Coverage read

get/Coverage/{id}
Page View

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.

read

This interaction allows you to review a specific Coverage resource with details about a patient’s insurance plan, as documented by one provider.

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
1
curl 'https://api.redoxengine.com/fhir/R4/{destinationSlug}/{environmentFlag}/Coverage/{id}' \
2
--request GET \
3
--header 'Authorization: Bearer $API_TOKEN'

Request Parameters

  • id
    required, string

    Coverage identifier

Response fields and example

HMO Deductible Plan
json
1
{}
  • 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.