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Version 1.1.1.0
The Coverage resource provides the high-level identifiers and descriptors for an insurance plan. Typically, this is the level of information that would appear on an insurance card, which it is customary to provide on claims and other communications between providers and insurers. The Coverage resource is used for both insurance payment and self-payment.
Note: Self-pay should not be confused with being a guarantor of the patient’s account. One does not need to be the guarantor to make a self-payment.
The Coverage resource is an event 
resource from a FHIR workflow perspective. An event is any description of an activity that has already taken place or that is currently ongoing.
Typically, the Coverage resource is used to specify high-level identifiers and descriptors for a specific insurance plan for a specific individual. However, the Coverage resource may alternately provide information to an individual or organization other than an insurer (i.e., self-pay) that is taking responsibility for payment for a portion of the health care costs.
Coverage is part of the eClaim domain. Other related resources from this domain are:
The Coverage resource is referenced by these resources:
The Coverage resource defines the following Slices :
$thistypeThe C4BBCoverage resource profile refers to data that reflect a payer’s coverage that was effective as of the date of service or the date of admission of the claim.
The C4BBCoverage structure is derived from the FHIR R4 Coverage resource. The structure refers to these other structures:
Use Postman to test Opala's Patient Access API by querying the API and returning the results. The Opala Collection is a group of API requests that are already saved in the Postman app and arranged in folders. You can access the Opala's Patient Access Sandbox and, if you have the correct credentials, the production environment as well. For more information see Setting Up Postman in this documentation set.
The Copverage resource is a financial instrument that may be used to reimburse or pay for health care products and services. This resource includes both insurance and self-payment.
Search for a Patient's Coverage
To query the Coverage resource for a specific patient:
[baseurl]/Coverage?patient=[patientid]
Search for Payors
To identify the insurers or parties paying for service:
[baseurl]/Coverage?_payor
Search for a Patient's Payor
To query the Coverage resource for a specific patient by payor:
[baseurl]/Coverage?_payor:Patient.name=[name]
Search for Coverage Status
To query the Coverage resource for coverage status:
[baseurl]/Coverage?_element:status
Note: You can also use the _element result parameter to search search coverage by other elements like plan and type.
resource. for the elements in the Coverage resource for the Coverage resource for the Coverage resource resource profile. for the Coverage resource profile