{
  "resourceType" : "Bundle",
  "id" : "uapi-copay-response-1",
  "meta" : {
    "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-query-response"]
  },
  "identifier" : {
    "use" : "usual",
    "system" : "http://connectiverx.com/requestId",
    "value" : "86a42a99-663b-48b8-8fd9-c1afdbca5b98"
  },
  "type" : "message",
  "timestamp" : "2023-01-11T08:10:17-05:00",
  "entry" : [{
    "fullUrl" : "urn:uuid:410f399f-e309-4bc9-be19-8ab330e40397",
    "resource" : {
      "resourceType" : "MessageHeader",
      "id" : "410f399f-e309-4bc9-be19-8ab330e40397",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_410f399f-e309-4bc9-be19-8ab330e40397\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 410f399f-e309-4bc9-be19-8ab330e40397</b></p><a name=\"410f399f-e309-4bc9-be19-8ab330e40397\"> </a><a name=\"hc410f399f-e309-4bc9-be19-8ab330e40397\"> </a><p><b>event</b>: uapi-event-type enrollment-response: Enrollment Response</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>Genentech-FHIR-DEV</td><td><a href=\"https://fhir.developer.gene.com/$process-message\">https://fhir.developer.gene.com/$process-message</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1-63c61a26-4965b3a156f488da6e0800ed</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-uapi-copay-response-1.html#urn-uuid-09cdac62-7c6b-48e6-8738-00f270280ba1\">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></div>"
      },
      "eventCoding" : {
        "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type",
        "code" : "enrollment-response",
        "display" : "Enrollment Response"
      },
      "source" : {
        "name" : "Genentech-FHIR-DEV",
        "endpoint" : "https://fhir.developer.gene.com/$process-message"
      },
      "response" : {
        "identifier" : "1-63c61a26-4965b3a156f488da6e0800ed",
        "code" : "ok"
      },
      "focus" : [{
        "reference" : "urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1"
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:09cdac62-7c6b-48e6-8738-00f270280ba1",
    "resource" : {
      "resourceType" : "Parameters",
      "id" : "09cdac62-7c6b-48e6-8738-00f270280ba1",
      "parameter" : [{
        "name" : "responder-patient",
        "valueReference" : {
          "reference" : "urn:uuid:b3d46ea3-62e6-4171-b818-d64712edfe55"
        }
      },
      {
        "name" : "search-result",
        "valueReference" : {
          "reference" : "urn:uuid:aecbb129-9a73-4b59-9d66-ff5cdb3f3164"
        }
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9",
    "resource" : {
      "resourceType" : "Patient",
      "id" : "2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9",
      "meta" : {
        "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-patient"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient 2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9</b></p><a name=\"2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9\"> </a><a name=\"hc2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-patient.html\">UAPI Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 8132413049\u00a0(use:\u00a0usual,\u00a0))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Other Id (see the one above)\">Other Id:</td><td colspan=\"3\">Patient internal identifier/ca3c6274-e70b-45cf-a65a-30e8386d50bb\u00a0(use:\u00a0usual,\u00a0)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><ul><li>ph: 1231231234(Home)</li><li>ph: 1234561234(Mobile)</li><li><a href=\"mailto:bobster83@example.com\">bobster83@example.com</a></li><li>1234 Main St San Francisco CA 94105 US </li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Language spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span> (preferred)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Patient Links\">Links:</td><td colspan=\"3\"><ul><li>Managing Organization: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-01c31a2f-321d-4c6e-8349-206af8a88088\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></li></ul></td></tr></table></div>"
      },
      "identifier" : [{
        "use" : "usual",
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "PI",
            "display" : "Patient internal identifier"
          }]
        },
        "system" : "http://gene.com/patientmaster",
        "value" : "ca3c6274-e70b-45cf-a65a-30e8386d50bb",
        "assigner" : {
          "display" : "Genentech Patient Master"
        }
      },
      {
        "use" : "usual",
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "PI",
            "display" : "Patient internal identifier"
          }]
        },
        "system" : "http://connectiverx.com/confirmationId",
        "value" : "8132413049",
        "assigner" : {
          "display" : "CRX"
        }
      }],
      "name" : [{
        "use" : "official",
        "family" : "Michaelson",
        "given" : ["Ryan"]
      }],
      "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:01c31a2f-321d-4c6e-8349-206af8a88088"
      }
    }
  },
  {
    "fullUrl" : "urn:uuid:b1fc009a-3710-49d8-81ad-cfa8e4a979fb",
    "resource" : {
      "resourceType" : "Bundle",
      "id" : "b1fc009a-3710-49d8-81ad-cfa8e4a979fb",
      "meta" : {
        "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-search-result"]
      },
      "type" : "searchset",
      "total" : 1,
      "link" : [{
        "relation" : "self",
        "url" : "ExplanationOfBenefit?patient=xyz&_include=ExplanationOfBenefit:coverage"
      }],
      "entry" : [{
        "fullUrl" : "urn:uuid:4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d",
        "resource" : {
          "resourceType" : "ExplanationOfBenefit",
          "id" : "4822ddcc-2ce7-4b43-b6af-4f3435ce5a6d",
          "contained" : [{
            "resourceType" : "Organization",
            "id" : "d02db104-a75c-433f-8764-9778c2e20626",
            "meta" : {
              "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"]
            },
            "identifier" : [{
              "use" : "usual",
              "system" : "http://gene.com",
              "value" : "ORG-00002",
              "assigner" : {
                "display" : "Genentech"
              }
            }],
            "type" : [{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "ins"
              }]
            }],
            "name" : "Copay Organization - CRX",
            "telecom" : [{
              "system" : "phone",
              "value" : "1800654332211",
              "use" : "work",
              "rank" : 1
            }]
          }],
          "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"
            }
          }]
        },
        "search" : {
          "mode" : "match"
        }
      },
      {
        "fullUrl" : "urn:uuid:597540c9-6248-466e-81e0-58e78f15454e",
        "resource" : {
          "resourceType" : "Coverage",
          "id" : "597540c9-6248-466e-81e0-58e78f15454e",
          "meta" : {
            "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"]
          },
          "contained" : [{
            "resourceType" : "Organization",
            "id" : "d02db104-a75c-433f-8764-9778c2e20626",
            "meta" : {
              "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"]
            },
            "identifier" : [{
              "use" : "usual",
              "system" : "http://gene.com",
              "value" : "ORG-00002",
              "assigner" : {
                "display" : "Genentech"
              }
            }],
            "type" : [{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "ins"
              }]
            }],
            "name" : "Copay Organization - CRX",
            "telecom" : [{
              "system" : "phone",
              "value" : "1800654332211",
              "use" : "work",
              "rank" : 1
            }]
          }],
          "extension" : [{
            "url" : "https://fhir.developer.gene.com/StructureDefinition/IssuedDate",
            "valueDate" : "2023-01-01"
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "pay",
              "display" : "Pay"
            }]
          },
          "subscriber" : {
            "reference" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9",
            "type" : "Patient"
          },
          "subscriberId" : "EYE00044117",
          "beneficiary" : {
            "reference" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9",
            "type" : "Patient"
          },
          "period" : {
            "start" : "2023-01-01",
            "end" : "2023-12-31"
          },
          "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" : "EC38517002",
            "name" : "Group Number"
          },
          {
            "type" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code" : "plan",
                "display" : "Plan"
              }]
            },
            "value" : "Vabysmo-Drug",
            "name" : "Ophthalmology Co Pay program"
          }],
          "order" : 1,
          "network" : "Genentech"
        },
        "search" : {
          "mode" : "include"
        }
      }]
    }
  }]
}