Retrieve a patient's insurance coverage

If you want to access a patient’s insurance coverage—as recorded by a specific organization—you can use this API action to retrieve insurance data. Typically, you can use this for:

  • identifying the insurance plan information for billing purposes; or 
  • finding out whether a patient is registered for SelfPay (e.g., for worker’s compensation or uninsured patients).

Patient identifier required

To use this API action, you must know the patient identifier. If you don’t, you must locate the appropriate identifier first. Learn how to search for a patient with demographics.

Supported systems

You can use this API action with the Redox FHIR® API.

Talk to a Redoxer

It’s also possible to use the Redox Data Model API for this API action. Talk to a Redoxer to learn about your options if you want to use alternative integration methods.

Your connection's system can return results with their own FHIR® or query-based API. 

Things you need to know

What's next?

Does this API action seem like a good fit for your unique workflow? If so, let your Redox rep know! You can begin development by downloading the relevant resource schema (which is noted in the relevant action step below), and deciding which data elements you need. Then head over to our Quickstart guide to dive right in.

If you're not engaged with our sales team yet, talk to a Redoxer to get started.

Action steps


The following actions must be completed before attempting the steps below.

  • 1
    Retrieve a patient's insurance coverage

This table has notes about how to use parameters for this API action specifically, but it's not exhaustive. Refer to the resource schema for more details.

Query parameter
You must include at least one identifier for the patient that's used by the EHR system you're querying. If you don't have a patient identifier, you can find one by searching for a patient with demographics.

The response contains fields with data about the insurance type(s) and beneficiary. You can find the insurance used for a particular encounter in the Order array.  You can ascertain the type of coverage in the class.type field.

Query Response
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