This CapabilityStatement describes the capabilities of a Genentech FHIR server which receives patient enrollments, sends enrollment status updates and serves related Questionnaire resources.

Enables searching by extension ServiceRequestType on CoverageEligilibityRequest resource.

Example of questionnaire to be filled out when submitting enrollment bundle for product Alecensa.

Example of questionnaire to be filled out when submitting Copay enrollment bundle for product Cotellic.

Example of questionnaire to be filled out when submitting enrollment bundle for product Cotellic.

Example of questionnaire to be filled out when submitting enrollment bundle for product Herceptin.

Example of questionnaire to be filled out when submitting enrollment bundle for product Lucentis.

This profile constrains a Bundle resource for use to submit enrollment into Access Solutions services. It CAN be used in following scenarios:

• Prescriber Service with Patient Consent
• Prescriber Service Only
• Patient Consent Only (Digital Consent)

This profile constrains a Bundle resource for use as Copay enrollment submission

This profile constrains a Bundle resource for use as Copay error reconciliation.

This profile constrains a Bundle resource for use in copay workflow to:

1. add existing Patient to Copay program,
2. search for Patients who are currently enrolled. It is critical to include Practice Organization ID in MessageHeader.sender.identifier.value to indicate the Practice to which the searched Patient belongs to.

This profile constrains a Bundle resource which combines all elements from copay request with all elements from copay response. Combine uapi-copay-enrollment-bundle with uapi-bundle-query-response for copay.

This profile constrains a Bundle resource for use as Access Solutions patient consent form submission

This profile constrains a Bundle resource for use as the request message in a UAPI Query process–with a Parameters resource as the bundle's message focus. It is based on IG http://build.fhir.org/ig/HL7/fhir-specialty-rx/branches/master/StructureDefinition-specialty-rx-bundle-query.html

This profile constrains a Bundle resource for use as the response message in a UAPI Query process–with a Parameters resource as the bundle's message focus. It is based on IG http://build.fhir.org/ig/HL7/fhir-specialty-rx/branches/master/StructureDefinition-specialty-rx-bundle-query-response.html

This profile constrains a Bundle resource for use as the response message in a Copay Search use case. It returns potentially multiple matching patients in query-result-patient entry element.

This profile constrains a Bundle resource to carry the query results from a UAPI Query - it is derived from IG http://build.fhir.org/ig/HL7/fhir-specialty-rx/branches/master/StructureDefinition-specialty-rx-bundle-search-result.html

This profile constrains a Bundle resource for use as an element in UapiBundleQueryResponseMultiPatient bundle query-result-patient entry element. It contains Patient with related query-result resources.

This profile constrains a Bundle resource for use as the Status Update for Service Request Using Coverage Eligibility Response

This profile constrains the Condition resource

This profile constrains the Consent resource for Patient and Practioner

This profile constrains the Coverage resource

This profile constrains the CoverageEligibilityRequest resource to be used in sharing service request results in UAPI

This profile constrains the CoverageEligibilityResponse resource to be used in sharing service request results in UAPI

This profile constrains the MedicationRequest resource to be included in UAPI data exchanges

This profile constrains the MessageHeader resource to be included in each bundle

This profile constrains the Organization resource for representing practice and insurance

This profile constrains the Patient resource to be included in UAPI data exchanges

This profile constrains the Practitioner resource to be included in UAPI data exchanges

This profile constrains the Provenance resource to be included in UAPI data exchanges

This profile constrains the Related Person resource to be included in UAPI data exchanges

This profile constrains the ServiceRequest resource

States how many level of appeals the Insurance allows.

States what documents are required to submit for appeal.

States when the deadline is to submit for an appeal with the Insurance.

Benefit Investigation Benefits Summary

Benefit Investigation Billing Instructions

Benefit Investigation Specialty Pharmacy

Date when the insurance company issued the insurance card.

