API end point: https://patient360mo.anthem.com/P360Member/api/fhir-r4.

Resource Coverage (R4)

Maps the CareEvolution Insurance concept

• Supported interactions
• Search parameters
• Sorts
• Includes
• Operations
• To FHIR mappings
• From FHIR mappings

Supported interactions

• read
• search
• create
• update
• delete

Search parameters

Name	Type	Modifiers , prefixes	Multiple values	Can be chained	Description
_id	Token		Yes		Resource id
_lastUpdated	Date	eq ne lt le gt ge sa eb ap			When the resource last changed
_source	Uri	:missing	Yes		Where the resource comes from
beneficiary	Reference (Patient)	:missing	Yes	Yes	The patient the Coverage is about. Functionally identical to the "patient" search parameter.
dependent	String	:contains :exact	Yes		Dependent number
group	String	:contains :exact :missing	Yes		Group identifier (as in DSTU2/STU3 Coverage)
identifier	Token	:missing	Yes		The primary identifier of the insured and the coverage
patient	Reference (Patient)	:missing	Yes	Yes	The patient the Coverage is about
plan	String	:contains :exact :missing	Yes		A plan or policy identifier (as in DSTU2/STU3 Coverage)
provenance-agent	Reference (Organization)	:missing	Yes	Yes	Search by provenance, specified by its author (aka originator) Organization
sequence	String	:contains :exact	Yes		Sequence number (as in DSTU2/STU3 Coverage)
subplan	String	:contains :exact :missing	Yes		Sub-plan identifier (as in DSTU2/STU3 Coverage)
type	Token	:not :in :not-in :missing	Yes		The kind of coverage (health plan, auto, Workers Compensation)

Sorts

• _id
• plan
• type

Supports multiple sorts

Includes

• beneficiary
• patient
• provenance-agent
• ExplanationOfBenefit:coverage
• Provenance:target

Operations

• validate - Validate a resource

To FHIR mappings

FHIR	CareEvolution
beneficiary	PatientID
class	PlanName	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|plan
	GroupEmpId	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|subplan
	GroupNumber	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|group
	GroupName	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|subgroup
	Class Domain: InsuranceClass	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|class
	Product Domain: InsuranceProduct	Maps the class with type=http://careevolution.com/fhir/CoverageClass|product
	ProductGroup Domain: InsuranceProductGroup	Maps the class with type=http://careevolution.com/fhir/CoverageClass|productgroup
dependent	Property('Dependent')
extension('http://careevolution.com/fhirextensions#coverage-authorizationDate')	AuthorizationDate
extension('http://careevolution.com/fhirextensions#coverage-authorizationNumber')	AuthorizationNumber
extension('http://careevolution.com/fhirextensions#coverage-authorizationSource')	AuthorizationSource
extension('http://careevolution.com/fhirextensions#coverage-details')	Details
extension('http://careevolution.com/fhirextensions#coverage-encounterID')	EncounterID
extension('http://careevolution.com/fhirextensions#coverage-groupEmpName')	GroupEmpName
extension('http://careevolution.com/fhirextensions#coverage-groupName')	GroupName
extension('http://careevolution.com/fhirextensions#coverage-insuranceCompanyIdentifier')	InsuranceCompanyIdentifier
extension('http://careevolution.com/fhirextensions#coverage-insuranceCompanyIdentifierType')	InsuranceCompanyIdentifierType Domain: IdentifierType
extension('http://careevolution.com/fhirextensions#coverage-insuredAddress')	InsuredAddress
	InsuredState
	InsuredCity
	InsuredPostalCode
extension('http://careevolution.com/fhirextensions#coverage-insuredAltPhone')	InsuredAltPhone
extension('http://careevolution.com/fhirextensions#coverage-insuredDob')	InsuredDob
extension('http://careevolution.com/fhirextensions#coverage-insuredGender')	InsuredGender
extension('http://careevolution.com/fhirextensions#coverage-insuredName')	InsuredName
extension('http://careevolution.com/fhirextensions#coverage-insuredPhone')	InsuredPhone
extension('http://careevolution.com/fhirextensions#coverage-insuredSsn')	InsuredSsn
extension('http://careevolution.com/fhirextensions#coverage-medicaidCaseName')	MedicaidCaseName
extension('http://careevolution.com/fhirextensions#coverage-medicaidCaseNumber')	MedicaidCaseNumber
extension('http://careevolution.com/fhirextensions#coverage-medicareCardNumber')	MedicareCardNumber
extension('http://careevolution.com/fhirextensions#coverage-pharmacyCoverage')	PharmacyCoverage
extension('http://careevolution.com/fhirextensions#coverage-policyNumber')	PolicyNumber
extension('http://careevolution.com/fhirextensions#coverage-primaryCaregiver')	PrimaryCaregiver
extension('http://careevolution.com/fhirextensions#coverage-rateCode')	RateCode Domain: InsuranceRateCode
extension('http://careevolution.com/fhirextensions#coverage-segment')	Segment Domain: InsuranceSegment
extension('http://careevolution.com/fhirextensions#coverage-sequence')	Property('Sequence')
extension('http://careevolution.com/fhirextensions#coverage-site')	Site
extension('http://careevolution.com/fhirextensions#coverage-sponsor')	Sponsor
extension('http://careevolution.com/fhirextensions#coverage-type')	Type Domain: InsuranceType
extension('http://careevolution.com/fhirextensions#dataSource')	DataSource
extension('http://careevolution.com/fhirextensions#properties')	Properties
identifier	PlanIdentifier
network	Network Domain: InsuranceNetwork
order	Priority
payor	InsuranceCompanyName
	InsuranceCompanyAddress
	InsuranceCompanyCity
	InsuranceCompanyState
	InsuranceCompanyPostalCode
	InsuranceCompanyPhone
period	StartDate
	EndDate
relationship Bindings:  valueset-subscriber-relationship	InsuredRelationship Domain: FamilyRelationship
status Bindings:  valueset-fm-status	Status Domain: InsuranceStatus
subscriber	InsuredName
	InsuredAddress
	InsuredCity
	InsuredState
	InsuredPostalCode
	InsuredPhone
	InsuredAltPhone
	InsuredDob
	InsuredSsn
	InsuredGender
subscriberId	Property('SusbcriberIdentifier')
text	Comment
type	PlanType Domain: InsurancePlanType

