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 Request - JSON Representation

Raw json | Download

{
  "resourceType" : "CoverageEligibilityRequest",
  "id" : "ex-check-coverage-2",
  "meta" : {
    "profile" : [
      🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityRequest"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest ex-check-coverage-2</b></p><a name=\"ex-check-coverage-2\"> </a><a name=\"hcex-check-coverage-2\"> </a><a name=\"ex-check-coverage-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>serviced</b>: 2024-07-01 --&gt; 2024-12-31</p><p><b>created</b>: 2024-06-01 15:00:00+0000</p><p><b>enterer</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>provider</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>facility</b>: <a href=\"Location-ex-hospital-2.html\">Location Local Hospital</a></p><blockquote><p><b>item</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-benefitcategory 1}\">Medical Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://loinc.org 21946-9}\">Chemotherapy treatment Cancer</span></p><p><b>provider</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>facility</b>: <a href=\"Location-ex-hospital-2.html\">Location Local Hospital</a></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://id.who.int/icd/release/11/mms XH1VB1}\">Hybrid oncocytic chromophobe tumour</span></td></tr></table></blockquote></div>"
  },
  "status" : "active",
  "purpose" : [
    "benefits"
  ],
  "patient" : {
    🔗 "reference" : "Patient/ex-beneficiary-1"
  },
  "servicedPeriod" : {
    "start" : "2024-07-01",
    "end" : "2024-12-31"
  },
  "created" : "2024-06-01T15:00:00Z",
  "enterer" : {
    🔗 "reference" : "Practitioner/ex-doctor-2"
  },
  "provider" : {
    🔗 "reference" : "Practitioner/ex-doctor-2"
  },
  "insurer" : {
    🔗 "reference" : "Organization/ex-insurer-1"
  },
  "facility" : {
    🔗 "reference" : "Location/ex-hospital-2"
  },
  "item" : [
    {
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
            "code" : "1"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "21946-9",
            "display" : "Chemotherapy treatment Cancer"
          }
        ]
      },
      "provider" : {
        🔗 "reference" : "Practitioner/ex-doctor-2"
      },
      "facility" : {
        🔗 "reference" : "Location/ex-hospital-2"
      },
      "diagnosis" : [
        {
          "diagnosisCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://id.who.int/icd/release/11/mms",
                "code" : "XH1VB1",
                "display" : "Hybrid oncocytic chromophobe tumour"
              }
            ]
          }
        }
      ]
    }
  ]
}