CMS — Centers for Medicare & Medicaid Services · Schema

Coverage

HL7 FHIR R4 Coverage resource as exposed by CMS Blue Button 2.0, BCDA, AB2D, DPC, and BFD. Represents Medicare Part A, B, C, or D enrollment.

HealthcareMedicareMedicaidFHIRBulk DataOpen DataGovernmentFederalClaimsInsuranceACAMarketplaceQuality

Properties

Name	Type	Description
resourceType	string
id	string
status	string
type	object	Coverage type: PART_A, PART_B, PART_C, PART_D
subscriberId	string
beneficiary	object
relationship	object
period	object
payor	array
class	array
extension	array

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/cms-gov/main/json-schema/cms-gov-coverage-schema.json",
  "title": "Coverage",
  "description": "HL7 FHIR R4 Coverage resource as exposed by CMS Blue Button 2.0, BCDA, AB2D, DPC, and BFD. Represents Medicare Part A, B, C, or D enrollment.",
  "type": "object",
  "required": ["resourceType", "id", "status", "beneficiary"],
  "properties": {
    "resourceType": { "type": "string", "const": "Coverage" },
    "id": { "type": "string" },
    "status": { "type": "string", "enum": ["active", "cancelled", "draft", "entered-in-error"] },
    "type": {
      "type": "object",
      "description": "Coverage type: PART_A, PART_B, PART_C, PART_D",
      "properties": {
        "coding": {
          "type": "array",
          "items": {
            "type": "object",
            "properties": {
              "system": { "type": "string", "format": "uri" },
              "code": { "type": "string", "enum": ["PART_A", "PART_B", "PART_C", "PART_D"] },
              "display": { "type": "string" }
            }
          }
        }
      }
    },
    "subscriberId": { "type": "string" },
    "beneficiary": {
      "type": "object",
      "properties": { "reference": { "type": "string" } }
    },
    "relationship": { "type": "object" },
    "period": {
      "type": "object",
      "properties": {
        "start": { "type": "string", "format": "date" },
        "end": { "type": "string", "format": "date" }
      }
    },
    "payor": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": { "reference": { "type": "string" } }
      }
    },
    "class": { "type": "array", "items": { "type": "object" } },
    "extension": { "type": "array", "items": { "type": "object" } }
  }
}