Cerner Coverage R4 API

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Assigned to Fenil....@cerner.com by me

Bharti Tijare

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Aug 5, 2021, 8:44:53 AM8/5/21
to Cerner FHIR Developers
Hi Team,

We are currently working on Coverage API to fetch patient's insurance details:

GET https://{{fhirDomain}}/r4/{{fhirTenatId}}/Coverage?patient={{patientId}}

We had few questions related to its response:

1. We found some examples in HL7 FHIR documentation (http://www.hl7.org/fhir/coverage-examples.html) which includes example for primary, secondary and SELF PAY insurance. Is there a way to identify that coverage resource is primary, secondary or self pay ?

2. If patient has no coverages, what will be the response ?

Thanks,
Bharti

Fenil Desani (Cerner)

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Aug 5, 2021, 3:03:49 PM8/5/21
to Cerner FHIR Developers
Hello,

1. We found some examples in HL7 FHIR documentation (http://www.hl7.org/fhir/coverage-examples.html) which includes example for primary, secondary and SELF PAY insurance. Is there a way to identify that coverage resource is primary, secondary or self pay ?
  • This is not supported as this time

2. If patient has no coverages, what will be the response ?
  • You would receive an empty bundle with https Status of 200

Thanks,
Fenil

Bharti Tijare

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Aug 6, 2021, 12:29:44 PM8/6/21
to Cerner FHIR Developers
Hi Fenil,

Thanks for information!! 
It was helpful.

I had a question specifically for SELF PAY. 

1. Is there a way to identify the coverage resource is 'SELF PAY' ?

2. And if patient don't have coverages associated with it, will it respond with SELF PAY?

Thanks, 
Bharti

Fenil Desani (Cerner)

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Aug 6, 2021, 12:51:22 PM8/6/21
to Cerner FHIR Developers
If a patient has Coverage of Self Pay, it would come back in the coverage response. If the patient does not have any coverage, you would get an empty response.
Example:
>Coverage</b></p><p><b>Status</b>: Active</p><p><b>Subscriber</b>: TEST</p><p><b>Beneficiary</b>: TEST</p><p><b>Relationship</b>: Self</p><p><b>Coverage Start Date</b>: Oct 6, 2020 5:00 A.M. UTC</p><p><b>Coverage End Date</b>: Aug 5, 2021 6:55 P.M. UTC</p><p><b>Payor</b>: SELF PAY</p><p><b>Class</b>:</p><dl><dt>Plan</dt><dd><b>Value</b>: 2800235</dd><dd><b>Name</b>: Self Pay</dd></dl></div>"

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