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FHIR Resources

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Coverage

GET https://api.flexpa.com/fhir/Coverage

  • Coverage is a base FHIR Resource ( JSON example)
  • Commonly available via the C4BB Coverage Profile.

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.

Search parameters

The full list of search parameters can be found here. Some of the most important are:

Parameters

patient
string

The ID of the patient for whom the coverage is or was active. We recommend using this search parameter along with the $PATIENT_ID wildcard

Sample request

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

ACCESS_TOKEN=flexpa-link-access-token

curl "https://api.flexpa.com/fhir/Coverage?patient=$PATIENT_ID" \
  -H "Authorization: Bearer $ACCESS_TOKEN"

Sample response

This is a sample response from Humana using Flexpa API in test mode

Notable fields

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 resourceType)
  • entry[i].status - A string representing the status of the Coverage, can have a value of "active", "cancelled", "draft", "entered-in-error"
  • 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.
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On this page
  • Search parameters
  • Sample request
  • Sample response
  • Notable fields