Describes Plan year for Coverage Status Outcome

Describes Reference Number for Coverage Status Outcome

Describes the Medication(Product) related to Coverage eligibility Request

Describes the ServiceRequest related to Coverage Eligibility Request

Describes shipment method for GPF Shipments, currently supported values are 'Upfront' and 'Replacement'

Provides the updated status of successfully enrolled Service Requests

Appeal Turn Around Time: Estimated time Insurance needs to review an appeal in business days.

Detailed breakdown of medication units with quantity to fill the prescription dosage requirement

Additional information for the dispenser

Timestamp when bundle was submitted

States what the first day of an on-file referral from a Primary Care Physician (When it starts)

States whether a referral from a Primary Care Physician is on-file with the Insurance

States what the last day of a on-file referral from a Primary Care Physician (When it expires)

States whether a referral from a Primary Care Physician is required.

States whether Peer to Peer is an option for appeals.

The preferred method of contact.

The preferred contact time.

PreDetermination Turn Around Time: Estimated time Insurance needs to review a PreDetermination in business days.

Prior Authorization Turn Around Time: Estimated time Insurance needs to review a Prior Authorization in business days.

States what the Spend down frequency is for Medicaid. Only applies to patients with Medicaid

This value set contains Benefit Types used in the UAPI

This value set contains Copay Adjudication Categories values used in copay enrollments in the UAPI. It is a combination of https://hl7.org/fhir/us/carin-bb/ValueSet-C4BBAdjudicationCategoryDiscriminator.html standard codes with subset of custom additional codes required for UAPI implementation.

This value set contains Insurance Plan Types values used in copay enrollments in the UAPI. It is a combination of http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode standard codes with subset of custom additional codes required for UAPI implementation.

This value set contains Coverage outcome as result of patient enrollment.

This value set contains Insurance Unit used in the UAPI

This value set contains Organization Types used in the UAPI

This value set contains PreDetermination information for patient enrollments.

This value set contains preferred contact methods.

This value set contains preferred contact times.

This value set contains product Auth used in the UAPI

This value set contains Specialty Pharmacy information for patient enrollments.

This value set contains product names used in the UAPI MedicationRequest profile.

This value set contains product service used in the UAPI

This value set contains regimen product names used in the UAPI MedicationRequest profile.

This value set contains Service Request types used in the UAPI ServiceRequest profile.

This value set contains Shipment method used for GPF medicine.

This value set contains Specialty Pharmacy information for patient enrollments.

This value set contains system event types used in the UAPI MessageHeader profile.

Genentech Authorizations Supported in UAPI

Genentech Benefit Types Supported in UAPI

Genentech additional Adjudication Categories supported in UAPI for Copay claims.

Genentech additional Benefit Types supported in UAPI

The BrandID identifies the product and the type(s) of Copay assistance the patient is applying for.

Copay Enrollment Channel

Copay Enrollment Status

Workflow selection. A workflow is a predetermined sequence of actions represented by a unique workflow name and capable of being mutated at the various available states via the settings object. Each workflow consists of a subset combination of these available internal actions:

Genentech claim statuses supported in UAPI for Copay claims.

Genentech supporting info categories utilized in UAPI for Copay claims.

Genentech possible Errors on rejected Copay Enrollment

Internal validation errors when processing incoming enrollment and claims copay messages.

Genentech additional Insurance Plan Types supported in UAPI for Copay enrollments.

Genentech payment types supported in UAPI for Copay claims.

This is used to define copay identifiers required by the system to process the Copay enrollment.

This is used to define copay identifiers returned by the Copay enrollment.

The enroll-by-id field identifies who is applying for Copay assistance.

Value to represent the type of Debit Card assignment that should occur with this enrollment.

This code system defines outcomes of eligibility status for requested services.

This code system defines event types used in UAPI message headers

Genentech Insurance Unit Supported in UAPI

PreDetermination information for patient enrollment

Prescriber's preferred contact methods supported in UAPI

Prescriber's preferred contact times supported in UAPI

JCodes for Products supported by UAPI

Genentech Product names supported in UAPI

Genentech product coverage categories returned in CoverageEligibilityResponse

Regimen Product names supported in UAPI

This code system defines Service Request types used in UAPI to indicate Patient Assistance Program services

Genentech shipment categories supported in UAPI

Specialty Pharmacy information for patient enrollments

Example of Questionnaire Response for product Alecensa.

