] ; fhir:value [ fhir:v "CHAMPVA" ] ; fhir:name [ fhir:v "SubPlan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ; fhir:display [ fhir:v "Plan" ] ] ) ] ; fhir:value [ fhir:v "Miltary" ] ; fhir:name [ fhir:v "Plan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "group" ] ; fhir:display [ fhir:v "Group" ] ] ) ] ; fhir:value [ fhir:v "12344frgr" ] ; fhir:name [ fhir:v "Group" ] ] ) ; fhir:order [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:network [ fhir:v "Dakotacare" ] ] ) ; # fhir:extension ( [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/statusOutcome"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://fhir.developer.gene.com/CodeSystem/uapi-coverage-outcome"^^xsd:anyURI ] ; fhir:code [ fhir:v "approved" ] ; fhir:display [ fhir:v "Approved" ] ] ) ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/predAuthTAT"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "5-7 Business Days" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "No" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "2022-05-14" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "2022-05-14" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "6" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "2" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "2022-05-14" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Denial Letter" ] ] [ fhir:url [ fhir:v "https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "4" ] ] ) ; # fhir:identifier ( [ fhir:use [ fhir:v "old" ] ; fhir:system [ fhir:v "https://fhir.developer.gene.com/enrollment/bundle-enrollment-id"^^xsd:anyURI ] ; fhir:value [ fhir:v "c78bde64-95e8-41f9-8a37-b2ac9aaf33d6" ] ] [ fhir:use [ fhir:v "old" ] ; fhir:system [ fhir:v "https://fhir.developer.gene.com/enrollment/Case"^^xsd:anyURI ] ; fhir:value [ fhir:v "05971219" ] ] [ fhir:use [ fhir:v "official" ] ; fhir:system [ fhir:v "https://genentech-pps.my.salesforce.com/ProductCoverageID"^^xsd:anyURI ] ; fhir:value [ fhir:v "PC-4856067" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:purpose ( [ fhir:v "benefits"] ) ; # fhir:patient [ fhir:reference [ fhir:v "urn:uuid:7c0c0017-e08d-4a14-9889-9eea26303ff2" ] ; fhir:type [ fhir:v "Patient"^^xsd:anyURI ] ] ; # fhir:serviced [ a fhir:date ; fhir:v "2021-06-01"^^xsd:date ] ; # fhir:created [ fhir:v "2021-05-27T08:10:13-05:00"^^xsd:dateTime] ; # fhir:request [ fhir:reference [ fhir:v "urn:uuid:a0e6a72c-a35b-4e1c-890e-6d34ed51d4de" ] ; fhir:type [ fhir:v "CoverageEligibilityRequest"^^xsd:anyURI ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Yes, if medically necessary"] ; # fhir:insurer [ fhir:reference [ fhir:v "#d3637025-883d-4678-9e0a-1d243a338f9f" ] ; fhir:type [ fhir:v "Organization"^^xsd:anyURI ] ] ; # fhir:insurance ( [ fhir:coverage [ fhir:reference [ fhir:v "#42b41bdb-1781-49aa-a091-78cdd92129df" ] ] ; ( fhir:item [ fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service"^^xsd:anyURI ] ; fhir:code [ fhir:v "billing" ] ; fhir:display [ fhir:v "Billing Code" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "fullBI" ] ; fhir:display [ fhir:v "Full BI" ] ] ) ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DeductibleApply" ] ; fhir:display [ fhir:v "Does Deductible Apply?" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "doesIndDedApplyFamily" ] ; fhir:display [ fhir:v "does ind ded apply to family" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamDedMetBefore" ] ; fhir:display [ fhir:v "Must Fam Ded Be Met Before Bene Cov" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "OOPApply" ] ; fhir:display [ fhir:v "Does OOP Apply" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "IndividualOOPFamily" ] ; fhir:display [ fhir:v "Does Individual OOP Apply to Family" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "100%Cov" ] ; fhir:display [ fhir:v "100% Cov only if Family OOP Met" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "InsurerCostShare" ] ; fhir:display [ fhir:v "Insurer Cost Share %" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "PatientCostShare" ] ; fhir:display [ fhir:v "Patient Cost Share %" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "BuyBill" ] ; fhir:display [ fhir:v "Buy and Bill" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DrugTierLevel" ] ; fhir:display [ fhir:v "Drug Tier Level" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "PatientCostInitial" ] ; fhir:display [ fhir:v "Patient Cost Share % **Initial Coverage Stage" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "25" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DaysSupplyInitial" ] ; fhir:display [ fhir:v "Day Supply **Initial Coverage Stage" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "30 day supply" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DrugCopayInitial" ] ; fhir:display [ fhir:v "Drug Copay **Initial Coverage Stage" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "30.00" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "PatientCostCatastrophic" ] ; fhir:display [ fhir:v "Patient Cost Share % **Catastrophic Coverage Stage" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "15" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DrugCopayCatastrophic" ] ; fhir:display [ fhir:v "Drug Co-pay **Catastrophic Coverage Stage" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "10" ] ] ) ; fhir:authorizationRequired [ fhir:v true ] ] [ fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service"^^xsd:anyURI ] ; fhir:code [ fhir:v "admin" ] ; fhir:display [ fhir:v "Admin Code" ] ] ) ] ; fhir:unit [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "indivitual" ] ; fhir:display [ fhir:v "Indivitual" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "deductible" ] ; fhir:display [ fhir:v "deductible" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "OOPMax" ] ; fhir:display [ fhir:v "OOP MAx" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "MaxBenefit/Year" ] ; fhir:display [ fhir:v "Max Benefit/Year" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "MaxLifetimeAmount" ] ; fhir:display [ fhir:v "Max Lifetime Amount" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "SpentDownAmount" ] ; fhir:display [ fhir:v "Spent Down Amount" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "CoverageGap" ] ; fhir:display [ fhir:v "Coverage Gap" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:authorizationRequired [ fhir:v true ] ; ( fhir:authorizationSupporting [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting"^^xsd:anyURI ] ; fhir:code [ fhir:v "form" ] ; fhir:display [ fhir:v "Form" ] ] ) ] ) ] [ fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service"^^xsd:anyURI ] ; fhir:code [ fhir:v "billing" ] ; fhir:display [ fhir:v "Billing Code" ] ] ) ] ; fhir:unit [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-insurance-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "family" ] ; fhir:display [ fhir:v "Family" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "deductible" ] ; fhir:display [ fhir:v "deductible" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "OOPMax" ] ; fhir:display [ fhir:v "OOP Max" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "MaxBenefit/Year" ] ; fhir:display [ fhir:v "Max Benefit/Year" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-product-service"^^xsd:anyURI ] ; fhir:code [ fhir:v "billing" ] ; fhir:display [ fhir:v "Billing Code" ] ] ) ] ; fhir:network [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ; fhir:display [ fhir:v "In Network" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DrugCo-Pay" ] ; fhir:display [ fhir:v "Drug Co-Pay" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "SpecialistCo-Pay" ] ; fhir:display [ fhir:v "Specialist Co-Pay" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "DeductibleApplyOOP" ] ; fhir:display [ fhir:v "Does Deductible Apply to OOP" ] ] ) ] ; fhir:allowed [ a fhir:string ; fhir:v "Yes" ] ] ) ] ) ] ) . #
IG © 2021+ . Package gene.com.fhir.uapi#1.1.20 based on FHIR 4.3.0. Generated 2025-06-25
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