From FHIR mappings

FHIR	CareEvolution
beneficiary	PatientID
class	PlanName	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|plan
	GroupEmpId	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|subplan
	GroupNumber	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|group
	GroupName	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|subgroup
	Class Domain: InsuranceClass	Maps the class with type=http://terminology.hl7.org/CodeSystem/coverage-class|class
	Product Domain: InsuranceProduct	Maps the class with type=http://careevolution.com/fhir/CoverageClass|product
	ProductGroup Domain: InsuranceProductGroup	Maps the class with type=http://careevolution.com/fhir/CoverageClass|productgroup
dependent	Property('Dependent')
extension('http://careevolution.com/fhirextensions#coverage-authorizationDate')	AuthorizationDate
extension('http://careevolution.com/fhirextensions#coverage-authorizationNumber')	AuthorizationNumber
extension('http://careevolution.com/fhirextensions#coverage-authorizationSource')	AuthorizationSource
extension('http://careevolution.com/fhirextensions#coverage-encounterID')	EncounterID
extension('http://careevolution.com/fhirextensions#coverage-groupEmpName')	GroupEmpName
extension('http://careevolution.com/fhirextensions#coverage-groupName')	GroupName
extension('http://careevolution.com/fhirextensions#coverage-insuranceCompanyIdentifier')	InsuranceCompanyIdentifier
extension('http://careevolution.com/fhirextensions#coverage-insuranceCompanyIdentifierType')	InsuranceCompanyIdentifierType Domain: IdentifierType
extension('http://careevolution.com/fhirextensions#coverage-medicaidCaseName')	MedicaidCaseName
extension('http://careevolution.com/fhirextensions#coverage-medicaidCaseNumber')	MedicaidCaseNumber
extension('http://careevolution.com/fhirextensions#coverage-medicareCardNumber')	MedicareCardNumber
extension('http://careevolution.com/fhirextensions#coverage-pharmacyCoverage')	PharmacyCoverage
extension('http://careevolution.com/fhirextensions#coverage-policyNumber')	PolicyNumber
extension('http://careevolution.com/fhirextensions#coverage-primaryCaregiver')	PrimaryCaregiver
extension('http://careevolution.com/fhirextensions#coverage-rateCode')	RateCode Domain: InsuranceRateCode
extension('http://careevolution.com/fhirextensions#coverage-segment')	Segment Domain: InsuranceSegment
extension('http://careevolution.com/fhirextensions#coverage-sequence')	Property('Sequence')
extension('http://careevolution.com/fhirextensions#coverage-site')	Site
extension('http://careevolution.com/fhirextensions#coverage-sponsor')	Sponsor
extension('http://careevolution.com/fhirextensions#coverage-type')	Type Domain: InsuranceType
extension('http://careevolution.com/fhirextensions#dataSource')	DataSource
extension('http://careevolution.com/fhirextensions#properties')	Properties
id	PlanIdentifier
identifier	PlanIdentifier
network	Network Domain: InsuranceNetwork
order	Priority
payor	InsuranceCompanyName
	InsuranceCompanyAddress
	InsuranceCompanyCity
	InsuranceCompanyState
	InsuranceCompanyPostalCode
	InsuranceCompanyPhone
period	StartDate
	EndDate
relationship Bindings:  valueset-subscriber-relationship	InsuredRelationship Domain: FamilyRelationship
status Bindings:  valueset-fm-status	Status Domain: InsuranceStatus
subscriber	InsuredName
	InsuredAddress
	InsuredCity
	InsuredState
	InsuredPostalCode
	InsuredPhone
	InsuredAltPhone
	InsuredDob
	InsuredSsn
	InsuredGender
subscriberId	Property('SusbcriberIdentifier')
text	Comment
type	PlanType Domain: InsurancePlanType

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