Create

Beta

POST

/coverages/v1/

POST

/coverages/v1/

1 from candid import CandidApiClient
2 from candid.resources.pre_encounter.resources.common import (
3     HumanName,
4     NameUse,
5     Relationship,
6     Sex,
7 )
8 from candid.resources.pre_encounter.resources.coverages.resources.v_1 import (
9     CoverageStatus,
10     InsurancePlan,
11     MutableCoverage,
12     Subscriber,
13 )
14 
15 client = CandidApiClient(
16     client_id="YOUR_CLIENT_ID",
17     client_secret="YOUR_CLIENT_SECRET",
18 )
19 client.pre_encounter.coverages.v_1.create(
20     request=MutableCoverage(
21         status=CoverageStatus.ACTIVE,
22         subscriber=Subscriber(
23             name=HumanName(
24                 family="family",
25                 given=["given", "given"],
26                 use=NameUse.USUAL,
27             ),
28             biological_sex=Sex.FEMALE,
29         ),
30         relationship=Relationship.SELF,
31         patient="patient",
32         insurance_plan=InsurancePlan(
33             member_id="member_id",
34             payer_id="payer_id",
35             payer_name="payer_name",
36         ),
37         verified=True,
38     ),
39 )

Try it

200Successful

1 {
2   "deactivated": true,
3   "id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
4   "insurance_plan": {
5     "member_id": "member_id",
6     "payer_id": "payer_id",
7     "payer_name": "payer_name",
8     "additional_payer_information": {
9       "availity_eligibility_id": "availity_eligibility_id",
10       "availity_payer_id": "availity_payer_id",
11       "availity_payer_name": "availity_payer_name",
12       "availity_remittance_payer_id": "availity_remittance_payer_id"
13     },
14     "group_number": "group_number",
15     "name": "name",
16     "plan_type": "09",
17     "type": "01",
18     "period": {
19       "start": "2023-01-15",
20       "end": "2023-01-15"
21     },
22     "insurance_card_image_locator": "insurance_card_image_locator",
23     "payer_plan_group_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
24   },
25   "organization_id": "organization_id",
26   "patient": "patient",
27   "relationship": "SELF",
28   "status": "ACTIVE",
29   "subscriber": {
30     "name": {
31       "family": "family",
32       "given": [
33         "given",
34         "given"
35       ],
36       "use": "USUAL",
37       "period": {
38         "start": "2023-01-15",
39         "end": "2023-01-15"
40       },
41       "suffix": "suffix"
42     },
43     "biological_sex": "FEMALE",
44     "date_of_birth": "2023-01-15",
45     "address": {
46       "use": "HOME",
47       "line": [
48         "line",
49         "line"
50       ],
51       "city": "city",
52       "state": "state",
53       "postal_code": "postal_code",
54       "country": "country",
55       "period": {
56         "start": "2023-01-15",
57         "end": "2023-01-15"
58       }
59     }
60   },
61   "updated_at": "2024-01-15T09:30:00Z",
62   "updating_user_id": "updating_user_id",
63   "verified": true,
64   "version": 1,
65   "benefits": {
66     "plan_coverage": {
67       "in_network": {
68         "deductible": {},
69         "deductible_contract": {},
70         "deductible_remaining": {},
71         "deductible_year_to_date": {},
72         "oop_max": {},
73         "oop_max_contract": {},
74         "oop_max_remaining": {},
75         "oop_max_year_to_date": {},
76         "additional_notes": "additional_notes"
77       },
78       "in_network_flat": [
79         {
80           "type": "DEDUCTIBLE",
81           "coverageLevel": "EMPLOYEE_AND_CHILDREN",
82           "unit": "PERCENT",
83           "value": 1.1,
84           "additional_notes": "additional_notes"
85         },
86         {
87           "type": "DEDUCTIBLE",
88           "coverageLevel": "EMPLOYEE_AND_CHILDREN",
89           "unit": "PERCENT",
90           "value": 1.1,
91           "additional_notes": "additional_notes"
92         }
93       ],
94       "out_of_network": {
95         "deductible": {},
96         "deductible_contract": {},
97         "deductible_remaining": {},
98         "deductible_year_to_date": {},
99         "oop_max": {},
100         "oop_max_contract": {},
101         "oop_max_remaining": {},
102         "oop_max_year_to_date": {},
103         "additional_notes": "additional_notes"
104       },
105       "out_of_network_flat": [
106         {
107           "type": "DEDUCTIBLE",
108           "coverageLevel": "EMPLOYEE_AND_CHILDREN",
109           "unit": "PERCENT",
110           "value": 1.1,
111           "additional_notes": "additional_notes"
112         },
113         {
114           "type": "DEDUCTIBLE",
115           "coverageLevel": "EMPLOYEE_AND_CHILDREN",
116           "unit": "PERCENT",
117           "value": 1.1,
118           "additional_notes": "additional_notes"
119         }
120       ]
121     },
122     "service_specific_coverage": [
123       {
124         "service_code": "1",
125         "in_network": {
126           "copay": {},
127           "coinsurance": {},
128           "visits": {},
129           "visits_remaining": {},
130           "additional_notes": "additional_notes"
131         },
132         "in_network_flat": [
133           {
134             "type": "DEDUCTIBLE",
135             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
136             "unit": "PERCENT",
137             "value": 1.1
138           },
139           {
140             "type": "DEDUCTIBLE",
141             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
142             "unit": "PERCENT",
143             "value": 1.1
144           }
145         ],
146         "out_of_network": {
147           "copay": {},
148           "coinsurance": {},
149           "visits": {},
150           "visits_remaining": {},
151           "additional_notes": "additional_notes"
152         },
153         "out_of_network_flat": [
154           {
155             "type": "DEDUCTIBLE",
156             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
157             "unit": "PERCENT",
158             "value": 1.1
159           },
160           {
161             "type": "DEDUCTIBLE",
162             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
163             "unit": "PERCENT",
164             "value": 1.1
165           }
166         ]
167       },
168       {
169         "service_code": "1",
170         "in_network": {
171           "copay": {},
172           "coinsurance": {},
173           "visits": {},
174           "visits_remaining": {},
175           "additional_notes": "additional_notes"
176         },
177         "in_network_flat": [
178           {
179             "type": "DEDUCTIBLE",
180             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
181             "unit": "PERCENT",
182             "value": 1.1
183           },
184           {
185             "type": "DEDUCTIBLE",
186             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
187             "unit": "PERCENT",
188             "value": 1.1
189           }
190         ],
191         "out_of_network": {
192           "copay": {},
193           "coinsurance": {},
194           "visits": {},
195           "visits_remaining": {},
196           "additional_notes": "additional_notes"
197         },
198         "out_of_network_flat": [
199           {
200             "type": "DEDUCTIBLE",
201             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
202             "unit": "PERCENT",
203             "value": 1.1
204           },
205           {
206             "type": "DEDUCTIBLE",
207             "coverageLevel": "EMPLOYEE_AND_CHILDREN",
208             "unit": "PERCENT",
209             "value": 1.1
210           }
211         ]
212       }
213     ],
214     "benefits_related_entities": [
215       {
216         "entityIdentifier": "entityIdentifier",
217         "entityType": "entityType",
218         "entityName": "entityName",
219         "contactInformation": [
220           {},
221           {}
222         ],
223         "serviceTypeCodes": [
224           "1",
225           "1"
226         ]
227       },
228       {
229         "entityIdentifier": "entityIdentifier",
230         "entityType": "entityType",
231         "entityName": "entityName",
232         "contactInformation": [
233           {},
234           {}
235         ],
236         "serviceTypeCodes": [
237           "1",
238           "1"
239         ]
240       }
241     ],
242     "notes": "notes"
243   },
244   "eligibility_checks": [
245     {
246       "check_id": "check_id",
247       "service_code": "1",
248       "status": "COMPLETED",
249       "initiated_by": "initiated_by",
250       "initiated_at": "2024-01-15T09:30:00Z"
251     },
252     {
253       "check_id": "check_id",
254       "service_code": "1",
255       "status": "COMPLETED",
256       "initiated_by": "initiated_by",
257       "initiated_at": "2024-01-15T09:30:00Z"
258     }
259   ],
260   "latest_eligibility_check": {
261     "check_id": "check_id",
262     "status": "ACTIVE",
263     "initiated_at": "2024-01-15T09:30:00Z"
264   }
265 }

