{
  "resourceType" : "Coverage",
  "id" : "8",
  "meta" : {
    "lastUpdated" : "2026-01-07T01:21:11.866-06:00",
    "profile" : ["https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-pas-coverage-profile"]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage 8</b></p><a name=\"8\"> </a><a name=\"hc8\"> </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\">Last updated: 2026-01-07 01:21:11-0600</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-athena-pas-coverage-profile.html\">PAS Coverage</a></p></div><p><b>org/fhir/us/davinci-pas/StructureDefinition/extension-coverageKind</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>identifier</b>: Member Number/665993433, National Insurance Payor Identifier (Payor)/Unknown, National Insurance Payor Identifier (Payor)/12345678, National Insurance Payor Identifier (Payor)/1101</p><p><b>status</b>: Active</p><p><b>policyHolder</b>: <a href=\"Patient/1442678380400620\">Patient/1442678380400620</a></p><p><b>subscriber</b>: <a href=\"Patient/1442678380400620\">Patient/1442678380400620</a></p><p><b>subscriberId</b>: 665993433</p><p><b>beneficiary</b>: <a href=\"Patient/1442678380400620\">Patient/1442678380400620</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship other}, {https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069 G8}\">other</span></p><p><b>period</b>: 2007-01-31 00:00:00-0600 --&gt; 2008-01-30 00:00:00-0600</p><p><b>payor</b>: <a href=\"Organization/IC-5\">Organization/IC-5</a></p></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-coverageKind",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "HIP",
        "display" : "health insurance plan policy"
      }]
    }
  }],
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "MB",
        "display" : "Member Number"
      }],
      "text" : "Member Number"
    },
    "value" : "665993433"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "NIIP",
        "display" : "National Insurance Payor Identifier (Payor)"
      }],
      "text" : "National Insurance Payor Identifier (Payor)"
    },
    "value" : "Unknown"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "NIIP",
        "display" : "National Insurance Payor Identifier (Payor)"
      }],
      "text" : "National Insurance Payor Identifier (Payor)"
    },
    "value" : "12345678"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "NIIP",
        "display" : "National Insurance Payor Identifier (Payor)"
      }],
      "text" : "National Insurance Payor Identifier (Payor)"
    },
    "value" : "1101"
  }],
  "status" : "active",
  "policyHolder" : {
    "reference" : "Patient/1442678380400620"
  },
  "subscriber" : {
    "reference" : "Patient/1442678380400620"
  },
  "subscriberId" : "665993433",
  "beneficiary" : {
    "reference" : "Patient/1442678380400620"
  },
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "other",
      "display" : "other"
    },
    {
      "system" : "https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069",
      "code" : "G8",
      "display" : "Other Relationship"
    }],
    "text" : "other"
  },
  "period" : {
    "start" : "2007-01-31T00:00:00-06:00",
    "end" : "2008-01-30T00:00:00-06:00"
  },
  "payor" : [{
    "reference" : "Organization/IC-5"
  }]
}