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

post
/Coverage

Coverage create

Attributes

resourceType
string

The FHIR Resource name.

status
enum [ active | cancelled ] required

The status of the Coverage.

In Canvas, the status of active means it appears in the Patient’s Profile page, while a status of cancelled means it was removed and no longer appears on the page. Of note, an expired coverage will still show as active, so be sure to set/read the period.end attribute.

type
json

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.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-type
code
string required

The code of the coverage type.

Value Options Supported:
  • ANNU
  • AUTOPOL
  • CHAR
  • COL
  • CRIME
  • DENTAL
  • DENTPRG
  • DIS
  • DISEASE
  • DRUGPOL
  • EAP
  • EWB
  • ENDRENAL
  • EHCPOL
  • FLEXP
  • GOVEMP
  • HIP
  • HMO
  • HSAPOL
  • HIRISK
  • HIVAIDS
  • IND
  • LIFE
  • LTC
  • MCPOL
  • MANDPOL
  • MENTPOL
  • MENTPRG
  • MILITARY
  • pay
  • POS
  • PPO
  • PNC
  • DISEASEPRG
  • PUBLICPOL
  • REI
  • RETIRE
  • SAFNET
  • SOCIAL
  • SUBSIDIZ
  • SUBSIDMC
  • SUBSUPP
  • SUBPOL
  • SUBPRG
  • SURPL
  • TLIFE
  • UMBRL
  • UNINSMOT
  • ULIFE
  • VET
  • VISPOL
  • CANPRG
  • WCBPOL
display
string

The display name of the coding.

Value Options Supported:
  • Annuity policy
  • Automobile
  • Charity program
  • Collision coverage policy
  • Crime victim program
  • Dental care policy
  • Dental program
  • Disability insurance policy
  • Disease specific policy
  • Drug policy
  • Employee assistance program
  • Employee welfare benefit plan policy
  • End renal program
  • Extended healthcare
  • Flexible benefit plan policy
  • Government employee health program
  • Health insurance plan policy
  • Health maintenance organization policy
  • Health spending account
  • High risk pool program
  • HIV-AIDS program
  • Indigenous peoples health program
  • Life insurance policy
  • Long term care policy
  • Managed care policy
  • Mandatory health program
  • Mental health policy
  • Mental health program
  • Military health program
  • Pay
  • Point of service policy
  • Preferred provider organization policy
  • Property and casualty insurance policy
  • Public health program
  • Public healthcare
  • Reinsurance policy
  • Retiree health program
  • Safety net clinic program
  • Social service program
  • Subsidized health program
  • Subsidized managed care program
  • Subsidized supplemental health program
  • Substance use policy
  • Substance use program
  • Surplus line insurance policy
  • Term life insurance policy
  • Umbrella liability insurance policy
  • Uninsured motorist policy
  • Universal life insurance policy
  • Veteran health program
  • Vision care policy
  • Women's cancer detection program
  • Worker's compensation
subscriber
json required

Who was signed up for or ‘owns’ the Coverage.

Click to view child attributes
reference
string required

The reference string of the patient subscriber in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

subscriberId
string required

The insurer-assigned ID for the subscriber.

beneficiary
json required

Who benefits from the coverage; the patient when products or services are provided.

Click to view child attributes
reference
string required

The reference string of the patient beneficiary in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

relationship
json required

The relationship of beneficiary (patient) to the subscriber.

Click to view child attributes
coding
array[json] required

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/subscriber-relationship
code
string required

The code of the relationship.

Value Options Supported:
  • child
  • spouse
  • other
  • self
  • injured
display
string

The display name of the coding.

period
json

If the start date is missing for a create/update interaction, it will be set to the current date of ingestion.

Click to view child attributes
start
date

Starting time with inclusive boundary

end
date

End time with inclusive boundary, if not ongoing.

payor
array[json] required

Issuer of the policy.

Two methods for specifying 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"
         }
       ],
    


  • sending a payor[0].identifier.value corresponding 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"
       }
     ],
    


    A reference or identifier.value is required in a Create/Update.

