wellcare-health-plans Patient API

openapi: 3.1.0
info:
  title: WellCare FHIR Access Condition Patient API
  description: The WellCare FHIR Patient Access API enables members and authorized third-party applications to securely access and exchange health data including medical, pharmacy, dental, and vision claims and clinical information. The API supports HL7 FHIR R4 standards and SMART on FHIR authorization, providing access to up to 5 years of historical health information. Required under CMS Interoperability and Patient Access final rule (CMS-9115-F) for Medicaid and Medicare Advantage plans. Access is managed through the Centene Partner Portal at partners.centene.com/apis.
  version: '1.0'
  contact:
    url: https://www.wellcare.com/en/interoperability-and-patient-access
servers:
- url: https://partners.centene.com
tags:
- name: Patient
  description: Patient demographic and identity resources.
paths:
  /fhir/r4/Patient/{id}:
    get:
      operationId: getPatient
      summary: Get Patient
      description: Retrieves a patient resource by FHIR Patient ID for an authenticated member, returning demographic information including name, birthdate, address, and contact details.
      tags:
      - Patient
      parameters:
      - name: id
        in: path
        description: The FHIR Patient resource ID.
        required: true
        schema:
          type: string
      security:
      - smartOnFhir:
        - patient/Patient.read
      responses:
        '200':
          description: Patient resource returned successfully.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Patient'
        '401':
          description: Unauthorized - invalid or missing access token.
        '404':
          description: Patient not found.
components:
  schemas:
    Patient:
      type: object
      description: A FHIR Patient resource.
      properties:
        resourceType:
          type: string
          example: Patient
        id:
          type: string
        name:
          type: array
          items:
            type: object
            properties:
              family:
                type: string
              given:
                type: array
                items:
                  type: string
        birthDate:
          type: string
          format: date
        gender:
          type: string
          enum:
          - male
          - female
          - other
          - unknown
        address:
          type: array
          items:
            type: object
  securitySchemes:
    smartOnFhir:
      type: oauth2
      description: SMART on FHIR OAuth 2.0 authorization for patient-facing apps.
      flows:
        authorizationCode:
          authorizationUrl: https://partners.centene.com/oauth2/authorize
          tokenUrl: https://partners.centene.com/oauth2/token
          scopes:
            patient/Patient.read: Read patient demographic data
            patient/Coverage.read: Read coverage and enrollment data
            patient/ExplanationOfBenefit.read: Read claims and EOB data
            patient/Condition.read: Read diagnosed conditions
            patient/Observation.read: Read observations and lab results
            patient/MedicationRequest.read: Read medication requests
            patient/Immunization.read: Read immunization records
            patient/Encounter.read: Read care encounters