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POST
Create a coverage

Authorizations

​
Authorization
string
header
required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Headers

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Idempotency-Key
string
required

A unique value you choose for this request, such as a UUID. Sending the same key again returns the first answer instead of doing the work twice, so a timed-out request is safe to retry. Reusing a key for a different request is refused with 409 idempotency_key_conflict, and retrying while the first request is still running with 409 idempotency_key_reused. See Retries and idempotency.

Minimum string length: 1

Path Parameters

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clinic_id
string<uuid>
required

Body

application/json

A coverage to record for a patient. It is saved straight away, but as unconfirmed with coverage_active: false; clinic staff confirm the payer match before it counts. payer_id must be a payer the clinic has enabled in Settings → Insurance (see GET …/payers), otherwise payer_not_enabled; a patient can hold one coverage per payer (coverage_exists). coverage_active: true is refused with activation_requires_staff. The clinic's notes, the deductible and out-of-pocket amounts met and every eligibility field cannot be sent. The Idempotency-Key header is REQUIRED. Send JSON; a FHIR Coverage body is not accepted.

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patient_id
string<uuid>
required
​
payer_id
string<uuid>
required
​
member_id
string
Maximum string length: 200
​
group_number
string
Maximum string length: 200
​
group_name
string
Maximum string length: 200
​
plan_name
string
Maximum string length: 200
​
coverage_type
enum<string>
Available options:
medical,
dental,
vision,
behavioral_health,
other
​
payment_responsibility
enum<string>
Available options:
P,
S,
T
​
relationship_to_subscriber
enum<string>
Available options:
self,
spouse,
child,
other,
employee,
organ_donor,
cadaver_donor,
life_partner
​
subscriber_first_name
string
Maximum string length: 200
​
subscriber_last_name
string
Maximum string length: 200
​
subscriber_date_of_birth
string<date>
​
subscriber_gender
enum<string>
Available options:
M,
F,
U
​
subscriber_member_id
string
Maximum string length: 200
​
subscriber_address_line1
string
Maximum string length: 200
​
subscriber_address_city
string
Maximum string length: 200
​
subscriber_address_state
string
Maximum string length: 200
​
subscriber_address_zip
string
Maximum string length: 200
​
coverage_active
boolean

Send false or omit it. true is refused: only clinic staff activate a coverage.

​
effective_date
string<date>
​
termination_date
string<date>
​
copay_amount
number
Required range: x >= 0
​
coinsurance_percent
number
Required range: 0 <= x <= 100
​
deductible_amount
number
Required range: x >= 0
​
out_of_pocket_max
number
Required range: x >= 0
​
pre_authorization_required
boolean
​
network_status
enum<string>
Available options:
in_network,
out_of_network,
unknown
​
is_primary
boolean
​
origin_assistant_name
string
Maximum string length: 200

Response

Created — saved, unconfirmed and inactive until staff confirm it.

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data
object
required

A patient's insurance coverage — the exposed-field allow-list, field by field. A coverage that came in through the API is saved straight away and visible here, but it is unconfirmed and coverage_active is false until clinic staff confirm the payer match; the clinic's own coverages are confirmed. Eligibility figures, the clinic's notes and the policy holder's address are never exposed.

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idempotent_replay
boolean

Present and true when this Idempotency-Key was already used and the original coverage is returned.