Click to view child attributes
reference
string

The Organization reference to the Coverage’s payor in the format “Organization/6741b035-2846-45b3-b7a3-251f7b7fc728”

type
string

Type the reference refers to (e.g. “Organization”).

display
string

The display name of the payor.

identifier
json

Logical reference, when literal reference is not known.

Click to view child attributes
value
string required

The value that is unique. These values can only be found and updated in the Insurers Admin view in Canvas.

system
string

The namespace for the identifier value.

Value Options Supported:
  • https://www.claim.md/services/era/
class
json

Additional coverage classifications.

Only plan and group will be visible in the Canvas UI.

Click to view child attributes
type
json required

Type of class such as ‘group’ or ‘plan’.

Click to view child attributes
coding
array[json] required

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-class
code
string required

The code of the class.

Value Options Supported:
  • plan
  • subplan
  • group
  • subgroup
value
string

Value associated with the type.

order
number [ 1-5 ] required

The order in which coverages should be used when adjudicating claims.

The order must between 1 and 5, inclusive.

If multiple coverages for a patient 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 inputted into Canvas) of the coverages at this rank will be displayed on the Canvas UI.

Responses

201 Created
The server has successfully processed the request; the new resource has been created and is now ready for interaction.

Canvas returns the created resource's id as a UUID within the location header and a null response body.

Errors

400 Bad Request
The request was invalid or cannot be otherwise served. An accompanying error message will explain further.
401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
405 Method Not Allowed
The request performs an operation that is either not supported or allowed.
422 Unprocessable Entity
The request cannot be processed due to semantic issues or conflicts with the database state.
get
/Coverage/{id}

Coverage read

Path Parameters

id required
string
The unique identifier for the Coverage

Response Payload Attributes

resourceType
string

The FHIR Resource name.

id
string

The identifier of the Coverage.

status
enum [ active | cancelled ]

The status of the Coverage.

In Canvas, the status of active means it appears in the Patient’s Profile page, while a status of cancelled means it was removed and no longer appears on the page. Of note, an expired coverage will still show as active, so be sure to set/read the period.end attribute.

type
json

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.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-type
code
string

The code of the coverage type.

Value Options Supported:
  • ANNU
  • AUTOPOL
  • CHAR
  • COL
  • CRIME
  • DENTAL
  • DENTPRG
  • DIS
  • DISEASE
  • DRUGPOL
  • EAP
  • EWB
  • ENDRENAL
  • EHCPOL
  • FLEXP
  • GOVEMP
  • HIP
  • HMO
  • HSAPOL
  • HIRISK
  • HIVAIDS
  • IND
  • LIFE
  • LTC
  • MCPOL
  • MANDPOL
  • MENTPOL
  • MENTPRG
  • MILITARY
  • pay
  • POS
  • PPO
  • PNC
  • DISEASEPRG
  • PUBLICPOL
  • REI
  • RETIRE
  • SAFNET
  • SOCIAL
  • SUBSIDIZ
  • SUBSIDMC
  • SUBSUPP
  • SUBPOL
  • SUBPRG
  • SURPL
  • TLIFE
  • UMBRL
  • UNINSMOT
  • ULIFE
  • VET
  • VISPOL
  • CANPRG
  • WCBPOL
display
string

The display name of the coding.

Value Options Supported:
  • Annuity policy
  • Automobile
  • Charity program
  • Collision coverage policy
  • Crime victim program
  • Dental care policy
  • Dental program
  • Disability insurance policy
  • Disease specific policy
  • Drug policy
  • Employee assistance program
  • Employee welfare benefit plan policy
  • End renal program
  • Extended healthcare
  • Flexible benefit plan policy
  • Government employee health program
  • Health insurance plan policy
  • Health maintenance organization policy
  • Health spending account
  • High risk pool program
  • HIV-AIDS program
  • Indigenous peoples health program
  • Life insurance policy
  • Long term care policy
  • Managed care policy
  • Mandatory health program
  • Mental health policy
  • Mental health program
  • Military health program
  • Pay
  • Point of service policy
  • Preferred provider organization policy
  • Property and casualty insurance policy
  • Public health program
  • Public healthcare
  • Reinsurance policy
  • Retiree health program
  • Safety net clinic program
  • Social service program
  • Subsidized health program
  • Subsidized managed care program
  • Subsidized supplemental health program
  • Substance use policy
  • Substance use program
  • Surplus line insurance policy
  • Term life insurance policy
  • Umbrella liability insurance policy
  • Uninsured motorist policy
  • Universal life insurance policy
  • Veteran health program
  • Vision care policy
  • Women's cancer detection program
  • Worker's compensation
text
string

