Coverage is a financial FHIR Resource that describes the financial terms of a specific health insurance plan for a specific person.
Accessing a patient's coverage can aid in workflows such as:
- Recommending services based on costs, co-pays, or features of a specific health plan
- Validating that a patient has an active health plan
- Retrieving information commonly found on an health insurance card such as Member ID and Group ID
As a core financial resource, almost all payers make this available. However, this resource typically does not provide a more detailed view of a patient's eligibility or accumulators.
The full list of search parameters can be found here. Some of the most important are:
The ID of the patient for whom the coverage is or was active. We recommend using this search parameter along with the
While some servers may support a resource-level search without any parameters, not all do. We recommend using the format below with the patient ID via the
$PATIENT_ID wildcard as a search parameter.
This is a sample request using
curl "https://api.flexpa.com/fhir/Coverage?patient=$PATIENT_ID" \
-H "Authorization: Bearer $ACCESS_TOKEN"
This is a sample response from Humana using Flexpa API in test mode
A Coverage response contains many fields. You can get an exhaustive list and explanation of each field here.
Some notable fields:
entry - A collection of Coverages (see response type on best practice of checking
entry[i].status - A string representing the status of the Coverage, can have a value of
entry[i].type - An object describing the Coverage category (e.g., drug policy, dental policy, automobile injury policy)
entry[i].period - A period datatype describing the Coverage's start and end date
entry[i].identifier - (optional) The primary identifier of the insured and the Coverage. May contain the insured's member ID, group ID, etc.