Coverage
Overview
The Coverage resource provides high-level information about an insurance plan for a specific person or patient or an encounter. Identifying coverage information would appear on an insurance card, and can be used to pay for health care services. The resource can also be used for “selfpay” where an individual takes responsibility for the cost of health care services, rather than a company or organization.
The following fields are returned if valued:
- Coverage id
- Status
- Subscriber of policy
- Subscriber id
- Beneficiary relationship to subscriber
- Plan beneficiary
- Dependent number
- Start/end time of the coverage
- Payor
- Class
- Extensions including encounter
Terminology Bindings
Coverage.relationship |
|
Extensions
Custom Extensions
All URLs for custom extensions are defined as https://fhir-ehr.cerner.com/r4/StructureDefinition/{id}
ID | Value[x] Type | Description |
---|---|---|
coverage-encounter |
Reference |
A reference to an Encounter. |
Search
Search for Patient-level or Encounter-level Coverages that meet supplied query parameters:
GET /Coverage?:parameters
Implementation Notes
- Public Healthcare represents an insurance policy funded by a public health system such as a provincial or national health plan. If there are any public coverages, they will return with an id prefixed with ‘PH’ or ‘PHP’ and will be returned in the payload with the rest of the coverages (private coverages).
Authorization Types
Parameters
Name | Required? | Type | Description |
---|---|---|---|
patient |
This or -encounter
|
reference |
Retrieve coverages for a patient. Example: 12345
|
-encounter |
This or patient
|
reference |
Retrieve coverages for an encounter. Example: 143242
|
Headers
Accept: application/fhir+json
Authorization: <OAuth2 Bearer Token>
Example - Patient-level Private Coverage
Request
GET https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?patient=12724066
Response
Status: 200 OK
{
"resourceType": "Bundle",
"id": "a8876443-c615-4244-9044-047dea2d92dd",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?patient=12724066"
}
],
"entry": [
{
"fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/12724066-490016987-490016987",
"resource": {
"resourceType": "Coverage",
"id": "12724066-490016987-490016987",
"meta": {
"versionId": "24-24",
"lastUpdated": "2020-07-06T17:03:43.000Z"
},
"text": {
"status": "generated",
"div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Coverage</b></p><p><b>Status</b>: Active</p><p><b>Subscriber</b>: SMART, NANCY</p><p><b>Beneficiary</b>: SMART, NANCY</p><p><b>Coverage Start Date</b>: Aug 14, 2015 7:07 P.M. UTC</p><p><b>Payor</b>: SELF PAY</p><p><b>Class</b>: plan: Value: 2800235 Name: Self Pay</p></div>"
},
"status": "active",
"subscriber": {
"reference": "Patient/12724066",
"display": "SMART, NANCY"
},
"beneficiary": {
"reference": "Patient/12724066",
"display": "SMART, NANCY"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "Self",
"userSelected": false
}
],
"text": "Self"
},
"period": {
"start": "2015-08-14T19:07:56.000Z"
},
"payor": [
{
"reference": "Organization/589803",
"display": "SELF PAY"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "2800235",
"name": "Self Pay"
}
]
}
}
]
}
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Patient-level Public Coverage
Request
GET https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?patient=12724066
Response
Status: 200 OK
{
"resourceType": "Bundle",
"id": "8ff4481d-ce55-4b3f-ac2c-4d4fd3cad4c0",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?patient=12724066"
}
],
"entry": [
{
"fullUrl": "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/PHP-490218084-12724066",
"resource": {
"resourceType": "Coverage",
"id": "PHP-490218084-12724066",
"meta": {
"versionId": "134-0",
"lastUpdated": "2021-03-16T20:04:11.000Z"
},
"text": {
"status": "generated",
"div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Coverage</b></p><p><b>Status</b>: Active</p><p><b>Beneficiary</b>: SMART, NANCY</p><p><b>Coverage Start Date</b>: Mar 16, 2021 8:04 P.M. UTC</p><p><b>Payor</b>: Government</p><p><b>Class</b>:</p><dl><dt>Charging Category</dt><dd><b>Value</b>:2572940471</dd><dd><b>Name</b>: 10-OPC, Class II</dd></dl><p><b>Type</b>: public healthcare</p></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "PUBLICPOL",
