Coverage
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
https://hl7.org/fhir/R4/coverage.html
Attributes
The identifier of the Coverage
The status of the Coverage
Supported codes for create interactions: active, cancelled
Type of coverage, such as medical, workers compensation, self pay, etc.
In order for this value to display on the Canvas UI, the coverage type needs to be configured for the specific payor via our insurer settings. To get to these settings, see this Zendesk article.
Who was signed up for or ‘owns’ the Coverage
Supported resource types: Patient
The insurer assigned ID for the subscriber
Who benefits from the coverage; the patient when products or services are provided.
Supported resource types for create interactions are: Patient
The relationship of beneficiary (patient) to the subscriber
Supported codes for create interactions are: child, spouse, other, self, injured with a system of http://hl7.org/fhir/ValueSet/subscriber-relationship
A single iteration is supported.
The period during which the Coverage is in force.
A missing start date indicates the start date isn’t known - for a create interaction, this will be set to the current date.
A missing end date means the coverage continues to be in force.
Issuer of the policy
Two methods for creating this data are supported:
- sending an Organization reference in
payor[0].reference"payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ],For Read/Search, this Organization reference will always be returned.
- sending a
payor[0].identifier.valuecorresponding to the Coverage’s payor id. For now, these values can only be found and updated in the Insurers Admin view in Canvas."payor": [ { "identifier": { "system": "https://www.claim.md/services/era/", "value": "13162" }, "display": "1199 National Benefit Fund" } ],
Additional coverage classifications.
Supported class types supported for create interactions: plan, subplan, group, subgroup with a system of http://hl7.org/fhir/ValueSet/coverage-class
Only plan and group are visible in the Canvas UI.
The order in which coverages should be used when adjudicating claims.
For create interactions, this must between 1 and 5, inclusive.
If multiple coverages are created with the same order number, the older one will be bumped down in rank, and the new one will take that rank.
If this leads to multiple coverages being incremented to 5, the oldest (first to be input) of the coverages at this rank will be displayed on the Canvas UI.
Coverage create
Attributes
The identifier of the Coverage
The status of the Coverage
Supported codes for create interactions: active, cancelled
Type of coverage, such as medical, workers compensation, self pay, etc.
In order for this value to display on the Canvas UI, the coverage type needs to be configured for the specific payor via our insurer settings. To get to these settings, see this Zendesk article.
Who was signed up for or ‘owns’ the Coverage
Supported resource types: Patient
The insurer assigned ID for the subscriber
Who benefits from the coverage; the patient when products or services are provided.
Supported resource types for create interactions are: Patient
The relationship of beneficiary (patient) to the subscriber
Supported codes for create interactions are: child, spouse, other, self, injured with a system of http://hl7.org/fhir/ValueSet/subscriber-relationship
A single iteration is supported.
The period during which the Coverage is in force.
A missing start date indicates the start date isn’t known - for a create interaction, this will be set to the current date.
A missing end date means the coverage continues to be in force.
Issuer of the policy
Two methods for creating this data are supported:
- sending an Organization reference in
payor[0].reference"payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ],For Read/Search, this Organization reference will always be returned.
- sending a
payor[0].identifier.valuecorresponding to the Coverage’s payor id. For now, these values can only be found and updated in the Insurers Admin view in Canvas."payor": [ { "identifier": { "system": "https://www.claim.md/services/era/", "value": "13162" }, "display": "1199 National Benefit Fund" } ],
Additional coverage classifications.
Supported class types supported for create interactions: plan, subplan, group, subgroup with a system of http://hl7.org/fhir/ValueSet/coverage-class
Only plan and group are visible in the Canvas UI.
The order in which coverages should be used when adjudicating claims.
For create interactions, this must between 1 and 5, inclusive.
If multiple coverages are created with the same order number, the older one will be bumped down in rank, and the new one will take that rank.
If this leads to multiple coverages being incremented to 5, the oldest (first to be input) of the coverages at this rank will be displayed on the Canvas UI.
Responses
Errors
Coverage read
Path Parameters
Responses
Errors
Coverage update
Attributes
The identifier of the Coverage
The status of the Coverage
Supported codes for create interactions: active, cancelled
Type of coverage, such as medical, workers compensation, self pay, etc.
In order for this value to display on the Canvas UI, the coverage type needs to be configured for the specific payor via our insurer settings. To get to these settings, see this Zendesk article.
Who was signed up for or ‘owns’ the Coverage
Supported resource types: Patient
The insurer assigned ID for the subscriber
Who benefits from the coverage; the patient when products or services are provided.
Supported resource types for create interactions are: Patient
The relationship of beneficiary (patient) to the subscriber
Supported codes for create interactions are: child, spouse, other, self, injured with a system of http://hl7.org/fhir/ValueSet/subscriber-relationship
A single iteration is supported.