The 2 character code that represents the patient relationship to the insured as defined by CMS.

subscriber
json

Who was signed up for or ‘owns’ the Coverage.

Click to view child attributes
reference
string

The reference string of the patient subscriber in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

subscriberId
string

The insurer-assigned ID for the subscriber.

beneficiary
json

Who benefits from the coverage; the patient when products or services are provided.

Click to view child attributes
reference
string

The reference string of the patient beneficiary in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

relationship
json

The relationship of beneficiary (patient) to the subscriber.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/subscriber-relationship
code
string

The code of the relationship.

Value Options Supported:
  • child
  • spouse
  • other
  • self
  • injured
  • parent
  • common
display
string

The display name of the coding.

text
string

The 2 character code that represents the patient relationship to the insured as defined by CMS.

Value Options Supported:
  • 18 (Self)
  • 01 (Spouse)
  • 19 (Natural Child, insured has financial responsibility)
  • 43 (Natural Child, insured does not have financial responsibility),
  • 17 (Step Child)
  • 10 (Foster Child)
  • 15 (Ward of the Court)
  • 20 (Employee)
  • 21 (Unknown)
  • 22 (Handicapped Dependent)
  • 39 (Organ donor)
  • 40 (Cadaver donor)
  • 05 (Grandchild)
  • 07 (Niece/Nephew)
  • 41 (Injured Plaintiff)
  • 23 (Sponsored Dependent)
  • 24 (Minor Dependent of a Minor Dependent)
  • 32 (Mother)
  • 33 (Father)
  • 04 (Grandparent)
  • 53 (Life Partner)
  • 29 (Significant Other)
  • G8 (Other)
period
json

The period during which the Coverage is in force.

A missing end date means the coverage continues to be in force.

Click to view child attributes
start
date

Starting time with inclusive boundary

end
date

End time with inclusive boundary, if not ongoing.

payor
array[json]

Issuer of the policy.

Click to view child attributes
reference
string

The Organization reference to the Coverage’s payor in the format “Organization/6741b035-2846-45b3-b7a3-251f7b7fc728”

type
string

Type the reference refers to (e.g. “Organization”).

display
string

The display name of the payor.

class
json

Additional coverage classifications.

Only plan and group will be visible in the Canvas UI.

Click to view child attributes
type
json

Type of class such as ‘group’ or ‘plan’.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-class
code
string

The code of the class.

Value Options Supported:
  • plan
  • subplan
  • group
  • subgroup
value
string

Value associated with the type.

order
number [ 1-5 ]

The order in which coverages should be used when adjudicating claims.

Responses

200 OK
Request was successful.

Errors

401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
404 Not Found
The requested resource was not found.
put
/Coverage/{id}

Coverage update

Attributes

resourceType
string

The FHIR Resource name.

id
string required

The identifier of the Coverage.

status
enum [ active | cancelled ] required

The status of the Coverage.

In Canvas, the status of active means it appears in the Patient’s Profile page, while a status of cancelled means it was removed and no longer appears on the page. Of note, an expired coverage will still show as active, so be sure to set/read the period.end attribute.

type
json

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.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-type
code
string required

The code of the coverage type.