"display": "public healthcare"
}
],
"text": "public healthcare"
},
"beneficiary": {
"reference": "Patient/12462008",
"display": "TRAUMA SURGERY, TESTONE"
},
"period": {
"start": "2021-03-16T20:04:11.000Z"
},
"payor": [
{
"display": "Government"
}
],
"class": [
{
"type": {
"text": "Charging Category"
},
"value": "2572940471",
"name": "10-OPC, Class II"
}
]
}
}
]
}
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Encounter-level Private Coverage
Request
GET https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?-encounter=97954095
Response
Status: 200 OK
{
"resourceType": "Bundle",
"id": "d42baa44-1566-458c-8457-10fbfacfc3e5",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?-encounter=97954095"
}
],
"entry": [
{
"fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/97954095-98320174",
"resource": {
"resourceType": "Coverage",
"id": "97954095-98320174",
"meta": {
"versionId": "0",
"lastUpdated": "2020-07-27T21:01:55.000Z"
},
"text": {
"status": "extensions",
"div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Coverage</b></p><p><b>Status</b>: Active</p><p><b>Subscriber</b>: SMART, NANCY</p><p><b>Subscriber Id</b>: 12345</p><p><b>Encounter</b>: 97954095</p><p><b>Beneficiary</b>: SMART, NANCY</p><p><b>Dependent Number</b>: 12345</p><p><b>Coverage Start Date</b>: Feb 2, 2020 6:00 A.M. UTC</p><p><b>Coverage End Date</b>: Feb 3, 2021 5:59 A.M. UTC</p><p><b>Payor</b>: Aetna</p><p><b>Class</b>: plan: Value: 2830233 Name: Aetna</p></div>"
},
"extension": [
{
"url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/coverage-encounter",
"valueReference": {
"reference": "Encounter/97954095"
}
}
],
"status": "active",
"subscriber": {
"reference": "Patient/12724066",
"display": "SMART, NANCY"
},
"subscriberId": "12345",
"beneficiary": {
"reference": "Patient/12724066",
"display": "SMART, NANCY"
},
"dependent": "12345",
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "Self",
"userSelected": false
}
],
"text": "Self"
},
"period": {
"start": "2020-02-02T06:00:00.000Z",
"end": "2021-02-03T05:59:59.000Z"
},
"payor": [
{
"reference": "Organization/3064032",
"display": "Aetna"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "2830233",
"name": "Aetna"
}
]
}
}
]
}
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Encounter-level Public Coverage
Request
GET https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?-encounter=97701467
Response
Status: 200 OK
{
"resourceType": "Bundle",
"id": "1714d1b5-cabf-4c4a-bb76-c1e2e4d76d64",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage?-encounter=97701467"
}
],
"entry": [
{
"fullUrl": "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/PH-98371617-97701467",
"resource": {
"resourceType": "Coverage",
"id": "PH-98371617-97701467",
"meta": {
"versionId": "2-0",
"lastUpdated": "2020-09-24T17:11:10.000Z"
},
"text": {
"status": "extensions",
"div": "<div xmlns='http://www.w3.org/1999/xhtml'><p><b>Coverage</b></p><p><b>Status</b>: Active</p><p><b>Encounter</b>: 97701467</p><p><b>Beneficiary</b>: TRAUMA SURGERY, TESTONE</p><p><b>Coverage Start Date</b>: Jul 1, 2022 5:00 A.M. UTC</p><p><b>Coverage End Date</b>: Jul 1, 2025 5:00 A.M. UTC</p><p><b>Payor</b>: Government</p><p><b>Class</b>:</p><dl><dt>Class</dt><dd><b>Value</b>: 2572499881</dd><dd><b>Name</b>: Charging Category</dd></dl><p><b>Type</b>: public healthcare</p></div>"
},
"extension": [
{
"valueReference": {
"reference": "Encounter/97701467"
},
"url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/coverage-encounter"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "PUBLICPOL",
"display": "public healthcare"
}
],
"text": "public healthcare"
},
"beneficiary": {
"reference": "Patient/12462008",
"display": "TRAUMA SURGERY, TESTONE"
},
"period": {
"start": "2022-07-01T05:00:00.000Z",
"end": "2025-07-01T05:00:00.000Z"
},
"payor": [
{
"display": "Government"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "class"
}
]
},
"value": "2572499881",
"name": "Charging Category"
}
]
}
}
]
}
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Errors
The common errors and OperationOutcomes may be returned.
Create
Create new Patient-level or Encounter-level Coverages.
