Coverage

{
  "$schema": "http://json-schema.org/draft-07/schema#",
  "$id": "https://api-evangelist.github.io/drchrono/json-schema/coverage.json",
  "title": "Coverage",
  "required": [],
  "type": "object",
  "properties": {
    "coverage_subscriber": {
      "readOnly": true,
      "type": "string",
      "description": "A variable size object containing subscriber information, if returned by the clearinghouse that ran the eligibility check",
      "title": "Coverage subscriber"
    },
    "appointment": {
      "readOnly": true,
      "type": "string",
      "description": "",
      "title": "Appointment"
    },
    "eligibility": {
      "type": "string",
      "description": "\nValue | Description\n--- | ----\n`'1'` | Active Coverage\n`'2'` | Active - Full Risk Capitation\n`'3'` | Active - Services Capitated\n`'4'` | Active - Services Capitated to Primary Care Physician\n`'5'` | Active - Pending Investigation\n`'6'` | Inactive\n`'7'` | Inactive - Pending Eligibility Update\n`'8'` | Inactive - Pending Investigation\n`'A'` | Co-Insurance\n`'B'` | Co-Payment\n`'C'` | Deductible\n`'CB'` | Coverage Basis\n`'D'` | Benefit Description\n`'E'` | Exclusions\n`'F'` | Limitations\n`'G'` | Out of Pocket (Stop Loss)\n`'H'` | Unlimited\n`'I'` | Non-Covered\n`'J'` | Cost Containment\n`'K'` | Reserve\n`'L'` | Primary Care Provider\n`'M'` | Pre-existing Condition\n`'MC'` | Managed Care Coordinator\n`'N'` | Services Restricted to Following Provider\n`'O'` | Not Deemed a Medical Necessity\n`'P'` | Benefit Disclaimer\n`'Q'` | Second Surgical Opinion Required\n`'R'` | Other or Additional Payor\n`'S'` | Prior Year(s) History\n`'T'` | Card(s) Reported Lost/Stolen\n`'U'` | Contact Following Entity for Eligibility or Benefit Information\n`'V'` | Cannot Process\n`'W'` | Other Source of Data\n`'X'` | Health Care Facility\n`'Y'` | Spend Down\n",
      "title": "Eligibility"
    },
    "payer_name": {
      "type": "string",
      "description": "The name of the payer as returned by the clearinghouse that ran the eligibility check",
      "title": "Payer name"
    },
    "coverage_details": {
      "readOnly": true,
      "type": "string",
      "description": "A variable size object containing the details of the eligibility check, if returned by the clearinghouse that ran the eligibility check",
      "title": "Coverage details"
    },
    "updated_at": {
      "readOnly": true,
      "type": "string",
      "description": "Timestamp of most recent record update",
      "title": "Updated at"
    },
    "query_date": {
      "readOnly": true,
      "type": "string",
      "description": "The time at which the request was made",
      "title": "Query date"
    },
    "service_type_description": {
      "readOnly": true,
      "type": "string",
      "description": "",
      "title": "Service type description"
    },
    "patient": {
      "readOnly": true,
      "type": "string",
      "description": "",
      "title": "Patient"
    },
    "request_service_type": {
      "enum": [
        "1",
        "2",
        "3",
        "4",
        "5",
        "6",
        "7",
        "8",
        "9",
        "10",
        "11",
        "12",
        "13",
        "14",
        "15",
        "16",
        "17",
        "18",
        "19",
        "20",
        "21",
        "22",
        "23",
        "24",
        "25",
        "26",
        "27",
        "28",
        "30",
        "32",
        "33",
        "34",
        "35",
        "36",
        "37",
        "38",
        "39",
        "40",
        "41",
        "42",
        "43",
        "44",
        "45",
        "46",
        "47",
        "48",
        "49",
        "50",
        "51",
        "52",
        "53",
        "54",
        "55",
        "56",
        "57",
        "58",
        "59",
        "60",
        "61",
        "62",
        "63",
        "64",
        "65",
        "66",
        "67",
        "68",
        "69",
        "70",
        "71",
        "72",
        "73",
