AmeriHealthCaritasCoverage
JSON Schema mirroring the FHIR R4 Coverage resource exposed by AmeriHealth Caritas Patient Access. Coverage identifies an insurance plan that pays for healthcare for a beneficiary; here it identifies a Medicaid, CHIP, D-SNP, LTSS, or Marketplace coverage relationship with an AmeriHealth Caritas plan.
Properties
| Name | Type | Description |
|---|---|---|
| resourceType | string | |
| id | string | |
| meta | object | |
| identifier | array | |
| status | string | |
| type | object | |
| policyHolder | object | |
| subscriber | object | |
| subscriberId | string | |
| beneficiary | object | Reference(Patient) |
| dependent | string | |
| relationship | object | |
| period | object | |
| payor | array | |
| class | array | |
| order | integer | |
| network | string | |
| costToBeneficiary | array | |
| subrogation | boolean | |
| contract | array |
JSON Schema
{
"$schema": "https://json-schema.org/draft/2020-12/schema",
"$id": "https://raw.githubusercontent.com/api-evangelist/amerihealth-caritas/refs/heads/main/json-schema/amerihealth-caritas-coverage-schema.json",
"title": "AmeriHealthCaritasCoverage",
"description": "JSON Schema mirroring the FHIR R4 Coverage resource exposed by AmeriHealth Caritas Patient Access. Coverage identifies an insurance plan that pays for healthcare for a beneficiary; here it identifies a Medicaid, CHIP, D-SNP, LTSS, or Marketplace coverage relationship with an AmeriHealth Caritas plan.",
"type": "object",
"required": ["resourceType", "status", "beneficiary", "payor"],
"properties": {
"resourceType": { "type": "string", "const": "Coverage" },
"id": { "type": "string" },
"meta": { "type": "object" },
"identifier": { "type": "array", "items": { "type": "object" } },
"status": { "type": "string", "enum": ["active", "cancelled", "draft", "entered-in-error"] },
"type": { "type": "object" },
"policyHolder": { "type": "object" },
"subscriber": { "type": "object" },
"subscriberId": { "type": "string" },
"beneficiary": { "type": "object", "description": "Reference(Patient)" },
"dependent": { "type": "string" },
"relationship": { "type": "object" },
"period": {
"type": "object",
"properties": {
"start": { "type": "string", "format": "date-time" },
"end": { "type": "string", "format": "date-time" }
}
},
"payor": {
"type": "array",
"items": { "type": "object", "description": "Reference(Organization|Patient|RelatedPerson)" }
},
"class": {
"type": "array",
"items": {
"type": "object",
"properties": {
"type": { "type": "object" },
"value": { "type": "string" },
"name": { "type": "string" }
}
}
},
"order": { "type": "integer" },
"network": { "type": "string" },
"costToBeneficiary": { "type": "array", "items": { "type": "object" } },
"subrogation": { "type": "boolean" },
"contract": { "type": "array", "items": { "type": "object" } }
}
}
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