AmeriHealth Caritas · JSON Structure

Amerihealth Caritas Health Plan Structure

JSON Structure describing one AmeriHealth Caritas health plan brand (state Medicaid managed care, CHIP, D-SNP, LTSS, Marketplace, or behavioral-health line of business). Aggregated from the family-of-plans health plan finder.

Type: object Properties: 10 Required: 5

HealthcareHealth InsuranceManaged CareMedicaidMedicareDual EligibleCHIPLTSSBehavioral HealthPharmacy BenefitsInteroperabilityFHIRCMSSMART On FHIRPatient AccessProvider Directory

Amerihealth Caritas Health Plan Structure is a JSON Structure definition published by AmeriHealth Caritas, describing 10 properties, of which 5 are required. It conforms to the https://json-structure.org/schema/v0.json meta-schema.

Properties

brand state lineOfBusiness url fhirPlanCode parent stateAgency fhirBaseUrl capabilityStatementUrl memberCount

Meta-schema: https://json-structure.org/schema/v0.json

JSON Structure

{
  "$schema": "https://json-structure.org/schema/v0.json",
  "$id": "https://raw.githubusercontent.com/api-evangelist/amerihealth-caritas/refs/heads/main/json-structure/amerihealth-caritas-health-plan-structure.json",
  "title": "AmeriHealthCaritasHealthPlan",
  "description": "JSON Structure describing one AmeriHealth Caritas health plan brand (state Medicaid managed care, CHIP, D-SNP, LTSS, Marketplace, or behavioral-health line of business). Aggregated from the family-of-plans health plan finder.",
  "type": "object",
  "required": ["brand", "state", "lineOfBusiness", "url", "fhirPlanCode"],
  "properties": {
    "brand": {
      "type": "string",
      "description": "Public brand name (e.g. AmeriHealth Caritas Louisiana, Keystone First, Blue Cross Complete of Michigan, First Choice by Select Health, PerformCare)."
    },
    "state": {
      "type": "string",
      "description": "U.S. state or D.C. served by the plan."
    },
    "lineOfBusiness": {
      "type": "string",
      "enum": [
        "Medicaid Managed Care",
        "CHIP",
        "D-SNP",
        "Dual Eligible",
        "LTSS Managed Care",
        "Marketplace",
        "Behavioral Health"
      ]
    },
    "url": {
      "type": "string",
      "format": "uri",
      "description": "Member-facing plan website."
    },
    "fhirPlanCode": {
      "type": "string",
      "description": "Four-digit plan code used to route per-plan FHIR endpoints at api-ext.amerihealthcaritas.com (e.g. 0100, 0500, 0900, 1200, 2100, 2400, 2600)."
    },
    "parent": {
      "type": "string",
      "description": "Operating parent (AmeriHealth Caritas, jointly owned by Independence Blue Cross and Blue Cross Blue Shield of Michigan)."
    },
    "stateAgency": {
      "type": "string",
      "description": "Contracting state Medicaid agency (e.g. PA DHS, LA LDH, NC DHHS, OH ODM, FL AHCA, MI MDHHS, DE DHSS, SC DHHS, NJ DHS, NH DHHS, DC DHCF)."
    },
    "fhirBaseUrl": {
      "type": "string",
      "format": "uri",
      "description": "Per-plan FHIR base URL, of the form https://api-ext.amerihealthcaritas.com/{fhirPlanCode}/patient-api or .../provider-api"
    },
    "capabilityStatementUrl": {
      "type": "string",
      "format": "uri"
    },
    "memberCount": {
      "type": "integer",
      "description": "Approximate enrolled members (where publicly disclosed)."
    }
  }
}