Value Options Supported:
  • ANNU
  • AUTOPOL
  • CHAR
  • COL
  • CRIME
  • DENTAL
  • DENTPRG
  • DIS
  • DISEASE
  • DRUGPOL
  • EAP
  • EWB
  • ENDRENAL
  • EHCPOL
  • FLEXP
  • GOVEMP
  • HIP
  • HMO
  • HSAPOL
  • HIRISK
  • HIVAIDS
  • IND
  • LIFE
  • LTC
  • MCPOL
  • MANDPOL
  • MENTPOL
  • MENTPRG
  • MILITARY
  • pay
  • POS
  • PPO
  • PNC
  • DISEASEPRG
  • PUBLICPOL
  • REI
  • RETIRE
  • SAFNET
  • SOCIAL
  • SUBSIDIZ
  • SUBSIDMC
  • SUBSUPP
  • SUBPOL
  • SUBPRG
  • SURPL
  • TLIFE
  • UMBRL
  • UNINSMOT
  • ULIFE
  • VET
  • VISPOL
  • CANPRG
  • WCBPOL
display
string

The display name of the coding.

Value Options Supported:
  • Annuity policy
  • Automobile
  • Charity program
  • Collision coverage policy
  • Crime victim program
  • Dental care policy
  • Dental program
  • Disability insurance policy
  • Disease specific policy
  • Drug policy
  • Employee assistance program
  • Employee welfare benefit plan policy
  • End renal program
  • Extended healthcare
  • Flexible benefit plan policy
  • Government employee health program
  • Health insurance plan policy
  • Health maintenance organization policy
  • Health spending account
  • High risk pool program
  • HIV-AIDS program
  • Indigenous peoples health program
  • Life insurance policy
  • Long term care policy
  • Managed care policy
  • Mandatory health program
  • Mental health policy
  • Mental health program
  • Military health program
  • Pay
  • Point of service policy
  • Preferred provider organization policy
  • Property and casualty insurance policy
  • Public health program
  • Public healthcare
  • Reinsurance policy
  • Retiree health program
  • Safety net clinic program
  • Social service program
  • Subsidized health program
  • Subsidized managed care program
  • Subsidized supplemental health program
  • Substance use policy
  • Substance use program
  • Surplus line insurance policy
  • Term life insurance policy
  • Umbrella liability insurance policy
  • Uninsured motorist policy
  • Universal life insurance policy
  • Veteran health program
  • Vision care policy
  • Women's cancer detection program
  • Worker's compensation
subscriber
json required

Who was signed up for or ‘owns’ the Coverage.

Click to view child attributes
reference
string required

The reference string of the patient subscriber in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

subscriberId
string required

The insurer-assigned ID for the subscriber.

beneficiary
json required

Who benefits from the coverage; the patient when products or services are provided.

Click to view child attributes
reference
string required

The reference string of the patient beneficiary in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

relationship
json required

The relationship of beneficiary (patient) to the subscriber.

Click to view child attributes
coding
array[json] required

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/subscriber-relationship
code
string required

The code of the relationship.

Value Options Supported:
  • child
  • spouse
  • other
  • self
  • injured
display
string

The display name of the coding.

period
json

If the start date is missing for a create/update interaction, it will be set to the current date of ingestion.

Click to view child attributes
start
date

Starting time with inclusive boundary

end
date

End time with inclusive boundary, if not ongoing.

payor
array[json] required

Issuer of the policy.

Two methods for specifying 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"
         }
       ],
    


  • sending a payor[0].identifier.value corresponding 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"
       }
     ],
    


    A reference or identifier.value is required in a Create/Update.

Click to view child attributes
reference
string

The Organization reference to the Coverage’s payor in the format “Organization/6741b035-2846-45b3-b7a3-251f7b7fc728”

type
string

Type the reference refers to (e.g. “Organization”).

display
string

The display name of the payor.

identifier
json

Logical reference, when literal reference is not known.

Click to view child attributes
value
string required

The value that is unique. These values can only be found and updated in the Insurers Admin view in Canvas.

system
string

The namespace for the identifier value.

Value Options Supported:
  • https://www.claim.md/services/era/
class
json

Additional coverage classifications.

Only plan and group will be visible in the Canvas UI.

Click to view child attributes
type
json required

Type of class such as ‘group’ or ‘plan’.

