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.

HealthcareHealth InsuranceManaged CareMedicaidMedicareDual EligibleCHIPLTSSBehavioral HealthPharmacy BenefitsInteroperabilityFHIRCMSSMART on FHIRPatient AccessProvider Directory

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
View JSON Schema on GitHub

JSON Schema

amerihealth-caritas-coverage-schema.json Raw ↑
{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$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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