Coverage read

get/Coverage/{id}

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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.

Supported fields and schema examples

We support any valid FHIR® field. However, we only display fields we’ve defined in our schema, which are usually based on what’s included in the U.S. Core profile. We recommend relying on U.S. Core requirements.

Our schema examples show the shape and possibility of each FHIR® resource; they aren’t code for real-time API calls. We don’t currently recommend copying and pasting these schema examples for your API calls. Consider reviewing FHIR® API actions for realistic examples for particular use cases.

read

Review a specific Coverage resource with details about a patient’s insurance plan, as documented by one provider.

FHIR read

To use a read interaction, you must know the related resource ID, which you may not have in your real workflows. A read is likely only a follow-up option after receiving the specific resource in a recent FHIR® passthrough or data on demand exchange.

Typically, you should use the more flexible _search with query parameters, unless you're guaranteed to request data directly from a FHIR® server using the resource ID. Learn more about using FHIR® identifiers.

Request parameters

cURL request example

bash

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curl 'https://api.redoxengine.com/fhir/R4/{destinationSlug}/{environmentFlag}/Coverage/{id}' \
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--request GET \
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--header 'Authorization: Bearer $API_TOKEN'

Request Parameters

id
required, string
Coverage identifier

Response fields and example

HMO Deductible Plan

json

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{}

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.
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.
  One of:
  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.

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