Example of Questionnaire Response for BIPA for Herceptin Hylecta .

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting BIPA or Patient Foundation services. Includes complex medicationRequest.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting BIPA services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting BIPA services. Includes complex medicationRequest with multiple dispense quantities.

Example for External Vendor systems. Include this prescription example in the Itovebi enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting GPF services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting Starter services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting BIPA or GPF services.

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting Patient Foundation services. Includes complex medicationRequest (prescription).

Example for External Vendor systems. Include this prescription example in the enrollment bundle when requesting GPF services.

Example for External Vendor systems. Include this prescription example in the Alecesna enrollment bundle when requesting BIPA services.

Example for External Vendor systems. Include this prescription example in the Cotellic enrollment bundle when requesting BIPA services.

Example for External Vendor systems. Include this prescription example in the Erivedge enrollment bundle when requesting BIPA services.

Example for External Vendor systems. Include this prescription example in the Herceptin enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the Lucentis enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the Lunsumio enrollment bundle when requesting Patient Foundation services.

Example for External Vendor systems. Include this prescription example in the Rozlytrek enrollment bundle when requesting BIPA services.

Example for External Vendor systems. Include this prescription example in the Vabysmo enrollment bundle when requesting Patient Foundation services.

Successful OperationOutcome

Example of Practice Organization which should be included in each enrollment bundle.

Example of MessageHeader which contains sender.endpoint with transaction identifier appended after /enrollmentID

Example of Questionnaire Response for product Rozlytrek.

Example of Site of Treatment/Infusion Centre- Organization which may be included in each enrollment bundle.

Example of a digital consent given by the RelatedPerson

Example for External Vendor systems. Use this example to send an Actemra Subcutaneous enrollment bundle to the UAPI enrollment endpoint, requesting Access Solution services. The bundle contains (Enrollment Only): BIPA SR, Prescription, Prescriber Signature (optional).

Example for External Vendor systems. Use this example to send an Alecensa enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Prescription, Digital Consent, Prescriber Signature

Example for External Vendor systems. Use this example to send an Avastin enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send an Columvi enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Cotellic enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Prescription, Digital Consent, Prescriber Signature, 2 Diagnosis Codes

Example for External Vendor systems Use this example to send an Enspryng enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Prescription, Digital Consent, and Site of Treatment.

Example for External Vendor systems. Use this example to send an Erivedge enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Prescription, Digital Consent, Prescriber Signature

Example for External Vendor systems. Use this example to send a Gazyva enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Hemlibra enrollment bundle to the UAPI enrollment endpoint, requesting Access Solution services. The bundle contains (Enrollment Only): BIPA SR, Prescription, optional Prescriber Signature not included.

Example for External Vendor systems. Use this example to send a Herceptin Hylecta enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent) BIPA SR, Digital Consent

Example for External Vendor systems. Use this example to send a Lucentis enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains BIPA SR, Copay SR, Digital Consent

Example for External Vendor systems. Use this example to send an Ocrevus enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, and Site of Treatment.

Example for External Vendor systems. Use this example to send a Perjeta enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Polivy enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send an Pulmozyme enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains (Enrollment + Digital Consent): Patient Foundation SR, Prescription, Prescriber Signature, Digital Consent.

