The FHIR R4 Coverage resource is used to capture insurance and financial support details for a patient, including information about payers, policyholders, and coverage periods. It helps ensure healthcare services are billed appropriately and supports the management of healthcare costs.
Use Cases
- Retrieve insurance details before procedures
- Validate coverage for patient eligibility
- Update coverage information during intake
- Monitor changes in coverage periods
- Submit claims based on coverage status
Base URLs
- Production: https://api.healthgorilla.com/fhir/R4/Coverage
- Sandbox: https://sandbox.healthgorilla.com/fhir/R4/Coverage
Authentication
All requests require OAuth 2.0 authentication using a Bearer Token. Unauthorized requests return 401 Unauthorized responses.
Required scopes:
coverage.readfor GETcoverage.writefor POST, PUT, DELETE
For more information, go to: OAuth 2.0 Authentication.
Supported Methods
| Method | Operation | Description |
|---|---|---|
GET | Read Coverage | Retrieves a Coverage resource by its unique ID. |
GET | Search Coverage | Searches for Coverage resources based on specified criteria, such as beneficiary. |
POST | Create Coverage | Adds a new Coverage resource to a patient's record. |
DELETE | Delete Coverage | Removes a Coverage resource from a patient's record. |
Frequently Used Search Parameters
| Parameter | Description | FHIR Value Set / Example Values | FHIR Data Type | Required |
|---|---|---|---|---|
patient | Filters by patient ID | Patient/{id} | Reference | Yes |
status | Filters by coverage status | CoverageStatus (active) | token | No |
type | Filters by coverage type | CoverageType (private) | token | No |
period | Filters by coverage effective period | ge2022-01-01, le2023-12-31 | date | No |
Commonly Returned Resource Attributes
| Attribute | Description | Example Values | FHIR Data Type | Required |
|---|---|---|---|---|
patient | Reference to the patient with the coverage | Patient/{id} | Reference(Patient) | Yes |
type | Type of insurance coverage | CoverageType (private) | CodeableConcept | Yes |
status | Current status of the coverage | CoverageStatus (active) | CodeableConcept | Yes |
period | Coverage effective period | 2024-01-01 to 2024-12-31 | Period | No |
payor | The organization or individual that is providing the coverage | Organization/{id}, RelatedPerson/{id} | Reference | No |
policyHolder | Person who holds the coverage policy | Patient/{id}, RelatedPerson/{id} | Reference | No |
subscriberId | Unique identifier for the subscriber of the coverage | S123456789 | string | No |
beneficiary | The individual who is receiving the benefits from the coverage | Patient/{id} | Reference | No |
Webhooks
Clients can subscribe to receive notifications when new coverage records are added, or when existing coverage details are updated. For more information, go to: Webhooks & Polling.
Error Handling
All Coverage operations follow standard Health Gorilla error handling, including use of FHIR OperationOutcome for structured responses. For more information, go to: Error Handling.