Candid Health subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1 API

openapi: 3.1.0
info:
  title: API Reference subpackage_auth.subpackage_auth/default subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1 API
  version: 1.0.0
servers:
- url: https://pre-api.joincandidhealth.com
  description: Production
- url: https://pre-api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-pre-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-pre-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:4000
  description: Local
- url: https://api.joincandidhealth.com
  description: Production
- url: https://api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:5050
  description: Local
tags:
- name: subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
paths:
  /coverages/v1/:
    post:
      operationId: create
      summary: Create
      description: Creates a new Coverage. A Coverage provides the high-level identifiers and descriptors of a specific insurance plan for a specific individual - typically the information you can find on an insurance card. Additionally a coverage will include detailed benefits information covered by the specific plan for the individual.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
    get:
      operationId: get-multi
      summary: Get Multi
      description: Returns a list of Coverages based on the search criteria.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: patient_id
        in: query
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
  /coverages/v1//{id}/{version}:
    put:
      operationId: update
      summary: Update
      description: Updates a Coverage. The path must contain the next version number to prevent race conditions. For example, if the current version of the coverage is n, you will need to send a request to this endpoint with `/{id}/n+1` to update the coverage. Updating historic versions is not supported.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
      - name: version
        in: path
        required: true
        schema:
          type: string
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - NotFoundError
                  content:
                    $ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
                required:
                - errorName
                - content
        '409':
          description: Error response with status 409
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - VersionConflictError
                  content:
                    $ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
  /coverages/v1//get-multi-paginated:
    get:
      operationId: get-multi-paginated
      summary: Get Multi Paginated
      description: Returns a page of Coverages based on the search criteria.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: patient_id
        in: query
        required: false
        schema:
          type: string
      - name: payer_plan_group_id
        in: query
        required: false
        schema:
          type: string
      - name: page_token
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:PageToken'
      - name: limit
        in: query
        description: Must be between 0 and 1000. Defaults to 100
        required: false
        schema:
          type: integer
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoveragesPage'
        '400':
          description: Error response with status 400
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - BadRequestError
                  content:
                    $ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
                required:
                - errorName
                - content
  /coverages/v1//{id}:
    get:
      operationId: get
      summary: Get
      description: gets a specific Coverage
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
  /coverages/v1//{id}/history:
    get:
      operationId: get-history
      summary: Get History
      description: "Gets a coverage's history. Full history is returned if no filters are \ndefined. The return list is ordered by version, defaulting to ascending."
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
      - name: start
        in: query
        required: false
        schema:
          type: string
          format: date
      - name: end
        in: query
        required: false
        schema:
          type: string
          format: date
      - name: non_auto_updated_coverages_only
        in: query
        description: If true, only returns coverages that have NOT been auto-updated by the system.
        required: false
        schema:
          type: boolean
      - name: sort_direction
        in: query
        description: Defaults to ascending. Sorts by version.
        required: false
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
      - name: limit
        in: query
        description: Must be between 0 and 1000. No default.
        required: false
        schema:
          type: integer
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
        '400':
          description: Error response with status 400
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - BadRequestError
                  content:
                    $ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
                required:
                - errorName
                - content
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - NotFoundError
                  content:
                    $ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
                required:
                - errorName
                - content
  /coverages/v1//updates/scan:
    get:
      operationId: scan
      summary: Scan
      description: 'Scans up to 100 coverage updates. The since query parameter is inclusive, and the result list is ordered by updatedAt ascending.


        **Polling Pattern:**

        To continuously poll for updates without gaps:

        1. Make your initial request with a `since` timestamp (e.g., `since=2020-01-01T13:00:00.000Z`)

        2. The API returns up to 100 coverage records, sorted by `updated_at` ascending

        3. Find the `updated_at` value from the last record in the response

        4. Use that `updated_at` value as the `since` parameter in your next request

        5. Repeat steps 2-4 to ingest updates until you receive an empty list


        **Important Notes:**

        - The `since` parameter is inclusive, so you may receive the last record from the previous batch again (you can deduplicate by ID and version)

        - All coverage records include `updated_at`, `id`, `version`, `deactivated`, and `updating_user` fields for tracking changes

        - Timestamps have millisecond resolution for precise ordering'
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: since
        in: query
        required: true
        schema:
          type: string
          format: date-time
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
  /coverages/v1//batch-update-ppg/{ppg_id}:
    post:
      operationId: batch-update-ppg
      summary: Batch Update Ppg
      description: Finds all coverages associated with the given ppg_id and updates the ppg_fields for each coverage.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: ppg_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:PayerPlanGroupId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Successful response
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_pre-encounter/coverages/v1:PayerPlanGroupFields'
  /coverages/v1//{id}/eligibility:
    post:
      operationId: check-eligibility
      summary: Check Eligibility
      description: Initiates an eligibility check. Returns the metadata of the check if successfully initiated.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata'
      requestBody:
        content:
          application/json:
            schema:
              type: object
              properties:
                service_code:
                  $ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
                date_of_service:
                  type: string
                  format: date
                npi:
                  type: string
              required:
              - service_code
              - date_of_service
              - npi
  /coverages/v1//{id}/eligibility/{check_id}:
    get:
      operationId: get-eligibility
      summary: Get Eligibility
      description: Gets the eligibility of a patient for a specific coverage if successful.
      tags:
      - subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
      parameters:
      - name: id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
      - name: check_id
        in: path
        required: true
        schema:
          type: string
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageEligibilityCheckResponse'
components:
  securitySchemes:
    OAuthScheme:
      type: http
      scheme: bearer
      description: OAuth 2.0 authentication