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Coverage
_search

Coverage _search

post/Coverage/_search
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This resource describes a patient’s insurance plan information, which you may typically find on the patient’s insurance card. You can also use this resource to register for Selfpay (i.e., when an entity other than the insurance or guarantor pays for healthcare costs, like worker’s compensation). Keep in mind that a Coverage resource contains details for your review, not approval or eligibility.

You can review or retrieve coverage information.

_search

Query for details about a patient’s insurance plan. Review tips for insurance searches.

Request parameters and payload

cURL request example

bash
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curl 'https://api.redoxengine.com/fhir/R4/{destinationSlug}/{environmentFlag}/Coverage/_search' \
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--request POST \
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--header 'Authorization: Bearer $API_TOKEN' \
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--header 'Content-Type: application/x-www-form-urlencoded' \
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--data-urlencode 'beneficiary=string'

Request Body Schema

  • beneficiary
    Array of string

    The beneficiary of insurance coverage.

Response fields and example

Example payload generated from schema
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{
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  "resourceType": "Bundle",
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  "type": "searchset",
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  "total": 1,
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  "entry": [
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    {
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      "resource": {
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        "resourceType": "Coverage",
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        "id": "RedoxCoverageExample",
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        "class": [
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          {
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            "type": {
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              "coding": [
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                {
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                  "code": "group",
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                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class"
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                }
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              ]
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            },
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            "value": "847025-024-0009",
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            "name": "Accelerator Labs"
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          },
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          {
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            "type": {
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              "coding": [
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                {
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                  "code": "plan",
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                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class"
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                }
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              ]
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            },
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            "value": "31572",
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            "name": "HMO Deductible Plan"
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          },
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          {
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            "type": {
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              "coding": [
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                {
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                  "code": "agreement-type",
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                  "system": "https://fhir.redoxengine.com/CodeSystem/other-coverage-class"
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                }
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              ]
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            },
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            "value": "Standard"
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          },
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          {
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            "type": {
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              "coding": [
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                {
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                  "code": "coverage-type",
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                  "system": "https://fhir.redoxengine.com/CodeSystem/other-coverage-class"
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                }
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              ]
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            },
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            "value": "Insurance"
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          }
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        ],
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        "identifier": [
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          {
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            "system": "urn:redox:example:MBRNUM",
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            "value": "2234566"
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          },
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          {
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            "system": "urn:redox:example:POLNUM",
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            "value": "9140860055"
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          }
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        ],
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        "type": {
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          "text": "HMO"
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        },
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        "status": "active",
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        "subscriber": {
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          "reference": "#RedoxRelatedPersonExample"
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        },
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        "beneficiary": {
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          "reference": "Patient/RedoxPatientExampleTimothy"
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        },
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        "period": {
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          "start": "2015-01-01",
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          "end": "2020-12-31"
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        },
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        "payor": [
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          {
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            "reference": "#RedoxInsurerOrganizationExample"
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          }
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        ],
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        "contained": [
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          {
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            "resourceType": "RelatedPerson",
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            "id": "RedoxRelatedPersonExample",
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            "patient": {
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              "reference": "Patient/RedoxPatientExampleTimothy"
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            },
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            "name": [
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              {
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                "given": [
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                  "Barbara"
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                ],
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                "family": "Bixby"
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              }
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            ],
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            "telecom": [
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              {
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                "value": "+18088675303",
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                "system": "phone",
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                "use": "home"
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              },
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              {
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                "value": "barbara.bixby@redoxengine.com",
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                "system": "email"
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              }
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            ],
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            "address": [
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              {
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                "line": [
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                  "4762 Hickory St."
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                ],
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                "city": "Monroe",
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                "district": "Green",
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                "state": "WI",
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                "postalCode": "53566",
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                "country": "USA"
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              }
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            ],
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            "relationship": [
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              {
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                "coding": [
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                  {
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                    "code": "MTH",
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                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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                    "display": "mother"
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                  }
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                ],
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                "text": "Mother"
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              },
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              {
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                "coding": [
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                  {
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                    "code": "C",
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                    "system": "http://terminology.hl7.org/CodeSystem/v2-0131",
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                    "display": "Emergency Contact"
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                  }
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                ],
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                "text": "Emergency Contact"
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              }
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            ]
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          },
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          {
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            "resourceType": "Organization",
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            "id": "RedoxInsurerOrganizationExample",
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            "active": true,
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            "identifier": [
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              {
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                "type": {
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                  "text": "PayorID"
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                },
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                "value": "60054"
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              }
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            ],
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            "telecom": [
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              {
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                "system": "phone",
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                "value": "+18089541123"
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              }
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            ],
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            "name": "Aetna",
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            "address": [
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              {
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                "line": [
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                  "PO Box 14080"
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                ],
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                "city": "Lexington",
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                "district": "Fayette",
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                "state": "KY",
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                "postalCode": "40512-4079",
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                "country": "USA"
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              }
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            ]
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          }
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        ]
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      },
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      "search": {
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        "mode": "match"
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      }
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    }
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  ]
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}

    Response to a Coverage search operation containing only coverage resources

  • resourceType
    required, string

    Identifies the type of the resource

    Value: Bundle
  • type
    required, string

    Identifies this bundle as a response to a search

    Value: searchset
  • total
    required, number

    The total number of matches

  • entry
    Array of Coverage or Other

    A resource matching the search criteria or related to a matching resource

    • resource
      required, object

      Information about healthcare coverage

      • resourceType
        required, string

        Identifies the type of the resource

        Value: Coverage
      • status
        required, string

        The status of the resource instance.

