{
  "resourceType" : "Bundle",
  "id" : "uapi-bundle-copay-claim-upsert",
  "identifier" : {
    "use" : "usual",
    "system" : "http://risrx.com/claimbundleid",
    "value" : "2f057cf1-19d5-425e-bae7-0612026b69cd"
  },
  "type" : "collection",
  "timestamp" : "2024-06-07T08:10:17-05:00",
  "entry" : [{
    "fullUrl" : "urn:uuid:d1e49065-2e38-45b0-af50-92e225868140",
    "resource" : {
      "resourceType" : "Bundle",
      "id" : "uapi-bundle-copay-claim-1",
      "identifier" : {
        "use" : "usual",
        "system" : "http://risrx.com/claimid",
        "value" : "123456"
      },
      "type" : "collection",
      "timestamp" : "2024-06-07T08:10:17-05:00",
      "entry" : [{
        "fullUrl" : "urn:uuid:61b950a7-e518-4f69-b8dd-a1729c8f4bd5",
        "resource" : {
          "resourceType" : "ExplanationOfBenefit",
          "id" : "uapi-eob-copay-claim-1",
          "identifier" : [{
            "use" : "usual",
            "type" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
              },
              {
                "code" : "uc"
              }]
            },
            "system" : "http://risrx.com/claimid",
            "value" : "123456"
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "code" : "institutional"
            }]
          },
          "use" : "claim",
          "patient" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a"
          },
          "created" : "2024-06-06T21:01:11.230Z",
          "insurer" : {
            "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"
          },
          "provider" : {
            "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"
          },
          "payee" : {
            "party" : {
              "reference" : "urn:uuid:081d9568-2f85-4211-a84e-224d675b18ef"
            }
          },
          "outcome" : "complete",
          "supportingInfo" : [{
            "sequence" : 1,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "eobdate"
              }]
            },
            "valueString" : "2024-06-07"
          },
          {
            "sequence" : 2,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "ndc"
              }]
            },
            "valueString" : "50242021501"
          },
          {
            "sequence" : 3,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "claimrequesteddate"
              }]
            },
            "valueString" : "2024-06-01"
          },
          {
            "sequence" : 4,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "claimapproveddate"
              }]
            },
            "valueString" : "2024-06-03"
          },
          {
            "sequence" : 5,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "jcode"
              }]
            },
            "valueString" : "J2357"
          }],
          "insurance" : [{
            "focal" : true,
            "coverage" : {
              "reference" : "urn:uuid:b0574bf9-d016-4af7-a895-269abd739db3"
            }
          }],
          "item" : [{
            "sequence" : 1,
            "productOrService" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes",
                "code" : "96401"
              }]
            },
            "servicedDate" : "2024-06-01",
            "adjudication" : [{
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "submitted"
                }]
              },
              "amount" : {
                "value" : 250
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "eligible"
                }]
              },
              "amount" : {
                "value" : 104.16
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "paidtoprovider"
                }]
              },
              "amount" : {
                "value" : 78.12
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "copay"
                }]
              },
              "amount" : {
                "value" : 0
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "deductible"
                }]
              },
              "amount" : {
                "value" : 25
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "coinsurance"
                }]
              },
              "amount" : {
                "value" : 26.04
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "patienttotalresponsibility"
                }]
              },
              "amount" : {
                "value" : 51.04
              }
            }]
          }],
          "adjudication" : [{
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/ValueSet/uapi-copay-adjudication-category-discriminator",
                "code" : "claimstatus"
              }]
            },
            "reason" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-status",
                "code" : "approved"
              }]
            }
          }],
          "total" : [{
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-payment-type",
                "code" : "check"
              }]
            },
            "amount" : {
              "value" : 5.01
            }
          },
          {
            "category" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
                "code" : "paidbypatient"
              }]
            },
            "amount" : {
              "value" : 5
            }
          },
          {
            "category" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
                "code" : "submitted"
              }]
            },
            "amount" : {
              "value" : 13.11
            }
          }],
          "payment" : {
            "type" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
                "code" : "paid"
              }]
            },
            "date" : "2024-06-06",
            "identifier" : {
              "system" : "http://risrx.com/checknum",
              "value" : "123456"
            }
          }
        }
      },
      {
        "fullUrl" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