Creates a new Coverage. A Coverage provides the high-level identifiers and descriptors of a specific insurance plan for a specific individual - typically the information you can find on an insurance card. Additionally a coverage will include detailed benefits information covered by the specific plan for the individual.

Request

This endpoint expects an object.

statusenumRequired

The status indiciating if the coverage is active or not.

Allowed values:

subscriberobjectRequired

The party who has signed-up for or ‘owns’ the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.

relationshipenumRequired

The relationship of beneficiary (patient) to the subscriber. https://hl7.org/fhir/valueset-relationship.html

Allowed values:

patientstringRequired

The canonical Candid patient UUID corresponding with the patient who benefits from the insurance coverage

insurance_planobjectRequired

verifiedbooleanRequired

A boolean indicating if the coverage has been verified by a user.

eligibility_checkslist of objectsOptional

A list of eligibility check metadata that have been initiated on this coverage.

latest_eligibility_checkobjectOptional

The latest eligibility check metadata that has been initiated on this coverage.

benefitsobjectOptional

The eligibility of the patient for the coverage, manually verified by users.

Response

This endpoint returns an object.

deactivatedboolean

True if the object is deactivated. Deactivated objects are not returned in search results but are returned in all other endpoints including scan.

idUUID

The unique identifier for a Coverage in the database

insurance_planobject

organization_idstring

The organization that owns this object.

patientstring

The canonical Candid patient UUID corresponding with the patient who benefits from the insurance coverage

relationshipenum

The relationship of beneficiary (patient) to the subscriber. https://hl7.org/fhir/valueset-relationship.html

Allowed values:

statusenum

The status indiciating if the coverage is active or not.

Allowed values:

subscriberobject

The party who has signed-up for or ‘owns’ the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.

updated_atdatetime

updating_user_idstring

The user ID of the user who last updated the object.

verifiedboolean

A boolean indicating if the coverage has been verified by a user.

versioninteger

The version of the object. Any update to any property of an object object will create a new version.

benefitsobject or null

The eligibility of the patient for the coverage, manually verified by users.

eligibility_checkslist of objects or null

A list of eligibility check metadata that have been initiated on this coverage.

latest_eligibility_checkobject or null

The latest eligibility check metadata that has been initiated on this coverage.

Headers

Request

Response