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API ReferencePre EncounterCoveragesV1

Beta
GET
/coverages/v1/
GET
/coverages/v1/
1curl https://pre-api.joincandidhealth.com/coverages/v1 \
2     -H "Authorization: Bearer <token>"
Try it
200Retrieved
1[
2  {
3    "deactivated": true,
4    "id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
5    "insurance_plan": {
6      "member_id": "member_id",
7      "payer_id": "payer_id",
8      "payer_name": "payer_name",
9      "additional_payer_information": {
10        "availity_eligibility_id": "availity_eligibility_id",
11        "availity_payer_id": "availity_payer_id",
12        "availity_payer_name": "availity_payer_name",
13        "availity_remittance_payer_id": "availity_remittance_payer_id"
14      },
15      "group_number": "group_number",
16      "name": "name",
17      "plan_type": "09",
18      "type": "01",
19      "period": {
20        "start": "2023-01-15",
21        "end": "2023-01-15"
22      },
23      "insurance_card_image_locator": "insurance_card_image_locator",
24      "payer_plan_group_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
25    },
26    "organization_id": "organization_id",
27    "patient": "patient",
28    "relationship": "SELF",
29    "status": "ACTIVE",
30    "subscriber": {
31      "name": {
32        "family": "family",
33        "given": [
34          "given",
35          "given"
36        ],
37        "use": "USUAL",
38        "period": {
39          "start": "2023-01-15",
40          "end": "2023-01-15"
41        },
42        "suffix": "suffix"
43      },
44      "biological_sex": "FEMALE",
45      "date_of_birth": "2023-01-15",
46      "address": {
47        "use": "HOME",
48        "line": [
49          "line",
50          "line"
51        ],
52        "city": "city",
53        "state": "state",
54        "postal_code": "postal_code",
55        "country": "country",
56        "period": {
57          "start": "2023-01-15",
58          "end": "2023-01-15"
59        }
60      }
61    },
62    "updated_at": "2024-01-15T09:30:00Z",
63    "updating_user_id": "updating_user_id",
64    "verified": true,
65    "version": 1,
66    "benefits": {
67      "plan_coverage": {
68        "in_network": {
69          "deductible": {},
70          "deductible_contract": {},
71          "deductible_remaining": {},
72          "deductible_year_to_date": {},
73          "oop_max": {},
74          "oop_max_contract": {},
75          "oop_max_remaining": {},
76          "oop_max_year_to_date": {},
77          "additional_notes": "additional_notes"
78        },
79        "in_network_flat": [
80          {
81            "type": "DEDUCTIBLE",
82            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
83            "unit": "PERCENT",
84            "value": 1.1,
85            "additional_notes": "additional_notes"
86          },
87          {
88            "type": "DEDUCTIBLE",
89            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
90            "unit": "PERCENT",
91            "value": 1.1,
92            "additional_notes": "additional_notes"
93          }
94        ],
95        "out_of_network": {
96          "deductible": {},
97          "deductible_contract": {},
98          "deductible_remaining": {},
99          "deductible_year_to_date": {},
100          "oop_max": {},
101          "oop_max_contract": {},
102          "oop_max_remaining": {},
103          "oop_max_year_to_date": {},
104          "additional_notes": "additional_notes"
105        },
106        "out_of_network_flat": [
107          {
108            "type": "DEDUCTIBLE",
109            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
110            "unit": "PERCENT",
111            "value": 1.1,
112            "additional_notes": "additional_notes"
113          },
114          {
115            "type": "DEDUCTIBLE",
116            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
117            "unit": "PERCENT",
118            "value": 1.1,
119            "additional_notes": "additional_notes"
120          }
121        ]
122      },
123      "service_specific_coverage": [
124        {
125          "service_code": "1",
126          "in_network": {
127            "copay": {},
128            "coinsurance": {},
129            "visits": {},
130            "visits_remaining": {},
131            "additional_notes": "additional_notes"
132          },
133          "in_network_flat": [
134            {
135              "type": "DEDUCTIBLE",
136              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
137              "unit": "PERCENT",
138              "value": 1.1
139            },
140            {
141              "type": "DEDUCTIBLE",
142              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
143              "unit": "PERCENT",
144              "value": 1.1
145            }
146          ],
147          "out_of_network": {
148            "copay": {},
149            "coinsurance": {},
150            "visits": {},
151            "visits_remaining": {},
152            "additional_notes": "additional_notes"
153          },
154          "out_of_network_flat": [
155            {
156              "type": "DEDUCTIBLE",
157              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
158              "unit": "PERCENT",
159              "value": 1.1
160            },
161            {
162              "type": "DEDUCTIBLE",
163              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
164              "unit": "PERCENT",
165              "value": 1.1
166            }
167          ]
168        },
169        {
170          "service_code": "1",
171          "in_network": {
172            "copay": {},
173            "coinsurance": {},
174            "visits": {},
175            "visits_remaining": {},
176            "additional_notes": "additional_notes"
177          },