        "resource" : {
          "resourceType" : "Patient",
          "id" : "3fd08ef2-34a2-4191-ad04-44353c2f133a",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-patient"]
          },
          "identifier" : [{
            "use" : "usual",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "PI",
                "display" : "Patient internal identifier"
              }]
            },
            "system" : "http://risrx.com/masterpatientcardid",
            "value" : "12220c4c-b03b-4ebc-9bb7-1c5ddafbb30c",
            "assigner" : {
              "display" : "RisRx"
            }
          }],
          "name" : [{
            "use" : "official",
            "family" : "Michaelson",
            "given" : ["Ryan",
            "Tom"]
          }],
          "telecom" : [{
            "system" : "phone",
            "value" : "1231231234",
            "use" : "home",
            "rank" : 1
          },
          {
            "system" : "phone",
            "value" : "1234561234",
            "use" : "mobile",
            "rank" : 2
          },
          {
            "system" : "email",
            "value" : "bobster83@example.com",
            "use" : "home",
            "rank" : 3
          }],
          "gender" : "male",
          "birthDate" : "1972-10-29",
          "address" : [{
            "line" : ["1234 Main St"],
            "city" : "San Francisco",
            "state" : "CA",
            "postalCode" : "94105",
            "country" : "US"
          }],
          "communication" : [{
            "language" : {
              "coding" : [{
                "system" : "urn:ietf:bcp:47",
                "code" : "en",
                "display" : "English"
              }]
            },
            "preferred" : true
          }],
          "managingOrganization" : {
            "reference" : "urn:uuid:cf3f3cea-f679-4e30-891b-457e4dd46468"
          }
        }
      },
      {
        "fullUrl" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1",
        "resource" : {
          "resourceType" : "Practitioner",
          "id" : "695d0991-5e03-46df-934a-85a28acd95c1",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"]
          },
          "identifier" : [{
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "PRN",
                "display" : "Provider number"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1922071448",
            "assigner" : {
              "display" : "Centers for Medicare & Medicaid Services"
            }
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "TAX",
                "display" : "Tax ID number"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "00000000"
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NPI",
                "display" : "National provider identifier"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1639285034"
          }],
          "name" : [{
            "use" : "official",
            "family" : "CRUZ",
            "given" : ["MARISSA"]
          }]
        }
      },
      {
        "fullUrl" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
        "resource" : {
          "resourceType" : "RelatedPerson",
          "id" : "4db51d32-65c3-4f8c-959e-0155c6d14545",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"]
          },
          "patient" : {
            "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
            "type" : "Patient"
          },
          "relationship" : [{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
              "code" : "SIGOTHR",
              "display" : "significant other"
            }]
          }],
          "name" : [{
            "use" : "official",
            "family" : "Smith",
            "given" : ["Bob Paul"]
          }],
          "telecom" : [{
            "system" : "phone",
            "value" : "1234567890",
            "use" : "mobile"
          }],
          "birthDate" : "1972-10-29"
        }
      },
      {
        "fullUrl" : "urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e",
        "resource" : {
          "resourceType" : "Coverage",
          "id" : "b0574bf9-d016-4af7-a895-269abd739db3",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"]
          },
          "extension" : [{
            "url" : "https://fhir.developer.gene.com/StructureDefinition/IssuedDate",
            "valueDate" : "2023-02-26"
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "pay",
              "display" : "Pay"
            }]
          },
          "subscriber" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
            "type" : "Patient"
          },
          "subscriberId" : "EYE00044137",
          "beneficiary" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
            "type" : "Patient"
          },
          "period" : {
            "start" : "2023-02-08",
            "end" : "2199-12-31"
          },
          "payor" : [{
            "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626",
            "type" : "Organization"
          }],
          "class" : [{
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "rxbin",
                "display" : "RX BIN"
              }]
            },
            "value" : "600426",
            "name" : "BIN"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "rxpcn",
                "display" : "RX PCN"
              }]
            },
            "value" : "54",
            "name" : "PCN"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "group",
                "display" : "Group"
              }]
            },
            "value" : "EC38532005",
            "name" : "Group Number"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "plan",
                "display" : "Plan"
              }]
            },
            "value" : "Xolair-Admin",
            "name" : "Xolair Co Pay program"
          }],
          "order" : 1,
          "network" : "Genentech"
        }