Example for External Vendor systems. Use this example to send a Rituxan Hycela enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent) BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send an Rituxan for Immunology enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains (Enrollment + Consent): Patient Foundation SR, Prescription, Prescriber Signature, Site of Treatment, Digital Consent

Example for External Vendor systems. Use this example to send a Rituxan for Oncology enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Digital Consent, Site of Treatment, Regimen Product

Example for External Vendor systems. Use this example to send a Rozlytrek enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment ONLY) BIPA SR, Prescription, Prescriber Signature

Example for External Vendor systems. Use this example to send a Susvimo enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Vabysmo enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains BIPA SR, Copay Referral SR, Digital Consent

Example for External Vendor systems. Use this example to send a Venclexta enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains BIPA SR, Copay Referral SR, Prescription, Digital Consent, Prescriber Signature

Example for External Vendor systems. Use this example to send a Xolair enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains BIPA and Starter SR, Digital Consent, Prescriber Signature, Site of Treatment, Starter Prescription

Example for External Vendor systems. Use this example to send a Evrysdi enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains BIPA SR, Prescription, Digital Consent, Prescriber Signature

Example for External Vendor systems. Use this example to send a Kadcyla enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Phesgo enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor systems. Use this example to send a Tecentriq enrollment bundle to the UAPI enrollment endpoint, requesting Access Solutions services. The bundle contains (Enrollment + Digital Consent): BIPA SR, Copay Referral SR, Digital Consent, Site of Treatment

Example for External Vendor Systems. Use this example to submit a Patient Consent Only bundle; contains Patient Authorization Signature.

Example of a consent to opt-in for marketing info

Example of copay card request bundle initiated from internal Genentech PACT/MPS system

Example of copay card request bundle initiated from External Vendor System

Example of request bundle initiated from External Vendor System that includes a combo therapy

Example of copay response for an APPROVED (active) enrollment.

Example of copay response for an APPROVED (active) enrollment with 2 brand ids

Example of copay response for a DENIED (cancelled) enrollment with an OperationOutcome resource

Example of eob resource which includes important response attributes returned as a result of copay enrollment request

Example of eob resource which includes important response attributes returned as a result of copay enrollment request

Example of Operation Outcome resource which includes rejection message for Copay Enrollment

Example data query message send as a request in copay search use case. Task identifiers to indicate brandId in Parameters.

Example of UAPI Copay update

Example Copay Update Response with status rejected for original copay enrollment request

Example representing bundle of claim bundles which will be send to Genentech endpoint by copay vendor to insert/update Copay Claims which were adjudicated by copay vendor.

Example of successfull copay enrollment sent to Genentech from copay adjudication vendor.

Example for External Vendor systems. Use this example to send an enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains Patient Foundation Service Request, Prescription, Digital Consent, Prescriber Signature

Example for External Vendor systems. Use this example to send a Lunsumio enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains (Enrollment + Digital Consent): Patient Foundation SR, Digital Consent, Site of Treatment, Prescriber Signature, Prescription

Example for External Vendor systems. Use this example to send Itovebi enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains (Enrollment + Digital Consent): Patient Foundation SR, Digital Consent, Prescriber Signature, Prescription.

Example for External Vendor systems. Use this example to send a Susvimo enrollment bundle to the UAPI enrollment endpoint, requesting Patient Foundation services. The bundle contains (Enrollment + Digital Consent): Patient Foundation SR, Digital Consent, Prescriber Signature, Site of Treatment. Contains prescription for implant kit (initial fill/refill).

Example response message to Copay Search request. It returns 2 matching patients in the MultiPatient bundle

Example of Status Query Request bundle for BIPA and GPF enrollment

Example of Status Query Response for BIPA investigation outcome (single search)

Example of Status Query Response for GPF eligibility status (single search)

Example to be used by MPS Redesign (internal). This is example of a bundle which is to be sent to Universal API enrollment endpoint in order to request Access Solutions Services.

Example representing combination of request and response bundle elements which will be generated internally by UAPI and published as an event to Genentech internal MessageBus. This contains error response to coapy enrollment request. This is used for notifications to internal Genentech systems.

Example representing combination of request and response bundle elements which will be generated internally by UAPI and published as an event to Genentech internal MessageBus. This is used for notifications to internal Genentech systems.

Example data query message without full resources (identifiers in parameters instead) after the internal Genentech middletier transformations

Example of UAPI Status Update - C&R

Example of UAPI Status Update - GPF