        "74",
        "75",
        "76",
        "77",
        "78",
        "79",
        "80",
        "81",
        "82",
        "83",
        "84",
        "85",
        "86",
        "87",
        "88",
        "89",
        "90",
        "91",
        "92",
        "93",
        "94",
        "95",
        "96",
        "97",
        "98",
        "99",
        "A0",
        "A1",
        "A2",
        "A3",
        "A4",
        "A5",
        "A6",
        "A7",
        "A8",
        "A9",
        "AA",
        "AB",
        "AC",
        "AD",
        "AE",
        "AF",
        "AG",
        "AH",
        "AI",
        "AJ",
        "AK",
        "AL",
        "AM",
        "AN",
        "AO",
        "AQ",
        "AR",
        "B1",
        "B2",
        "B3",
        "BA",
        "BB",
        "BC",
        "BD",
        "BE",
        "BF",
        "BG",
        "BH",
        "BI",
        "BJ",
        "BK",
        "BL",
        "BM",
        "BN",
        "BP",
        "BQ",
        "BR",
        "BS",
        "BT",
        "BU",
        "BV",
        "BW",
        "BX",
        "BY",
        "BZ",
        "C1",
        "CA",
        "CB",
        "CC",
        "CD",
        "CE",
        "CF",
        "CG",
        "CH",
        "CI",
        "CJ",
        "CK",
        "CL",
        "CM",
        "CN",
        "CO",
        "CP",
        "CQ",
        "DG",
        "DM",
        "DS",
        "GF",
        "GN",
        "GY",
        "IC",
        "MH",
        "NI",
        "ON",
        "PT",
        "PU",
        "RN",
        "RT",
        "TC",
        "TN",
        "UC"
      ],
      "type": "string",
      "description": "\nValue | Description\n--- | ----\n`'1'` | Medical Care\n`'2'` | Surgical\n`'3'` | Consultation\n`'4'` | Diagnostic X-Ray\n`'5'` | Diagnostic Lab\n`'6'` | Radiation Therapy\n`'7'` | Anesthesia\n`'8'` | Surgical Assistance\n`'9'` | Other Medical\n`'10'` | Blood Charges\n`'11'` | Used Durable Medical Equipment\n`'12'` | Durable Medical Equipment Purchase\n`'13'` | Ambulatory Service Center Facility\n`'14'` | Renal Supplies in the Home\n`'15'` | Alternate Method Dialysis\n`'16'` | Chronic Renal Disease (CRD) Equipment\n`'17'` | Pre-Admission Testing\n`'18'` | Durable Medical Equipment Rental\n`'19'` | Pneumonia Vaccine\n`'20'` | Second Surgical Opinion\n`'21'` | Third Surgical Opinion\n`'22'` | Social Work\n`'23'` | Diagnostic Dental\n`'24'` | Periodontics\n`'25'` | Restorative\n`'26'` | Endodontics\n`'27'` | Maxillofacial Prosthetics\n`'28'` | Adjunctive Dental Services\n`'30'` | Health Benefit Plan Coverage\n`'32'` | Plan Waiting Period\n`'33'` | Chiropractic\n`'34'` | Chiropractic Office Visits\n`'35'` | Dental Care\n`'36'` | Dental Crowns\n`'37'` | Dental Accident\n`'38'` | Orthodontics\n`'39'` | Prosthodontics\n`'40'` | Oral Surgery\n`'41'` | Routine (Preventive) Dental\n`'42'` | Home Health Care\n`'43'` | Home Health Prescriptions\n`'44'` | Home Health Visits\n`'45'` | Hospice\n`'46'` | Respite Care\n`'47'` | Hospital\n`'48'` | Hospital - Inpatient\n`'49'` | Hospital - Room and Board\n`'50'` | Hospital - Outpatient\n`'51'` | Hospital - Emergency Accident\n`'52'` | Hospital - Emergency Medical\n`'53'` | Hospital - Ambulatory Surgical\n`'54'` | Long Term Care\n`'55'` | Major Medical\n`'56'` | Medically Related Transportation\n`'57'` | Air Transportation\n`'58'` | Cabulance\n`'59'` | Licensed Ambulance\n`'60'` | General Benefits\n`'61'` | In-vitro Fertilization\n`'62'` | MRI/CAT Scan\n`'63'` | Donor Procedures\n`'64'` | Acupuncture\n`'65'` | Newborn Care\n`'66'` | Pathology\n`'67'` | Smoking Cessation\n`'68'` | Well Baby Care\n`'69'` | Maternity\n`'70'` | Transplants\n`'71'` | Audiology Exam\n`'72'` | Inhalation Therapy\n`'73'` | Diagnostic Medical\n`'74'` | Private Duty Nursing\n`'75'` | Prosthetic Device\n`'76'` | Dialysis\n`'77'` | Otological Exam\n`'78'` | Chemotherapy\n`'79'` | Allergy Testing\n`'80'` | Immunizations\n`'81'` | Routine Physical\n`'82'` | Family