Click to view child attributes
coding
array[json] required

Identifies where the definition of the code comes from.

Click to view child attributes
system
string required

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-class
code
string required

The code of the class.

Value Options Supported:
  • plan
  • subplan
  • group
  • subgroup
value
string

Value associated with the type.

order
number [ 1-5 ] required

The order in which coverages should be used when adjudicating claims.

The order must between 1 and 5, inclusive.

If multiple coverages for a patient 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 inputted into Canvas) of the coverages at this rank will be displayed on the Canvas UI.

Responses

200 OK
The server has successfully processed the request.

Canvas returns a null response body.

Errors

400 Bad Request
The request was invalid or cannot be otherwise served. An accompanying error message will explain further.
401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
404 Not Found
The requested resource was not found.
405 Method Not Allowed
The request performs an operation that is either not supported or allowed.
412 Precondition Failed
The request depends on a precondition that has not been met.
422 Unprocessable Entity
The request cannot be processed due to semantic issues or conflicts with the database state.

Query Parameters

_id
string

The Canvas resource identifier of the Coverage.

patient
string

Retrieve coverages for a patient in the format Patient/a39cafb9d1b445be95a2e2548e12a787.

subscriberid
string

Retrieve all coverages with a specific subscriberID

status
string

Retrieve coverages by a specific status.

Search Values Supported:
  • active
  • cancelled

Response Payload Attributes

resourceType
string

The FHIR Resource name.

type
string

This element and value designate that the bundle is a search response. Search result bundles will always have the Bundle.type of searchset .

total
integer

The number of resources that match the search parameter.

link
array[json]

Attributes relevant to pagination, see our Pagination page for more detail.

Click to view child attributes
relation
enum [self|first|next|last]

The relation of the page search

url

The search url for the specific relation

entry
array[json]

The results bundle that lists out each object returned in the search

Click to view child attributes
resource
json

The attributes specific to the resource type, see the Attributes section below

Attributes

resourceType
string

The FHIR Resource name.

id
string

The identifier of the Coverage.

status
enum [ active | cancelled ]

The status of the Coverage.

In Canvas, the status of active means it appears in the Patient’s Profile page, while a status of cancelled means it was removed and no longer appears on the page. Of note, an expired coverage will still show as active, so be sure to set/read the period.end attribute.

type
json

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.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-type
code
string

The code of the coverage type.

Value Options Supported:
  • ANNU
  • AUTOPOL
  • CHAR
  • COL
  • CRIME
  • DENTAL
  • DENTPRG
  • DIS
  • DISEASE
  • DRUGPOL
  • EAP
  • EWB
  • ENDRENAL
  • EHCPOL
  • FLEXP
  • GOVEMP
  • HIP
  • HMO
  • HSAPOL
  • HIRISK
  • HIVAIDS
  • IND
  • LIFE
  • LTC
  • MCPOL
  • MANDPOL
  • MENTPOL
  • MENTPRG
  • MILITARY
  • pay
  • POS
  • PPO
  • PNC
  • DISEASEPRG
  • PUBLICPOL
  • REI
  • RETIRE
  • SAFNET
  • SOCIAL
  • SUBSIDIZ
  • SUBSIDMC
  • SUBSUPP
  • SUBPOL
  • SUBPRG
  • SURPL
  • TLIFE
  • UMBRL
  • UNINSMOT
  • ULIFE
  • VET
  • VISPOL
  • CANPRG
  • WCBPOL
display
string

The display name of the coding.

