Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import type { CoverageEligibilityRequest, CoverageEligibilityResponse } from '@medplum/fhirtypes'; const eligibilityCheck: CoverageEligibilityRequest = // start-block eligibilityRequest { resourceType: 'CoverageEligibilityRequest', id: 'coverage-validation-request', status: 'active', purpose: ['validation'], created: '2021-01-01T00:00:00.000Z', patient: { reference: 'Patient/homer-simpson', }, provider: { reference: 'Practitioner/dr-alice-smith', }, insurer: { reference: 'Organization/blue-cross-blue-shield', }, insurance: [ { coverage: { reference: 'Coverage/homer-simpson-coverage', }, }, ], item: [ { category: { coding: [ { system: 'https://x12.org/codes/service-type-codes', code: '3', display: 'Consultation', }, ], }, productOrService: { coding: [ { system: 'http://www.ama-assn.org/go/cpt', code: '80504', display: 'Consultation for a moderately complex clinical problem', }, ], }, }, ], }; // end-block eligibilityRequest const generalBenefitsCheckRequest: CoverageEligibilityRequest = // start-block generalBenefitsCheckRequest { resourceType: 'CoverageEligibilityRequest', id: 'general-benefits-check', status: 'active', purpose: ['benefits', 'discovery'], created: '2021-01-01T00:00:00.000Z', patient: { reference: 'Patient/jane-doe', }, provider: { reference: 'Organization/example-hospital', }, insurer: { reference: 'Organization/kaiser-permanente', }, insurance: [ { coverage: { reference: 'Coverage/jane-doe-coverage', }, }, ], item: [ { category: { coding: [ { system: 'https://x12.org/codes/service-type-codes', code: '30', display: 'Plan Coverage and General Benefits', }, ], }, }, ], }; // end-block generalBenefitsCheckRequest const eligibilityResponse: CoverageEligibilityResponse = // start-block eligibilityResponse { resourceType: 'CoverageEligibilityResponse', status: 'active', purpose: ['validation'], created: '2021-01-01T00:00:00.000Z', patient: { reference: 'Patient/homer-simpson', }, request: { reference: 'CoverageEligibilityRequest/coverage-validation-request', }, outcome: 'complete', disposition: 'Coverage is currently in-force', insurer: { reference: 'Organization/blue-cross-blue-shield', }, insurance: [ { coverage: { reference: 'Coverage/homer-simpson-coverage', }, inforce: true, item: [ { category: { coding: [ { system: 'https://x12.org/codes/service-type-codes', code: '3', display: 'Consultation', }, ], }, network: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-network', code: 'in', }, ], }, unit: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-unit', code: 'individual', }, ], }, term: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-term', code: 'annual', }, ], }, benefit: [ { type: { coding: [ { code: 'copay-maximum', }, ], }, allowedMoney: { value: 100, currency: 'USD', }, }, ], }, ], }, ], }; // end-block eligibilityResponse const generalBenefitsCheckResponse: CoverageEligibilityResponse = // start-block generalBenefitsCheckResponse { resourceType: 'CoverageEligibilityResponse', status: 'active', purpose: ['benefits', 'discovery'], created: '2021-01-01T00:00:00.000Z', patient: { reference: 'Patient/jane-doe', }, request: { reference: 'CoverageEligibilityRequest/general-benefits-check', }, outcome: 'complete', disposition: 'Coverage is currently in-force', insurer: { reference: 'Organization/kaiser-permanente', }, insurance: [ { coverage: { reference: 'Coverage/jane-doe-coverage', }, inforce: true, item: [ { category: { coding: [ { system: 'https://x12.org/codes/service-type-codes', code: '30', display: 'Plan Coverage and General Benefits', }, ], }, network: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-network', code: 'in', }, ], }, unit: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-unit', code: 'family', }, ], }, term: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/benefit-term', code: 'lifetime', }, ], }, benefit: [ { type: { coding: [ { code: 'benefit', }, ], }, allowedMoney: { value: 100000, currency: 'USD', }, usedMoney: { value: 1233.4, currency: 'USD', }, }, { type: { coding: [ { code: 'copay-percent', }, ], }, allowedUnsignedInt: 20, }, ], }, ], }, ], }; // end-block generalBenefitsCheckResponse console.log(eligibilityCheck, generalBenefitsCheckRequest, eligibilityResponse, generalBenefitsCheckResponse);