178          "in_network_flat": [
179            {
180              "type": "DEDUCTIBLE",
181              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
182              "unit": "PERCENT",
183              "value": 1.1
184            },
185            {
186              "type": "DEDUCTIBLE",
187              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
188              "unit": "PERCENT",
189              "value": 1.1
190            }
191          ],
192          "out_of_network": {
193            "copay": {},
194            "coinsurance": {},
195            "visits": {},
196            "visits_remaining": {},
197            "additional_notes": "additional_notes"
198          },
199          "out_of_network_flat": [
200            {
201              "type": "DEDUCTIBLE",
202              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
203              "unit": "PERCENT",
204              "value": 1.1
205            },
206            {
207              "type": "DEDUCTIBLE",
208              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
209              "unit": "PERCENT",
210              "value": 1.1
211            }
212          ]
213        }
214      ],
215      "benefits_related_entities": [
216        {
217          "entityIdentifier": "entityIdentifier",
218          "entityType": "entityType",
219          "entityName": "entityName",
220          "contactInformation": [
221            {},
222            {}
223          ],
224          "serviceTypeCodes": [
225            "1",
226            "1"
227          ]
228        },
229        {
230          "entityIdentifier": "entityIdentifier",
231          "entityType": "entityType",
232          "entityName": "entityName",
233          "contactInformation": [
234            {},
235            {}
236          ],
237          "serviceTypeCodes": [
238            "1",
239            "1"
240          ]
241        }
242      ],
243      "notes": "notes"
244    },
245    "eligibility_checks": [
246      {
247        "check_id": "check_id",
248        "service_code": "1",
249        "status": "COMPLETED",
250        "initiated_by": "initiated_by",
251        "initiated_at": "2024-01-15T09:30:00Z"
252      },
253      {
254        "check_id": "check_id",
255        "service_code": "1",
256        "status": "COMPLETED",
257        "initiated_by": "initiated_by",
258        "initiated_at": "2024-01-15T09:30:00Z"
259      }
260    ],
261    "latest_eligibility_check": {
262      "check_id": "check_id",
263      "status": "ACTIVE",
264      "initiated_at": "2024-01-15T09:30:00Z"
265    },
266    "orcon": true
267  },
268  {
269    "deactivated": true,
270    "id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
271    "insurance_plan": {
272      "member_id": "member_id",
273      "payer_id": "payer_id",
274      "payer_name": "payer_name",
275      "additional_payer_information": {
276        "availity_eligibility_id": "availity_eligibility_id",
277        "availity_payer_id": "availity_payer_id",
278        "availity_payer_name": "availity_payer_name",
279        "availity_remittance_payer_id": "availity_remittance_payer_id"
280      },
281      "group_number": "group_number",
282      "name": "name",
283      "plan_type": "09",
284      "type": "01",
285      "period": {
286        "start": "2023-01-15",
287        "end": "2023-01-15"
288      },
289      "insurance_card_image_locator": "insurance_card_image_locator",
290      "payer_plan_group_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
291    },
292    "organization_id": "organization_id",
293    "patient": "patient",
294    "relationship": "SELF",
295    "status": "ACTIVE",
296    "subscriber": {
297      "name": {
298        "family": "family",
299        "given": [
300          "given",
301          "given"
302        ],
303        "use": "USUAL",
304        "period": {
305          "start": "2023-01-15",
306          "end": "2023-01-15"
307        },
308        "suffix": "suffix"
309      },
310      "biological_sex": "FEMALE",
311      "date_of_birth": "2023-01-15",
312      "address": {
313        "use": "HOME",
314        "line": [
315          "line",
316          "line"
317        ],
318        "city": "city",
319        "state": "state",
320        "postal_code": "postal_code",
321        "country": "country",
322        "period": {
323          "start": "2023-01-15",
324          "end": "2023-01-15"
325        }
326      }
327    },
328    "updated_at": "2024-01-15T09:30:00Z",
329    "updating_user_id": "updating_user_id",
330    "verified": true,
331    "version": 1,
332    "benefits": {
333      "plan_coverage": {
334        "in_network": {
335          "deductible": {},
336          "deductible_contract": {},
337          "deductible_remaining": {},
338          "deductible_year_to_date": {},
339          "oop_max": {},
340          "oop_max_contract": {},
341          "oop_max_remaining": {},
342          "oop_max_year_to_date": {},
343          "additional_notes": "additional_notes"
344        },
345        "in_network_flat": [
346          {
347            "type": "DEDUCTIBLE",
348            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
349            "unit": "PERCENT",
350            "value": 1.1,
351            "additional_notes": "additional_notes"
352          },
353          {
354            "type": "DEDUCTIBLE",
355            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
356            "unit": "PERCENT",
357            "value": 1.1,
358            "additional_notes": "additional_notes"
359          }
360        ],
361        "out_of_network": {
362          "deductible": {},
363          "deductible_contract": {},
364          "deductible_remaining": {},
365          "deductible_year_to_date": {},
366          "oop_max": {},
367          "oop_max_contract": {},
368          "oop_max_remaining": {},