The period during which the Coverage is in force.
A missing start date indicates the start date isn’t known - for a create interaction, this will be set to the current date.
A missing end date means the coverage continues to be in force.
Issuer of the policy
Two methods for creating this data are supported:
- sending an Organization reference in
payor[0].reference"payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ],For Read/Search, this Organization reference will always be returned.
- sending a
payor[0].identifier.valuecorresponding to the Coverage’s payor id. For now, these values can only be found and updated in the Insurers Admin view in Canvas."payor": [ { "identifier": { "system": "https://www.claim.md/services/era/", "value": "13162" }, "display": "1199 National Benefit Fund" } ],
Additional coverage classifications.
Supported class types supported for create interactions: plan, subplan, group, subgroup with a system of http://hl7.org/fhir/ValueSet/coverage-class
Only plan and group are visible in the Canvas UI.
The order in which coverages should be used when adjudicating claims.
For create interactions, this must between 1 and 5, inclusive.
If multiple coverages are created with the same order number, the older one will be bumped down in rank, and the new one will take that rank.
If this leads to multiple coverages being incremented to 5, the oldest (first to be input) of the coverages at this rank will be displayed on the Canvas UI.
Responses
Errors
Coverage search
Query Parameters
The Canvas resource identifier of the Coverage
Retrieve coverages for a patient
Retrieve all coverages with a specific subscriberID
Responses
Errors
curl --request POST \ --url 'https://fumage-example.canvasmedical.com/Coverage' \ --header 'Authorization: Bearer <token>' \ --header 'accept: application/json' \ --header 'content-type: application/json' \ --data ' { "resourceType": "Coverage", "order": 1, "status": "active", "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-type", "code": "MILITARY", "display": "military health program" } ] }, "subscriber": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b34" }, "subscriberId": "1234", "beneficiary": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b3" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self" } ] }, "period": { "start": "2021-06-27", "end": "2023-06-27" }, "payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ], "class": [ { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "plan" } ] }, "value": "Starfleet HMO" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subplan" } ] }, "value": "Stars" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "group" } ] }, "value": "Captains Only" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subgroup" } ] }, "value": "Subgroup 2" } ] } 'import requests url = "https://fumage-example.canvasmedical.com/Coverage" payload = { "resourceType": "Coverage", "order": 1, "status": "active", "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-type", "code": "MILITARY", "display": "military health program" } ] }, "subscriber": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b34" }, "subscriberId": "1234", "beneficiary": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b3" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self" } ] }, "period": { "start": "2021-06-27", "end": "2023-06-27" }, "payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ], "class": [ { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "plan" } ] }, "value": "Starfleet HMO" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subplan" } ] }, "value": "Stars" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "group" } ] }, "value": "Captains Only" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subgroup" } ] }, "value": "Subgroup 2" } ] } headers = { "accept": "application/json", "Authorization": "Bearer <token>", "content-type": "application/json" } response = requests.post(url, json=payload, headers=headers) print(response.text)
null{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "invalid", "details": { "text": "Bad request" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "unknown", "details": { "text": "Authentication failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "forbidden", "details": { "text": "Authorization failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "not-supported", "details": { "text": "Operation is not supported" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "business-rule", "details": { "text": "Unprocessable entity" } } ] }
curl --request GET \ --url 'https://fumage-example.canvasmedical.com/Coverage/<id>' \ --header 'Authorization: Bearer <token>' \ --header 'accept: application/json'import requests url = "https://fumage-example.canvasmedical.com/Coverage/<id>" headers = { "accept": "application/json", "Authorization": "Bearer <token>" } response = requests.get(url, headers=headers) print(response.text)
{ "resourceType": "Coverage", "id": "a7c6af04-a22f-47bf-9cc8-d41158b2ad62", "status": "active", "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-type", "code": "MILITARY", "display": "Military health program" } ] }, "subscriber": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "subscriberId": "12345", "beneficiary": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self", "display": "Self" } ], "text": "18" }, "period": { "start": "2023-09-19" }, "payor": [ { "reference": "Organization/c152eeb7-f204-4e28-acb5-c7e85390b17e", "type": "Organization", "display": " Custody Medical Services Program" } ], "class": [ { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "plan" } ] }, "value": "Starfleet HMO" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subplan" } ] }, "value": "Stars" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "group" } ] }, "value": "Captains Only" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subgroup" } ] }, "value": "Subgroup 2" } ], "order": 1 }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "unknown", "details": { "text": "Authentication failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "forbidden", "details": { "text": "Authorization failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "not-found", "details": { "text": "Unknown coverage resource 'a47c7b0ebbb442cdbc4adf259d148ea1'" } } ] }
