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

: External - UAPI Copay Explanation of Benefit in copay enrollment response - JSON Representation

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{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit 4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d</b></p><a name=\"4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d\"> </a><a name=\"hc4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d\"> </a><p><b>identifier</b>: <code>http://connectiverx.com/enrollmentId</code>/45d1b98c-587c-ed11-8279-d6b6a2da4722\u00a0(use:\u00a0usual,\u00a0)</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:\">pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Bundle-uapi-copay-request-response-with-error.html#urn-uuid-2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9\">Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98\u00a0(use:\u00a0usual,\u00a0); type = message; timestamp = 2023-01-11 08:10:17-0500</a></p><p><b>created</b>: 2023-02-07 08:10:13-0500</p><p><b>insurer</b>: <a href=\"Bundle-uapi-copay-request-response-enrollment.html#urn-uuid-d02db104-a75c-433f-8764-9778c2e20626\">Bundle: identifier = http://risrx.com/requestId#42c481a9-7e7e-4d14-ab37-f648e376802d\u00a0(use:\u00a0usual,\u00a0); type = message; timestamp = 2024-04-19 08:10:17-0500</a></p><p><b>provider</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-695d0991-5e03-46df-934a-85a28acd95c1\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>outcome</b>: Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Bundle-uapi-copay-request-response.html#urn-uuid-597540c9-6248-466e-81e0-58e78f15454e\">Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98\u00a0(use:\u00a0usual,\u00a0); type = message; timestamp = 2023-01-11 08:10:17-0500</a></td></tr></table></div>"
  },
  "identifier" : [
    {
      "use" : "usual",
      "system" : "http://connectiverx.com/enrollmentId",
      "value" : "45d1b98c-587c-ed11-8279-d6b6a2da4722"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "code" : "pharmacy"
      }
    ]
  },
  "use" : "predetermination",
  "patient" : {
    "reference" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9"
  },
  "created" : "2023-02-07T08:10:13-05:00",
  "insurer" : {
    "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"
  },
  "provider" : {
    "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"
  },
  "outcome" : "complete",
  "insurance" : [
    {
      "focal" : true,
      "coverage" : {
        "reference" : "urn:uuid:597540c9-6248-466e-81e0-58e78f15454e"
      }
    }
  ]
}