369          "oop_max_year_to_date": {},
370          "additional_notes": "additional_notes"
371        },
372        "out_of_network_flat": [
373          {
374            "type": "DEDUCTIBLE",
375            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
376            "unit": "PERCENT",
377            "value": 1.1,
378            "additional_notes": "additional_notes"
379          },
380          {
381            "type": "DEDUCTIBLE",
382            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
383            "unit": "PERCENT",
384            "value": 1.1,
385            "additional_notes": "additional_notes"
386          }
387        ]
388      },
389      "service_specific_coverage": [
390        {
391          "service_code": "1",
392          "in_network": {
393            "copay": {},
394            "coinsurance": {},
395            "visits": {},
396            "visits_remaining": {},
397            "additional_notes": "additional_notes"
398          },
399          "in_network_flat": [
400            {
401              "type": "DEDUCTIBLE",
402              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
403              "unit": "PERCENT",
404              "value": 1.1
405            },
406            {
407              "type": "DEDUCTIBLE",
408              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
409              "unit": "PERCENT",
410              "value": 1.1
411            }
412          ],
413          "out_of_network": {
414            "copay": {},
415            "coinsurance": {},
416            "visits": {},
417            "visits_remaining": {},
418            "additional_notes": "additional_notes"
419          },
420          "out_of_network_flat": [
421            {
422              "type": "DEDUCTIBLE",
423              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
424              "unit": "PERCENT",
425              "value": 1.1
426            },
427            {
428              "type": "DEDUCTIBLE",
429              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
430              "unit": "PERCENT",
431              "value": 1.1
432            }
433          ]
434        },
435        {
436          "service_code": "1",
437          "in_network": {
438            "copay": {},
439            "coinsurance": {},
440            "visits": {},
441            "visits_remaining": {},
442            "additional_notes": "additional_notes"
443          },
444          "in_network_flat": [
445            {
446              "type": "DEDUCTIBLE",
447              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
448              "unit": "PERCENT",
449              "value": 1.1
450            },
451            {
452              "type": "DEDUCTIBLE",
453              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
454              "unit": "PERCENT",
455              "value": 1.1
456            }
457          ],
458          "out_of_network": {
459            "copay": {},
460            "coinsurance": {},
461            "visits": {},
462            "visits_remaining": {},
463            "additional_notes": "additional_notes"
464          },
465          "out_of_network_flat": [
466            {
467              "type": "DEDUCTIBLE",
468              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
469              "unit": "PERCENT",
470              "value": 1.1
471            },
472            {
473              "type": "DEDUCTIBLE",
474              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
475              "unit": "PERCENT",
476              "value": 1.1
477            }
478          ]
479        }
480      ],
481      "benefits_related_entities": [
482        {
483          "entityIdentifier": "entityIdentifier",
484          "entityType": "entityType",
485          "entityName": "entityName",
486          "contactInformation": [
487            {},
488            {}
489          ],
490          "serviceTypeCodes": [
491            "1",
492            "1"
493          ]
494        },
495        {
496          "entityIdentifier": "entityIdentifier",
497          "entityType": "entityType",
498          "entityName": "entityName",
499          "contactInformation": [
500            {},
501            {}
502          ],
503          "serviceTypeCodes": [
504            "1",
505            "1"
506          ]
507        }
508      ],
509      "notes": "notes"
510    },
511    "eligibility_checks": [
512      {
513        "check_id": "check_id",
514        "service_code": "1",
515        "status": "COMPLETED",
516        "initiated_by": "initiated_by",
517        "initiated_at": "2024-01-15T09:30:00Z"
518      },
519      {
520        "check_id": "check_id",
521        "service_code": "1",
522        "status": "COMPLETED",
523        "initiated_by": "initiated_by",
524        "initiated_at": "2024-01-15T09:30:00Z"
525      }
526    ],
527    "latest_eligibility_check": {
528      "check_id": "check_id",
529      "status": "ACTIVE",
530      "initiated_at": "2024-01-15T09:30:00Z"
531    },
532    "orcon": true
533  }
534]
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Returns a list of Coverages based on the search criteria.
Get Multi

Authentication

AuthorizationBearer
OAuth authentication of the form `<token>`.

Query Parameters

patient_idstringOptional

Response

This endpoint returns a list of objects.
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.
orconboolean or null
ORCON (Originator Controlled) - When set to true, the Candid system will hide this coverage from downstream integrations. Defaults to false.

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

OAuth authentication of the form <token>.

ORCON (Originator Controlled) - When set to true, the Candid system will hide this coverage from downstream integrations. Defaults to false.