AmeriHealth Caritas · Schema

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

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$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" } }
  }
}