Finance and Insurance Service (FAIS)
1.0.0 - trial-use International flag

This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Use Case 2 - Example Coverage Eligibility Response Bundle - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="ex-check-coverage-resp-bundle-2"/>
  <meta>
    <profile
             value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CEResponse.Bundle"/>
  </meta>
  <type value="collection"/>
  <entry>
    <fullUrl
             value="https://profiles.ihe.net/ITI/FAIS/CoverageEligibilityResponse/ex-check-coverage-resp-2"/>
    <resource>
      <CoverageEligibilityResponse>
        <id value="ex-check-coverage-resp-2"/>
        <meta>
          <profile
                   value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="CoverageEligibilityResponse_ex-check-coverage-resp-2"> </a><p class="res-header-id"><b>Generated Narrative: CoverageEligibilityResponse ex-check-coverage-resp-2</b></p><a name="ex-check-coverage-resp-2"> </a><a name="hcex-check-coverage-resp-2"> </a><a name="ex-check-coverage-resp-2-en-US"> </a><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-06-01 15:01:00+0000</p><p><b>request</b>: <a href="CoverageEligibilityRequest-ex-check-coverage-2.html">CoverageEligibilityRequest: status = active; purpose = benefits; serviced[x] = 2024-07-01 --&gt; 2024-12-31; created = 2024-06-01 15:00:00+0000</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Allowed</p><p><b>insurer</b>: <a href="Organization-ex-insurer-1.html">Organization National Health Insurance Scheme</a></p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Coverage</b></td><td><b>Inforce</b></td></tr><tr><td style="display: none">*</td><td><a href="Coverage-ex-coverage-1.html">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --&gt; 2024-12-31</a></td><td>true</td></tr></table></div>
        </text>
        <status value="active"/>
        <purpose value="benefits"/>
        <patient>🔗 
          <reference value="Patient/ex-beneficiary-1"/>
        </patient>
        <created value="2024-06-01T15:01:00Z"/>
        <request>🔗 
          <reference value="CoverageEligibilityRequest/ex-check-coverage-2"/>
        </request>
        <outcome value="complete"/>
        <disposition value="Allowed"/>
        <insurer>🔗 
          <reference value="Organization/ex-insurer-1"/>
        </insurer>
        <insurance>
          <coverage>🔗 
            <reference value="Coverage/ex-coverage-1"/>
          </coverage>
          <inforce value="true"/>
        </insurance>
      </CoverageEligibilityResponse>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1"/>
    <resource>
      <Organization>
        <id value="ex-insurer-1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_ex-insurer-1"> </a><p class="res-header-id"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name="ex-insurer-1"> </a><a name="hcex-insurer-1"> </a><a name="ex-insurer-1-en-US"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>
        </text>
        <name value="National Health Insurance Scheme"/>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1"/>
    <resource>
      <Patient>
        <id value="ex-beneficiary-1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_ex-beneficiary-1"> </a><p class="res-header-id"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name="ex-beneficiary-1"> </a><a name="hcex-beneficiary-1"> </a><a name="ex-beneficiary-1-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Purity Atieno  Female, DoB: 2000-05-04</p><hr/></div>
        </text>
        <name>
          <family value="Atieno"/>
          <given value="Purity"/>
        </name>
        <gender value="female"/>
        <birthDate value="2000-05-04"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1"/>
    <resource>
      <Coverage>
        <id value="ex-coverage-1"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_ex-coverage-1"> </a><p class="res-header-id"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name="ex-coverage-1"> </a><a name="hcex-coverage-1"> </a><a name="ex-coverage-1-en-US"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}">public healthcare</span></p><p><b>policyHolder</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2024-01-01 --&gt; 2024-12-31</p><p><b>payor</b>: <a href="Organization-ex-insurer-1.html">Organization National Health Insurance Scheme</a></p></div>
        </text>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
            <code value="PUBLICPOL"/>
            <display value="public healthcare"/>
          </coding>
        </type>
        <policyHolder>🔗 
          <reference value="Patient/ex-beneficiary-1"/>
        </policyHolder>
        <subscriber>🔗 
          <reference value="Patient/ex-beneficiary-1"/>
        </subscriber>
        <subscriberId value="05710b56-4448-11ef-b676-774a043da147"/>
        <beneficiary>🔗 
          <reference value="Patient/ex-beneficiary-1"/>
        </beneficiary>
        <relationship>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
            <code value="self"/>
            <display value="Self"/>
          </coding>
        </relationship>
        <period>
          <start value="2024-01-01"/>
          <end value="2024-12-31"/>
        </period>
        <payor>🔗 
          <reference value="Organization/ex-insurer-1"/>
        </payor>
      </Coverage>
    </resource>
  </entry>
</Bundle>