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:45597178-f243-419e-8af3-462359f89e91",
    "resource" : {
      "resourceType" : "Bundle",
      "id" : "uapi-bundle-copay-claim-2",
      "identifier" : {
        "use" : "usual",
        "system" : "http://risrx.com/claimid",
        "value" : "953f66c2-383c-4d8b-a306-2938b1b92f6b"
      },
      "type" : "collection",
      "timestamp" : "2024-06-07T08:10:17-05:00",
      "entry" : [{
        "fullUrl" : "urn:uuid:61b950a7-e518-4f69-b8dd-a1729c8f4bd5",
        "resource" : {
          "resourceType" : "ExplanationOfBenefit",
          "id" : "uapi-eob-copay-claim-1",
          "identifier" : [{
            "use" : "usual",
            "type" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
              },
              {
                "code" : "uc"
              }]
            },
            "system" : "http://risrx.com/claimid",
            "value" : "123456"
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "code" : "institutional"
            }]
          },
          "use" : "claim",
          "patient" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a"
          },
          "created" : "2024-06-06T21:01:11.230Z",
          "insurer" : {
            "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626"
          },
          "provider" : {
            "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1"
          },
          "payee" : {
            "party" : {
              "reference" : "urn:uuid:081d9568-2f85-4211-a84e-224d675b18ef"
            }
          },
          "outcome" : "complete",
          "supportingInfo" : [{
            "sequence" : 1,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "eobdate"
              }]
            },
            "valueString" : "2024-06-07"
          },
          {
            "sequence" : 2,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "ndc"
              }]
            },
            "valueString" : "50242021501"
          },
          {
            "sequence" : 3,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "claimrequesteddate"
              }]
            },
            "valueString" : "2024-06-01"
          },
          {
            "sequence" : 4,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "claimapproveddate"
              }]
            },
            "valueString" : "2024-06-03"
          },
          {
            "sequence" : 5,
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-supporting-info-category",
                "code" : "jcode"
              }]
            },
            "valueString" : "J2357"
          }],
          "insurance" : [{
            "focal" : true,
            "coverage" : {
              "reference" : "urn:uuid:b0574bf9-d016-4af7-a895-269abd739db3"
            }
          }],
          "item" : [{
            "sequence" : 1,
            "productOrService" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes",
                "code" : "96401"
              }]
            },
            "servicedDate" : "2024-06-01",
            "adjudication" : [{
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "submitted"
                }]
              },
              "amount" : {
                "value" : 250
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "eligible"
                }]
              },
              "amount" : {
                "value" : 104.16
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "paidtoprovider"
                }]
              },
              "amount" : {
                "value" : 78.12
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "copay"
                }]
              },
              "amount" : {
                "value" : 0
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "deductible"
                }]
              },
              "amount" : {
                "value" : 25
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "coinsurance"
                }]
              },
              "amount" : {
                "value" : 26.04
              }
            },
            {
              "category" : {
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationCategory",
                  "code" : "patienttotalresponsibility"
                }]
              },
              "amount" : {
                "value" : 51.04
              }
            }]
          }],
          "adjudication" : [{
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/ValueSet/uapi-copay-adjudication-category-discriminator",
                "code" : "claimstatus"
              }]
            },
            "reason" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-claim-status",
                "code" : "approved"
              }]
            }
          }],
          "total" : [{
            "category" : {
              "coding" : [{
                "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-payment-type",
                "code" : "check"
              }]
            },
            "amount" : {
              "value" : 5.01
            }
          },
          {
            "category" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
                "code" : "paidbypatient"
              }]
            },
            "amount" : {
              "value" : 5
            }
          },
          {
            "category" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
                "code" : "submitted"
              }]
            },
            "amount" : {
              "value" : 13.11
            }
          }],
          "payment" : {
            "type" : {
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
                "code" : "paid"
              }]
            },
            "date" : "2024-06-06",
            "identifier" : {
              "system" : "http://risrx.com/checknum",
              "value" : "123456"
            }
          }
        }
      },
      {
        "fullUrl" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
