CoverageEligibilityRequest

The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force.

https://hl7.org/fhir/R4/coverageeligibilityrequest.html

Endpoints

post
/CoverageEligibilityRequest

Attributes

status
string required

Describes the state the request is in.

Supported values: active

purpose
array[string] required

What information is being requested.

Supported values: only [“benefits”] is valid

patient
json required

Canvas patient resource whom the eligibility request is for

created
date required

Creation date, required by the FHIR schema, but unused by Canvas.

Canvas recommends sending the current datetime in ISO 8601 format.

insurer
json required

Coverage issuer, required by the FHIR schema but unused by Canvas.

Canvas recommends setting insurer to {}.

insurance
array[json] required

Canvas Coverage resource identifying the insurance to check eligibility against

Supported values: a single iteration containing a Coverage resource.

focal is not required - all requests are processed as true

post
/CoverageEligibilityRequest

CoverageEligibilityRequest create

Attributes

status
string required

Describes the state the request is in.

Supported values: active

purpose
array[string] required

What information is being requested.

Supported values: only [“benefits”] is valid

patient
json required

Canvas patient resource whom the eligibility request is for

created
date required

Creation date, required by the FHIR schema, but unused by Canvas.

Canvas recommends sending the current datetime in ISO 8601 format.

insurer
json required

Coverage issuer, required by the FHIR schema but unused by Canvas.

Canvas recommends setting insurer to {}.

insurance
array[json] required

Canvas Coverage resource identifying the insurance to check eligibility against

Supported values: a single iteration containing a Coverage resource.

focal is not required - all requests are processed as true

Responses

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

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.
  • curl --request POST \
     --url 'https://fumage-example.canvasmedical.com/CoverageEligibilityRequest' \
     --header 'Authorization: Bearer <token>' \
     --header 'accept: application/json' \
     --header 'content-type: application/json' \
     --data '
{
    "resourceType": "CoverageEligibilityRequest",
    "status": "active",
    "purpose": [
        "benefits"
    ],
    "patient": {
        "reference": "Patient/9713f5a3c8464a2587912e80bc2dd938"
    },
    "created": "2023-09-19",
    "insurer": {},
    "insurance": [
        {
            "focal": true,
            "coverage": {
                "reference": "Coverage/743aa331-2f85-420b-ab10-8a6b7bb6a1cf"
            }
        }
    ]
}'

  • import requests

url = "https://fumage-example.canvasmedical.com/CoverageEligibilityRequest"

payload = {
    "resourceType": "CoverageEligibilityRequest",
    "status": "active",
    "purpose": [
        "benefits"
    ],
    "patient": {
        "reference": "Patient/9713f5a3c8464a2587912e80bc2dd938"
    },
    "created": "2023-09-19",
    "insurer": {},
    "insurance": [
        {
            "focal": True,
            "coverage": {
                "reference": "Coverage/743aa331-2f85-420b-ab10-8a6b7bb6a1cf"
            }
        }
    ]
}
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"
      }
    }
  ]
}