Coverage - FHIR Resource (stu3)


This Coverage Resource uses the FHIR API standard for access and structure.

Validate an Coverage FHIR Resource (stu3)



Resource Attributes

AttributeField is listTypeDescription
beneficiaryfalseReference# Plan Beneficiary
contracttrueReference# Contract details
dependentfalsestring# Dependent number
groupingfalseData Type# Additional coverage classifications
identifiertrueIdentifier# The primary coverage ID
networkfalsestring# Insurer network
orderfalsepositiveInt# Relative order of the coverage
payortrueReference# Identifier for the plan or agreement issuer
periodfalsePeriod# Coverage start and end dates
policyHolderfalseReference# Owner of the policy
relationshipfalseCodeableConcept# Beneficiary relationship to the Subscriber
sequencefalsestring# The plan instance or sequence counter
statusfalsecode# active | cancelled | draft | entered-in-error
subscriberfalseReference# Subscriber to the policy
subscriberIdfalsestring# ID assigned to the Subscriber
typefalseCodeableConcept# Type of coverage such as medical or accident

Coverage Example

{
  "status": "active",
  "beneficiary": {
    "reference": "Patient/4"
  },
  "payor": [
    {
      "reference": "Organization/2"
    }
  ],
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "sequence": "9",
  "resourceType": "Coverage",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "period": {
    "start": "2011-05-23",
    "end": "2012-05-23"
  },
  "subscriber": {
    "reference": "Patient/4"
  },
  "dependent": "0",
  "identifier": [
    {
      "system": "http://benefitsinc.com/certificate",
      "value": "12345"
    }
  ],
  "type": {
    "coding": [
      {
        "code": "EHCPOL",
        "system": "http://hl7.org/fhir/v3/ActCode",
        "display": "extended healthcare"
      }
    ]
  },
  "id": "9876B1",
  "policyHolder": {
    "reference": "http://benefitsinc.com/FHIR/Organization/CBI35"
  },
  "grouping": {
    "group": "CBI35",
    "subPlanDisplay": "Includes afterlife benefits",
    "subClassDisplay": "Low deductable, max $20 copay",
    "groupDisplay": "Corporate Baker's Inc. Local #35",
    "subClass": "Tier2",
    "subPlan": "P7",
    "plan": "B37FC",
    "subGroupDisplay": "Trainee Part-time Benefits",
    "planDisplay": "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC",
    "class": "SILVER",
    "classDisplay": "Silver: Family Plan spouse only",
    "subGroup": "123"
  }
}

Coverage Structure


  
{
  "resourceType" : "Coverage",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // The primary coverage ID
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type of coverage such as medical or accident
  "policyHolder" : { Reference(Patient|RelatedPerson|Organization) }, // Owner of the policy
  "subscriber" : { Reference(Patient|RelatedPerson) }, // Subscriber to the policy
  "subscriberId" : "<string>", // ID assigned to the Subscriber
  "beneficiary" : { Reference(Patient) }, // Plan Beneficiary
  "relationship" : { CodeableConcept }, // Beneficiary relationship to the Subscriber
  "period" : { Period }, // Coverage start and end dates
  "payor" : [{ Reference(Organization|Patient|RelatedPerson) }], // Identifier for the plan or agreement issuer
  "grouping" : { // Additional coverage classifications
    "group" : "<string>", // An identifier for the group
    "groupDisplay" : "<string>", // Display text for an identifier for the group
    "subGroup" : "<string>", // An identifier for the subsection of the group
    "subGroupDisplay" : "<string>", // Display text for the subsection of the group
    "plan" : "<string>", // An identifier for the plan
    "planDisplay" : "<string>", // Display text for the plan
    "subPlan" : "<string>", // An identifier for the subsection of the plan
    "subPlanDisplay" : "<string>", // Display text for the subsection of the plan
    "class" : "<string>", // An identifier for the class
    "classDisplay" : "<string>", // Display text for the class
    "subClass" : "<string>", // An identifier for the subsection of the class
    "subClassDisplay" : "<string>" // Display text for the subsection of the subclass
  },
  "dependent" : "<string>", // Dependent number
  "sequence" : "<string>", // The plan instance or sequence counter
  "order" : "<positiveInt>", // Relative order of the coverage
  "network" : "<string>", // Insurer network
  "contract" : [{ Reference(Contract) }] // Contract details
}


 

Coverage Search Parameters

The following search parameters can be used to query Coverage resources. Just submit the like so:

https://api.1up.health/fhir/stu3/Coverage?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
beneficiaryreferencebeneficiary
classtextgrouping.class
dependenttextdependent
grouptextgrouping.group
identifiertextidentifier
payorreferencepayor
plantextgrouping.plan
policy-holderreferencepolicyHolder
sequencetextsequence
subclasstextgrouping.subClass
subgrouptextgrouping.subGroup
subplantextgrouping.subPlan
subscriberreferencesubscriber
typetexttype