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Coverage

Overview​

The Coverage resource provides information about insurance or payment for healthcare services. This includes details about the insurance plan, policy holder, and coverage benefits.

Resource Schema​

Key fields in the Coverage resource:

{
  "resourceType": "Coverage",
  "id": "example-coverage-123",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "EHCPOL",
        "display": "extended healthcare"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/123456"
  },
  "beneficiary": {
    "reference": "Patient/123456"
  },
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "period": {
    "start": "2023-01-01",
    "end": "2023-12-31"
  },
  "payor": [
    {
      "reference": "Organization/insurance-789"
    }
  ]
}

Operations​

The Coverage resource supports Read and Search operations. Support varies by CareRecord solution.

CareRecord / SolutionReadSearch
GEHRIMED✅✅
myAvatar✅✅
myEvolv✅✅
myUnity✅✅
TheraOffice✅✅

Read​

HTTP Method: GET
URL: /Coverage/{id}

curl -X GET https://fhir.netsmartcloud.com/uscore/v1/Coverage/123456 \
    -H "Authorization: Bearer {token}" \
    -H "Accept: application/fhir+json"

HTTP Method: GET or POST
URL: /Coverage or /Coverage/_search

Search by Patient
curl -X POST https://fhir.netsmartcloud.com/uscore/v1/Coverage/_search \
    -H "Authorization: Bearer {token}" \
    -H "Accept: application/fhir+json" \
    -H "Content-Type: application/x-form-urlencoded" \
    -d "patient=Patient/123"

Integration Patterns​

Common Workflows​

  1. Insurance Verification - Verify patient insurance coverage
  2. Benefits Checking - Determine coverage benefits and limitations
  3. Claims Processing - Support insurance claims and billing

Relationships to Other Resources​

Error Handling​

For common errors and troubleshooting guidance, see Common Errors.

Supported Profiles​