AmeriHealth Caritas · Example Payload

Amerihealth Caritas Explanation Of Benefit Search Example

HealthcareHealth InsuranceManaged CareMedicaidMedicareDual EligibleCHIPLTSSBehavioral HealthPharmacy BenefitsInteroperabilityFHIRCMSSMART on FHIRPatient AccessProvider Directory

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

{
  "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" } }
        ]
      }
    }
  ]
}

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