Value Options Supported:
  • Annuity policy
  • Automobile
  • Charity program
  • Collision coverage policy
  • Crime victim program
  • Dental care policy
  • Dental program
  • Disability insurance policy
  • Disease specific policy
  • Drug policy
  • Employee assistance program
  • Employee welfare benefit plan policy
  • End renal program
  • Extended healthcare
  • Flexible benefit plan policy
  • Government employee health program
  • Health insurance plan policy
  • Health maintenance organization policy
  • Health spending account
  • High risk pool program
  • HIV-AIDS program
  • Indigenous peoples health program
  • Life insurance policy
  • Long term care policy
  • Managed care policy
  • Mandatory health program
  • Mental health policy
  • Mental health program
  • Military health program
  • Pay
  • Point of service policy
  • Preferred provider organization policy
  • Property and casualty insurance policy
  • Public health program
  • Public healthcare
  • Reinsurance policy
  • Retiree health program
  • Safety net clinic program
  • Social service program
  • Subsidized health program
  • Subsidized managed care program
  • Subsidized supplemental health program
  • Substance use policy
  • Substance use program
  • Surplus line insurance policy
  • Term life insurance policy
  • Umbrella liability insurance policy
  • Uninsured motorist policy
  • Universal life insurance policy
  • Veteran health program
  • Vision care policy
  • Women's cancer detection program
  • Worker's compensation
text
string

The 2 character code that represents the patient relationship to the insured as defined by CMS.

subscriber
json

Who was signed up for or ‘owns’ the Coverage.

Click to view child attributes
reference
string

The reference string of the patient subscriber in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

subscriberId
string

The insurer-assigned ID for the subscriber.

beneficiary
json

Who benefits from the coverage; the patient when products or services are provided.

Click to view child attributes
reference
string

The reference string of the patient beneficiary in the format of "Patient/a39cafb9d1b445be95a2e2548e12a787".

type
string

Type the reference refers to (e.g. “Patient”).

relationship
json

The relationship of beneficiary (patient) to the subscriber.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/subscriber-relationship
code
string

The code of the relationship.

Value Options Supported:
  • child
  • spouse
  • other
  • self
  • injured
  • parent
  • common
display
string

The display name of the coding.

text
string

The 2 character code that represents the patient relationship to the insured as defined by CMS.

Value Options Supported:
  • 18 (Self)
  • 01 (Spouse)
  • 19 (Natural Child, insured has financial responsibility)
  • 43 (Natural Child, insured does not have financial responsibility),
  • 17 (Step Child)
  • 10 (Foster Child)
  • 15 (Ward of the Court)
  • 20 (Employee)
  • 21 (Unknown)
  • 22 (Handicapped Dependent)
  • 39 (Organ donor)
  • 40 (Cadaver donor)
  • 05 (Grandchild)
  • 07 (Niece/Nephew)
  • 41 (Injured Plaintiff)
  • 23 (Sponsored Dependent)
  • 24 (Minor Dependent of a Minor Dependent)
  • 32 (Mother)
  • 33 (Father)
  • 04 (Grandparent)
  • 53 (Life Partner)
  • 29 (Significant Other)
  • G8 (Other)
period
json

The period during which the Coverage is in force.

A missing end date means the coverage continues to be in force.

Click to view child attributes
start
date

Starting time with inclusive boundary

end
date

End time with inclusive boundary, if not ongoing.

payor
array[json]

Issuer of the policy.

Click to view child attributes
reference
string

The Organization reference to the Coverage’s payor in the format “Organization/6741b035-2846-45b3-b7a3-251f7b7fc728”

type
string

Type the reference refers to (e.g. “Organization”).

display
string

The display name of the payor.

class
json

Additional coverage classifications.

Only plan and group will be visible in the Canvas UI.

Click to view child attributes
type
json

Type of class such as ‘group’ or ‘plan’.

Click to view child attributes
coding
array[json]

Identifies where the definition of the code comes from.

Click to view child attributes
system
string

The system url of the coding.

Value Options Supported:
  • http://hl7.org/fhir/ValueSet/coverage-class
code
string

The code of the class.

Value Options Supported:
  • plan
  • subplan
  • group
  • subgroup
value
string

Value associated with the type.

order
number [ 1-5 ]

The order in which coverages should be used when adjudicating claims.

Responses

200 OK
Request was successful.

Errors

400 Bad Request
The request was invalid or cannot be otherwise served. An accompanying error message will explain further.
401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
  • 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 'c152eeb7-f204-4e28-acb5-c7e85390b17e'"
          }
        }
      ]
    }
    
  • 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"
          }
        }
      ]
    }