{ "resourceType" : "Bundle", "id" : "uapi-copay-update-response-3", "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" : "2023-04-11T08:10:17-05:00", "entry" : [{ "fullUrl" : "urn:uuid:76559729-e6ad-43d6-ab26-a98a4fe0a87b", "resource" : { "resourceType" : "MessageHeader", "id" : "76559729-e6ad-43d6-ab26-a98a4fe0a87b", "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader 76559729-e6ad-43d6-ab26-a98a4fe0a87b

event: uapi-event-type copay-update-resp: Copay Update Response

Sources

-NameEndpoint
*Genentech-FHIR-DEVhttps://fhir.developer.gene.com/$process-message

Responses

-IdentifierCode
*1-63c61a26-4965b3a156f488da6e0800edOK

focus: Bundle: identifier = http://connectiverx.com/requestId#86a42a99-663b-48b8-8fd9-c1afdbca5b98\u00a0(use:\u00a0usual,\u00a0); type = message; timestamp = 2023-04-11 08:10:17-0500

" }, "eventCoding" : { "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type", "code" : "copay-update-resp", "display" : "Copay Update 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:f36738d7-c4bd-4f36-b842-cddd50800cc3" }] } }, { "fullUrl" : "urn:uuid:f36738d7-c4bd-4f36-b842-cddd50800cc3", "resource" : { "resourceType" : "Parameters", "id" : "f36738d7-c4bd-4f36-b842-cddd50800cc3", "parameter" : [{ "name" : "responder-patient", "valueReference" : { "reference" : "urn:uuid:16ddbd62-396d-4f84-80db-0346ae44e995" } }, { "name" : "search-result", "valueReference" : { "reference" : "urn:uuid:f8835064-7810-4d5a-b8cc-0a62aff991ef" } }, { "name" : "search-result", "valueReference" : { "reference" : "urn:uuid:743cfeb3-ed54-4887-ad84-73023ea3451a" } }, { "name" : "search-result", "valueReference" : { "reference" : "urn:uuid:803a1b8b-a597-4543-aa38-109d9d15f51d" } }] } }, { "fullUrl" : "urn:uuid:16ddbd62-396d-4f84-80db-0346ae44e995", "resource" : { "resourceType" : "Patient", "id" : "16ddbd62-396d-4f84-80db-0346ae44e995", "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient 16ddbd62-396d-4f84-80db-0346ae44e995

Anonymous Patient (no stated gender), DoB Unknown ( Patient internal identifier: 8132413049\u00a0(use:\u00a0usual,\u00a0))

Links:

Contained Resource

Organization #01c31a2f-321d-4c6e-8349-206af8a88088

Profile: UAPI Organization

identifier: http://vendor.com/ab/HOSP-12345\u00a0(use:\u00a0usual,\u00a0)

type: Healthcare Provider

name: Mid Atlantic Retina

telecom: mar@example.com

address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US

contact

name: Venus Yardav (Official)

telecom: ph: 8882704882(Work), fax: 8179974042(Work)

" }, "contained" : [{ "resourceType" : "Organization", "id" : "01c31a2f-321d-4c6e-8349-206af8a88088", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"] }, "identifier" : [{ "use" : "usual", "system" : "http://vendor.com/ab", "value" : "HOSP-12345", "assigner" : { "display" : "AB Vendor" } }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "prov", "display" : "Healthcare Provider" }] }], "name" : "Mid Atlantic Retina", "telecom" : [{ "system" : "email", "value" : "mar@example.com" }], "address" : [{ "line" : ["8 Ranoldo Terrace"], "city" : "Cherry Hill", "state" : "NJ", "postalCode" : "08034", "country" : "US" }], "contact" : [{ "name" : { "use" : "official", "family" : "Yardav", "given" : ["Venus"] }, "telecom" : [{ "system" : "phone", "value" : "8882704882", "use" : "work", "rank" : 1 }, { "system" : "fax", "value" : "8179974042", "use" : "work", "rank" : 2 }] }] }], "identifier" : [{ "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" } }], "managingOrganization" : { "reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" } } }, { "fullUrl" : "urn:uuid:f8835064-7810-4d5a-b8cc-0a62aff991ef", "resource" : { "resourceType" : "Bundle", "id" : "f8835064-7810-4d5a-b8cc-0a62aff991ef", "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&_include=ExplanationOfBenefit:provider" }], "entry" : [{ "fullUrl" : "urn:uuid:e344813d-eb60-466e-806b-ebd35c988293", "resource" : { "resourceType" : "ExplanationOfBenefit", "id" : "e344813d-eb60-466e-806b-ebd35c988293", "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 }] }, { "resourceType" : "OperationOutcome", "id" : "5ce061a8-302e-4135-a300-f68c73f31100", "issue" : [{ "severity" : "error", "code" : "processing", "details" : { "coding" : [{ "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-copay-enrollment-error", "code" : "identification-check", "display" : "Identification Check" }], "text" : "Provided patient information does not meet minimum criteria for verification." } }] }], "identifier" : [{ "use" : "usual", "system" : "http://connectiverx.com/enrollmentId", "value" : "ad44f19a-42b6-ed11-827c-9e11af077484" }], "status" : "cancelled", "type" : { "coding" : [{ "code" : "institutional" }] }, "use" : "predetermination", "patient" : { "reference" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9" }, "created" : "2023-04-11T21:01:11.230Z", "insurer" : { "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626" }, "provider" : { "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1" }, "outcome" : "error", "insurance" : [{ "focal" : false, "coverage" : { "reference" : "urn:uuid:e6e8d8c6-a074-4ea5-be1a-a67cb8628a85" } }] }, "search" : { "mode" : "match" } }, { "fullUrl" : "urn:uuid:e6e8d8c6-a074-4ea5-be1a-a67cb8628a85", "resource" : { "resourceType" : "Coverage", "id" : "e6e8d8c6-a074-4ea5-be1a-a67cb8628a85", "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 }] }], "status" : "cancelled", "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" }, "beneficiary" : { "reference" : "urn:uuid:2c5aa62c-b6cd-49d2-ad9f-3128a69a32a9", "type" : "Patient" }, "payor" : [{ "reference" : "urn:uuid:d02db104-a75c-433f-8764-9778c2e20626", "type" : "Organization" }], "class" : [{ "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" } }, { "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"] }] }, "search" : { "mode" : "include" } }] } }, { "fullUrl" : "urn:uuid:743cfeb3-ed54-4887-ad84-73023ea3451a", "resource" : { "resourceType" : "Bundle", "id" : "743cfeb3-ed54-4887-ad84-73023ea3451a", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-bundle-search-result"] }, "type" : "searchset", "total" : 1, "link" : [{ "relation" : "self", "url" : "Task?for=xyz" }], "entry" : [{ "fullUrl" : "urn:uuid:b4b2493c-f20d-4a83-849c-ebbd64ec2ff3", "resource" : { "resourceType" : "Task", "id" : "b4b2493c-f20d-4a83-849c-ebbd64ec2ff3", "status" : "requested", "intent" : "plan", "code" : { "coding" : [{ "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type", "code" : "copay" }] }, "for" : { "reference" : "urn:uuid:77a64848-bcb5-4fa1-a132-d09952b1c891", "type" : "Patient" }, "authoredOn" : "2023-01-23T08:10:13-05:00", "input" : [{ "type" : { "coding" : [{ "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type", "code" : "brandId" }] }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-brand-id", "code" : "9c2693fd-4eb2-4543-a26b-2c85a3450fe2" }] } }] }, "search" : { "mode" : "match" } }] } }] }