AmeriHealth Caritas · Example Payload

Amerihealth Caritas Explanation Of Benefit Search Example

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Amerihealth Caritas Explanation Of Benefit Search Example is an example object payload from AmeriHealth Caritas, with 5 top-level fields. It illustrates the shape of data this provider's APIs accept or return.

Top-level fields

resourceTypetypetotallinkentry

Example Payload

Raw ↑ 
{
  "resourceType": "Bundle",
  "type": "searchset",
  "total": 1,
  "link": [
    {
      "relation": "self",
      "url": "https://api-ext.amerihealthcaritas.com/0500/patient-api/ExplanationOfBenefit?patient=ahc-member-example"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://api-ext.amerihealthcaritas.com/0500/patient-api/ExplanationOfBenefit/eob-1",
      "resource": {
        "resourceType": "ExplanationOfBenefit",
        "id": "eob-1",
        "status": "active",
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/claim-type",
              "code": "professional",
              "display": "Professional"
            }
          ]
        },
        "use": "claim",
        "patient": { "reference": "Patient/ahc-member-example" },
        "billablePeriod": { "start": "2026-04-01", "end": "2026-04-30" },
        "created": "2026-05-05T10:00:00Z",
        "insurer": { "reference": "Organization/amerihealth-caritas-dc", "display": "AmeriHealth Caritas DC" },
        "provider": { "reference": "PractitionerRole/pr-12345" },
        "outcome": "complete",
        "insurance": [
          { "focal": true, "coverage": { "reference": "Coverage/cov-1" } }
        ],
        "item": [
          {
            "sequence": 1,
            "productOrService": {
              "coding": [
                { "system": "http://www.ama-assn.org/go/cpt", "code": "99213", "display": "Office or other outpatient visit" }
              ]
            },
            "servicedDate": "2026-04-12",
            "quantity": { "value": 1 },
            "unitPrice": { "value": 150, "currency": "USD" },
            "net": { "value": 150, "currency": "USD" },
            "adjudication": [
              { "category": { "text": "eligible" }, "amount": { "value": 150, "currency": "USD" } },
              { "category": { "text": "benefit" }, "amount": { "value": 120, "currency": "USD" } }
            ]
          }
        ],
        "total": [
          { "category": { "text": "submitted" }, "amount": { "value": 150, "currency": "USD" } },
          { "category": { "text": "benefit" }, "amount": { "value": 120, "currency": "USD" } }
        ]
      }
    }
  ]
}