        "resource" : {
          "resourceType" : "Patient",
          "id" : "3fd08ef2-34a2-4191-ad04-44353c2f133a",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-patient"]
          },
          "identifier" : [{
            "use" : "usual",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "PI",
                "display" : "Patient internal identifier"
              }]
            },
            "system" : "http://risrx.com/masterpatientcardid",
            "value" : "12220c4c-b03b-4ebc-9bb7-1c5ddafbb30c",
            "assigner" : {
              "display" : "RisRx"
            }
          }],
          "name" : [{
            "use" : "official",
            "family" : "Michaelson",
            "given" : ["Ryan",
            "Tom"]
          }],
          "telecom" : [{
            "system" : "phone",
            "value" : "1231231234",
            "use" : "home",
            "rank" : 1
          },
          {
            "system" : "phone",
            "value" : "1234561234",
            "use" : "mobile",
            "rank" : 2
          },
          {
            "system" : "email",
            "value" : "bobster83@example.com",
            "use" : "home",
            "rank" : 3
          }],
          "gender" : "male",
          "birthDate" : "1972-10-29",
          "address" : [{
            "line" : ["1234 Main St"],
            "city" : "San Francisco",
            "state" : "CA",
            "postalCode" : "94105",
            "country" : "US"
          }],
          "communication" : [{
            "language" : {
              "coding" : [{
                "system" : "urn:ietf:bcp:47",
                "code" : "en",
                "display" : "English"
              }]
            },
            "preferred" : true
          }],
          "managingOrganization" : {
            "reference" : "urn:uuid:cf3f3cea-f679-4e30-891b-457e4dd46468"
          }
        }
      },
      {
        "fullUrl" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1",
        "resource" : {
          "resourceType" : "Practitioner",
          "id" : "695d0991-5e03-46df-934a-85a28acd95c1",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"]
          },
          "identifier" : [{
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "PRN",
                "display" : "Provider number"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1922071448",
            "assigner" : {
              "display" : "Centers for Medicare & Medicaid Services"
            }
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "TAX",
                "display" : "Tax ID number"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "00000000"
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NPI",
                "display" : "National provider identifier"
              }]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1639285034"
          }],
          "name" : [{
            "use" : "official",
            "family" : "CRUZ",
            "given" : ["MARISSA"]
          }]
        }
      },
      {
        "fullUrl" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545",
        "resource" : {
          "resourceType" : "RelatedPerson",
          "id" : "4db51d32-65c3-4f8c-959e-0155c6d14545",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"]
          },
          "patient" : {
            "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
            "type" : "Patient"
          },
          "relationship" : [{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
              "code" : "SIGOTHR",
              "display" : "significant other"
            }]
          }],
          "name" : [{
            "use" : "official",
            "family" : "Smith",
            "given" : ["Bob Paul"]
          }],
          "telecom" : [{
            "system" : "phone",
            "value" : "1234567890",
            "use" : "mobile"
          }],
          "birthDate" : "1972-10-29"
        }
      },
      {
        "fullUrl" : "urn:uuid:5c2e19ac-8227-4de5-a893-069dec07448e",
        "resource" : {
          "resourceType" : "Coverage",
          "id" : "b0574bf9-d016-4af7-a895-269abd739db3",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"]
          },
          "extension" : [{
            "url" : "https://fhir.developer.gene.com/StructureDefinition/IssuedDate",
            "valueDate" : "2023-02-26"
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "pay",
              "display" : "Pay"
            }]
          },
          "subscriber" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
            "type" : "Patient"
          },
          "subscriberId" : "EYE00044137",
          "beneficiary" : {
            "reference" : "urn:uuid:3fd08ef2-34a2-4191-ad04-44353c2f133a",
            "type" : "Patient"
          },
          "period" : {
            "start" : "2023-02-08",
            "end" : "2199-12-31"
          },
          "payor" : [{
            "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626",
            "type" : "Organization"
          }],
          "class" : [{
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "rxbin",
                "display" : "RX BIN"
              }]
            },
            "value" : "600426",
            "name" : "BIN"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "rxpcn",
                "display" : "RX PCN"
              }]
            },
            "value" : "54",
            "name" : "PCN"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "group",
                "display" : "Group"
              }]
            },
            "value" : "EC38532005",
            "name" : "Group Number"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "plan",
                "display" : "Plan"
              }]
            },
            "value" : "Xolair-Admin",
            "name" : "Xolair Co Pay program"
          }],
          "order" : 1,
          "network" : "Genentech"
        }
      }]
    }
  }]
}