        Possible Values: active, cancelled, draft, entered-in-error
      • beneficiary
        required, object

        The party who benefits from the insurance coverage; the patient when products and/or services are provided.

        Must be a resource of type Patient.

        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • payor
        required, Array of object

        The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

        Must reference one of the following types of resources:

        • Organization
        • Patient
        • RelatedPerson
        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • id
        string

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      • contained
        Array of subscriber or company

        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

          A person that is related to a patient, but who is not a direct target of care

        • resourceType
          required, string

          Identifies the type of the resource

          Value: RelatedPerson
        • patient
          required, object

          The patient this person is related to.

          Must be a resource of type Patient.

          • reference
            string

            A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

        • id
          string

          The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        • extension
          Array of spouse, employer or Other

          May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            Contains the spouse's name of a RelatedPerson resource

          • url
            required, string

            Source of the definition for the extension code - a logical name or a URL.

            Value: https://fhir.redoxengine.com/StructureDefinition/relatedperson-spouse
          • valueHumanName
            object

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            • use
              string

              Identifies the purpose for this name.

              Possible Values: usual, official, temp, nickname, anonymous, old, maiden
            • family
              string

              The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

            • given
              Array of string

              Given name.

        • identifier
          Array of object

          Identifier for a person within a particular scope.

          • extension
            Array of Boolean, String, CodeableConcept, Coding

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            • url
              required, string

              Source of the definition for the extension code - a logical name or a URL.

            • valueBoolean
              boolean

              A single value for the extension.

          • use
            string

            The purpose of this identifier.

            Possible Values: usual, official, temp, secondary, old (If known)
          • system
            string

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          • value
            string

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        • relationship
          Array of object

          The nature of the relationship between a patient and the related person.

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

        • name
          Array of object

          A name associated with the person.

          • use
            string

            Identifies the purpose for this name.

            Possible Values: usual, official, temp, nickname, anonymous, old, maiden
          • family
            string

            The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.

          • given
            Array of string

            Given name.

        • telecom
          Array of object

          A contact detail for the person, e.g. a telephone number or an email address.

          • system
            string

            Telecommunications form for contact point - what communications system is required to make use of the contact.

            Possible Values: phone, fax, email, pager, url, sms, other
          • value
            string

            The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).

          • use
            string

            Identifies the purpose for the contact point.

            Possible Values: home, work, temp, old, mobile
        • gender
          string

          Administrative Gender - the gender that the person is considered to have for administration and record keeping purposes.

          Possible Values: male, female, other, unknown
        • birthDate
          string

          The date on which the related person was born.

        • address
          Array of object

          Address where the related person can be contacted or visited.

          • use
            string

            The purpose of this address.

            Possible Values: home, work, temp, old, billing
          • line
            Array of string

            This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

          • city
            string

            The name of the city, town, suburb, village or other community or delivery center.

          • district
            string

            The name of the administrative area (county).

          • state
            string

            Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

          • postalCode
            string

            A postal code designating a region defined by the postal service.

          • country
            string

            Country - a nation as commonly understood or generally accepted.

      • identifier
        Array of object

        A unique identifier assigned to this coverage.

        • extension
          Array of Boolean, String, CodeableConcept, Coding

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          • url
            required, string

            Source of the definition for the extension code - a logical name or a URL.

          • valueBoolean
            boolean

            A single value for the extension.

        • use
          string

          The purpose of this identifier.

          Possible Values: usual, official, temp, secondary, old (If known)
        • system
          string

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        • value
          string

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      • type
        object

        The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.

        • text
          string

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • subscriber
        object

        The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.

        Must reference one of the following types of resources:

        • Patient
        • RelatedPerson
        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • period
        object

        Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.

        • start
          string

          The start of the period. The boundary is inclusive.

        • end
          string

          The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

      • class
        Array of group, plan, agreementType, coverageType or Other

        A suite of underwriter specific classifiers.

          An employee group.

        • type
          required, object

          Identifies this class as representing the insurance group.

          • coding
            required, Array of object

            A reference to a code defined by a terminology system.

            • code
              required, string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              Value: group
            • system
              required, string

              The identification of the code system that defines the meaning of the symbol in the code.

              Value: http://terminology.hl7.org/CodeSystem/coverage-class
          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

        • value
          required, string

          Identifier of the group.

        • name
          string

          Name of the group.

    • search
      required, object

      Information about the search process that lead to the creation of this entry.

      • mode
        required, string

        Identifies the Coverage as matching the search parameters

        Value: match