POST /Coverage
Authorization Types
Headers
Authorization: <OAuth2 Bearer Token>
Content-Type: application/fhir+json
Body Fields
Name | Required | Type | |
---|---|---|---|
resourceType
|
Yes |
string |
|
|
|||
Coverage Encounter Extension
|
No |
Extension |
|
|
|||
status
|
Yes |
code |
|
|
|||
subscriber
|
Yes |
Reference (Patient ) |
|
|
|||
subscriberId
|
No |
string |
|
|
|||
beneficiary
|
Yes |
Reference (Patient ) |
|
|
|||
dependent
|
No |
string |
|
|
|||
relationship
|
No |
CodeableConcept |
|
|
|||
period
|
No |
Period |
|
|
|||
payor
|
Yes |
List of Reference (Organization ) |
|
|
|||
class
|
No |
List of BackboneElement |
|
|
|||
class.type
|
Yes |
CodeableConcept |
|
|
|||
class.value
|
Yes |
string |
|
|
|||
class.name
|
No |
string |
|
|
Example - Patient-level Private Coverage
Request
POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage
Body
{
"resourceType": "Coverage",
"status": "active",
"subscriber": {
"reference": "Patient/589763"
},
"subscriberId": "123",
"beneficiary": {
"reference": "Patient/589763"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "other"
}
]
},
"period": {
"start": "2014-09-05T14:30:12.000Z",
"end": "2015-09-05T14:30:12.000Z"
},
"payor": [
{
"reference": "Organization/643847",
"display": "Aetna Missouri POS - Open"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "plan"
}
],
"text": "plan"
},
"value": "729827",
"name": "Aetna Missouri POS Open"
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "group"
}
],
"text": "group"
},
"value": "729839",
"name": "Aetna Missouri POS Open group"
}
]
}
Response
Status: 201 Created
Cache-Control: no-cache Content-Length: 0 Content-Type: text/html Date: Tue, 22 Oct 2019 15:59:33 GMT Etag: W/"0$0" Last-Modified: Tue, 22 Oct 2019 15:59:30 GMT Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/589763-11500257-11500257 Vary: Origin X-Request-Id: ef7c0ee60a8cf431403fe82d9009640b
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Patient-level Public Coverage
Request
POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage
Body
{
"resourceType": "Coverage",
"status": "active",
"beneficiary": {
"reference": "Patient/1626016"
},
"period": {
"start": "2021-01-18T14:30:20.000Z",
"end": "2021-01-18T14:30:21.000Z"
},
"payor": [
{
"display": "Government"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "plan"
}
],
"text": "Charging Category"
},
"value": "2572940471",
"name": "10-OPC, Class II"
}
]
}
Response
Status: 201 Created
Cache-Control: no-cache Content-Length: 0 Content-Type: text/html Date: Tue, 22 Oct 2019 15:59:33 GMT Etag: W/"135-0" Last-Modified: Tue, 22 Oct 2019 15:59:30 GMT Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/PHP-1626016-11500257 Vary: Origin X-Request-Id: ef7c0ee60a8cf431403fe82d9009640b
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Encounter-level Private Coverage
Request
POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage
Body
{
"resourceType": "Coverage",
"status": "active",
"subscriber": {
"reference": "Patient/1626016",
"display": "WOLFE, STEPHANIE T"
},
"extension": [
{
"url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/coverage-encounter",
"valueReference": {
"reference": "Encounter/31363178"
}
}
],
"subscriberId": "2461235",
"dependent": "74965675",
"beneficiary": {
"reference": "Patient/1626016"
},
"relationship": {
"coding": [
{
"system": "https://fhir.cerner.com/2c400054-42d8-4e74-87b7-80b5bd5fde9f/codeSet/40",
"code": "156",
"display": "child",
"userSelected": true
}
]
},
"period": {
"start": "2014-09-05T14:30:12.000Z",
"end": "2015-09-05T14:30:12.000Z"
},
"payor": [
{
"reference": "Organization/643847",
"display": "Aetna Missouri POS - Open"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "plan"
}
],
"text": "plan"
},
"value": "729825",
"name": "Aetna Missouri POS Open"
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "group"
}
],
"text": "group"
},
"value": "8939999",
"name": "Aetna Missouri POS Open group"
}
]
}
Response
Status: 201 Created
Cache-Control: no-cache Content-Length: 0 Content-Type: text/html Date: Tue, 22 Oct 2019 15:59:33 GMT Etag: W/"0" Last-Modified: Tue, 22 Oct 2019 15:59:30 GMT Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/31363178-11500257 Vary: Origin X-Request-Id: ef7c0ee60a8cf431403fe82d9009640b
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Example - Encounter-level Public Coverage
Request
POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage
Body
{
"resourceType": "Coverage",
"status": "active",
"beneficiary": {
"reference": "Patient/1626016"
},
"period": {
"start": "2021-01-18T14:30:20.000Z",
"end": "2021-01-18T14:30:21.000Z"
},
"payor": [
{
"display": "Government"
}
],
"extension": [
{
"url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/coverage-encounter",
"valueReference": {
"reference": "Encounter/31363178"
}
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/coverage-class",
"code": "plan"
}
],
"text": "Charging Category"
},
"value": "2572940471",
"name": "10-OPC, Class II"
}
]
}
Response
Status: 201 Created
Cache-Control: no-cache Content-Length: 0 Content-Type: text/html Date: Tue, 22 Oct 2019 15:59:33 GMT Etag: W/"42-0" Last-Modified: Tue, 22 Oct 2019 15:59:30 GMT Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/PH-31363178-11500257 Vary: Origin X-Request-Id: ef7c0ee60a8cf431403fe82d9009640b
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Errors
The common errors and OperationOutcomes may be returned.