Planning\n`'83'` | Infertility\n`'84'` | Abortion\n`'85'` | AIDS\n`'86'` | Emergency Services\n`'87'` | Cancer\n`'88'` | Pharmacy\n`'89'` | Free Standing Prescription Drug\n`'90'` | Mail Order Prescription Drug\n`'91'` | Brand Name Prescription Drug\n`'92'` | Generic Prescription Drug\n`'93'` | Podiatry\n`'94'` | Podiatry - Office Visits\n`'95'` | Podiatry - Nursing Home Visits\n`'96'` | Professional (Physician)\n`'97'` | Anesthesiologist\n`'98'` | Professional (Physician) Visit - Office\n`'99'` | Professional (Physician) Visit - Inpatient\n`'A0'` | Professional (Physician) Visit - Outpatient\n`'A1'` | Professional (Physician) Visit - Nursing Home\n`'A2'` | Professional (Physician) Visit - Skilled Nursing Facility\n`'A3'` | Professional (Physician) Visit - Home\n`'A4'` | Psychiatric\n`'A5'` | Psychiatric - Room and Board\n`'A6'` | Psychotherapy\n`'A7'` | Psychiatric - Inpatient\n`'A8'` | Psychiatric - Outpatient\n`'A9'` | Rehabilitation\n`'AA'` | Rehabilitation - Room and Board\n`'AB'` | Rehabilitation - Inpatient\n`'AC'` | Rehabilitation - Outpatient\n`'AD'` | Occupational Therapy\n`'AE'` | Physical Medicine\n`'AF'` | Speech Therapy\n`'AG'` | Skilled Nursing Care\n`'AH'` | Skilled Nursing Care - Room and Board\n`'AI'` | Substance Abuse\n`'AJ'` | Alcoholism\n`'AK'` | Drug Addiction\n`'AL'` | Vision (Optometry)\n`'AM'` | Frames\n`'AN'` | Routine Exam\n`'AO'` | Lenses\n`'AQ'` | Nonmedically Necessary Physical\n`'AR'` | Experimental Drug Therapy\n`'B1'` | Burn Care\n`'B2'` | Brand Name Prescription Drug - Formulary\n`'B3'` | Brand Name Prescription Drug - Non-Formulary\n`'BA'` | Independent Medical Evaluation\n`'BB'` | Partial Hospitalization (Psychiatric)\n`'BC'` | Day Care (Psychiatric)\n`'BD'` | Cognitive Therapy\n`'BE'` | Massage Therapy\n`'BF'` | Pulmonary Rehabilitation\n`'BG'` | Cardiac Rehabilitation\n`'BH'` | Pediatric\n`'BI'` | Nursery\n`'BJ'` | Skin\n`'BK'` | Orthopedic\n`'BL'` | Cardiac\n`'BM'` | Lymphatic\n`'BN'` | Gastrointestinal\n`'BP'` | Endocrine\n`'BQ'` | Neurology\n`'BR'` | Eye\n`'BS'` | Invasive Procedures\n`'BT'` | Gynecological\n`'BU'` | Obstetrical\n`'BV'` | Obstetrical/Gynecological\n`'BW'` | Mail Order Prescription Drug: Brand Name\n`'BX'` | Mail Order Prescription Drug: Generic\n`'BY'` | Physician Visit - Office: Sick\n`'BZ'` | Physician Visit - Office: Well\n`'C1'` | Coronary Care\n`'CA'` | Private Duty Nursing - Inpatient\n`'CB'` | Private Duty Nursing - Home\n`'CC'` | Surgical Benefits - Professional (Physician)\n`'CD'` | Surgical Benefits - Facility\n`'CE'` | Mental Health Provider - Inpatient\n`'CF'` | Mental Health Provider - Outpatient\n`'CG'` | Mental Health Facility - Inpatient\n`'CH'` | Mental Health Facility - Outpatient\n`'CI'` | Substance Abuse Facility - Inpatient\n`'CJ'` | Substance Abuse Facility - Outpatient\n`'CK'` | Screening X-ray\n`'CL'` | Screening laboratory\n`'CM'` | Mammogram, High Risk Patient\n`'CN'` | Mammogram, Low Risk Patient\n`'CO'` | Flu Vaccination\n`'CP'` | Eyewear and Eyewear Accessories\n`'CQ'` | Case Management\n`'DG'` | Dermatology\n`'DM'` | Durable Medical Equipment\n`'DS'` | Diabetic Supplies\n`'GF'` | Generic Prescription Drug - Formulary\n`'GN'` | Generic Prescription Drug - Non-Formulary\n`'GY'` | Allergy\n`'IC'` | Intensive Care\n`'MH'` | Mental Health\n`'NI'` | Neonatal Intensive Care\n`'ON'` | Oncology\n`'PT'` | Physical Therapy\n`'PU'` | Pulmonary\n`'RN'` | Renal\n`'RT'` | Residential Psychiatric Treatment\n`'TC'` | Transitional Care\n`'TN'` | Transitional Nursery Care\n`'UC'` | Urgent Care\n",
      "title": "Request service type"
    },
    "id": {
      "readOnly": true,
      "type": "integer",
      "description": "System identifier",
      "title": "ID"
    },
    "cob_level": {
      "readOnly": true,
      "type": "string",
      "description": "The level of insurance the eligibility check was run on. Can be one of the following: `Primary Insurance` or `Secondary Insurance`",
      "title": "Cob level"
    }
  },
  "x-verbose-required": []
}