curl --request PUT \ --url 'https://fumage-example.canvasmedical.com/Coverage/<id>' \ --header 'Authorization: Bearer <token>' \ --header 'accept: application/json' \ --header 'content-type: application/json' \ --data ' { "resourceType": "Coverage", "order": 1, "status": "active", "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-type", "code": "MILITARY", "display": "military health program" } ] }, "subscriber": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b34" }, "subscriberId": "1234", "beneficiary": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b3" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self" } ] }, "period": { "start": "2021-06-27", "end": "2023-06-27" }, "payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ], "class": [ { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "plan" } ] }, "value": "Starfleet HMO" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subplan" } ] }, "value": "Stars" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "group" } ] }, "value": "Captains Only" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subgroup" } ] }, "value": "Subgroup 2" } ] } 'import requests url = "https://fumage-example.canvasmedical.com/Coverage/<id>" payload = { "resourceType": "Coverage", "order": 1, "status": "active", "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-type", "code": "MILITARY", "display": "military health program" } ] }, "subscriber": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b34" }, "subscriberId": "1234", "beneficiary": { "reference": "Patient/febae9dcb7cf4d88ba27cc552a3f96b3" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self" } ] }, "period": { "start": "2021-06-27", "end": "2023-06-27" }, "payor": [ { "reference": "Organization/6741b035-2846-45b3-b7a3-251f7b7fc728", "type": "Organization", "display": "Medicare Advantage" } ], "class": [ { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "plan" } ] }, "value": "Starfleet HMO" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subplan" } ] }, "value": "Stars" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "group" } ] }, "value": "Captains Only" }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/coverage-class", "code": "subgroup" } ] }, "value": "Subgroup 2" } ] } headers = { "accept": "application/json", "Authorization": "Bearer <token>", "content-type": "application/json" } response = requests.put(url, json=payload, headers=headers) print(response.text)
null{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "invalid", "details": { "text": "Bad request" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "unknown", "details": { "text": "Authentication failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "forbidden", "details": { "text": "Authorization failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "not-found", "details": { "text": "Unknown Coverage resource 'a47c7b0e-bbb4-42cd-bc4a-df259d148ea1'" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "not-supported", "details": { "text": "Operation is not supported" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "conflict", "details": { "text": "Resource updated since If-Unmodified-Since date" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "business-rule", "details": { "text": "Unprocessable entity" } } ] }
curl --request GET \ --url 'https://fumage-example.canvasmedical.com/Coverage?subscriberid=12345&patient=Patient/b3084f7e884e4af2b7e23b1dca494abd' \ --header 'Authorization: Bearer <token>' \ --header 'accept: application/json'import requests url = "https://fumage-example.canvasmedical.com/Coverage?subscriberid=12345&patient=Patient/b3084f7e884e4af2b7e23b1dca494abd" headers = { "accept": "application/json", "Authorization": "Bearer <token>" } response = requests.get(url, headers=headers) print(response.text)
{ "resourceType": "Bundle", "type": "searchset", "total": 2, "link": [ { "relation": "self", "url": "/Coverage?subscriberid=12345&patient=Patient%2Fb3084f7e884e4af2b7e23b1dca494abd" }, { "relation": "first", "url": "/Coverage?subscriberid=12345&patient=Patient%2Fb3084f7e884e4af2b7e23b1dca494abd" }, { "relation": "last", "url": "/Coverage?subscriberid=12345&patient=Patient%2Fb3084f7e884e4af2b7e23b1dca494abd" } ], "entry": [ { "resource": { "resourceType": "Coverage", "id": "171a7243-f568-48cb-8052-3f2990dac1cd", "status": "cancelled", "subscriber": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "subscriberId": "11111", "beneficiary": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self", "display": "Self" } ], "text": "18" }, "period": { "start": "2022-01-01" }, "payor": [ { "reference": "Organization/9b6709aa-a84e-4070-9a83-7c14dc31a511", "type": "Organization", "display": "AL BCBS" } ], "order": 2 } }, { "resource": { "resourceType": "Coverage", "id": "27f42512-23e6-4c17-8569-80e14792b6f8", "status": "cancelled", "subscriber": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "subscriberId": "A1", "beneficiary": { "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd", "type": "Patient" }, "relationship": { "coding": [ { "system": "http://hl7.org/fhir/ValueSet/subscriber-relationship", "code": "self", "display": "Self" } ], "text": "18" }, "period": { "start": "2022-05-31" }, "payor": [ { "reference": "Organization/02211bf5-9ee1-47d1-a1bc-e06bd848e5f3", "type": "Organization", "display": "Kevin Carey Insurance, Inc." } ], "order": 1 } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "invalid", "details": { "text": "Bad request" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "unknown", "details": { "text": "Authentication failed" } } ] }{ "resourceType": "OperationOutcome", "issue": [ { "severity": "error", "code": "forbidden", "details": { "text": "Authorization failed" } } ] }