Patch
Patch an existing Encounter-level or Patient-level Coverage.
PATCH /Coverage/:id
Implementation Notes
- This implementation follows the JSON Patch spec.
- Only operations on the paths listed below are supported.
- For Private Coverages, both Encounter-level and Patient-level Coverages may be patched, with the caveat of only supporting the
/period
and/dependent
operations on Patient-level Coverages. - For Public Coverages, both Encounter-level and Patient-level Coverages may be patched, with the caveat of only supporting the
/period
and/class/0/value
operations.
Authorization Types
Headers
Authorization: <OAuth2 Bearer Token>
Accept: application/fhir+json
Content-Type: application/json-patch+json
If-Match: W/"<Current version of the Coverage resource>"
Patch Operations
Path | Operation | Value Type | |
---|---|---|---|
/class/0/value
|
replace |
string |
|
|
|||
/class/1/value
|
replace |
string |
|
|
|||
/class/1/name
|
replace |
string |
|
|
|||
/dependent
|
replace |
string |
|
|
|||
/period
|
replace |
Period |
|
|
|||
/relationship
|
replace |
CodeableConcept |
|
|
|||
/subscriberId
|
replace |
string |
|
|
|||
/subscriber
|
replace |
Reference |
|
|
Example
Request
PATCH https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/623884-674012
Body
[
{
"op": "replace",
"path": "/class/0/value",
"value": "729825"
},
{
"op": "replace",
"path": "/class/1/value",
"value": "456"
},
{
"op": "replace",
"path": "/class/1/name",
"value": "Miscellaneous Commercial Health Plan"
},
{
"op": "replace",
"path": "/dependent",
"value": "9816564"
},
{
"op": "replace",
"path": "/period",
"value": {
"start": "2014-09-05T14:30:12.000Z",
"end": "2015-09-05T14:30:12.000Z"
}
},
{
"op": "replace",
"path": "/relationship",
"value": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "parent"
}
]
}
},
{
"op": "replace",
"path": "/subscriberId",
"value": "4655446"
},
{
"op": "replace",
"path": "/subscriber",
"value": {
"reference": "Patient/1626016"
}
}
]
Response
Status: 200 OK
Cache-Control: no-cache Content-Length: 0 Content-Type: text/html Date: Tue, 26 Mar 2019 15:42:29 GMT Etag: W/"10" Last-Modified: Tue, 26 Mar 2019 15:42:27 GMT Vary: Origin X-Request-Id: 47306a14c8a2c3afd4ab85aa9594101d
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
The ETag
response header indicates the current If-Match
version to use on subsequent updates.
Errors
The common errors and OperationOutcomes may be returned.
Delete
Delete an existing Encounter-level or Patient-level Coverage.
DELETE /Coverage/:id
Authorization Types
Headers
Authorization: <OAuth2 Bearer Token>
If-Match: W/"<Current version of the Coverage resource>"
Example
Request
DELETE https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Coverage/623884-674012
Response
Status: 204 No Content
Cache-Control: no-cache Date: Wed, 20 May 2020 18:55:23 GMT Vary: Origin X-Request-Id: 160d603d256dce10d510f7da2ca1780e
Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.
Errors
The common errors and OperationOutcomes may be returned.