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Coverages

Coverages (FHIR Coverage) represent a patient’s insurance plan details — the payor, subscriber info, plan class, and coverage period. ClinikAPI simplifies the most common coverage fields — for advanced scenarios like cost-to-beneficiary or exception details, use the FHIR passthrough.

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Create a Coverage

const { data: coverage } = await clinik.coverages.create({
  status: 'active',
  patientId: 'pt_abc123',
  type: 'medical',
  subscriberId: 'SUB-98765',
  subscriberRef: 'Patient/pt_abc123',
  relationship: 'self',
  payorIds: ['org_ins_bluecross'],
  period: {
    start: '2024-01-01',
    end: '2024-12-31',
  },
  class: [
    { type: 'group', value: 'GRP-100', name: 'Employer Group Plan' },
    { type: 'plan', value: 'PLN-GOLD', name: 'Gold PPO' },
  ],
  network: 'PPO Network',
});

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Dependent Coverage

const { data: dependent } = await clinik.coverages.create({
  status: 'active',
  patientId: 'pt_child456',
  type: 'medical',
  subscriberId: 'SUB-98765',
  subscriberRef: 'Patient/pt_abc123',
  policyHolderRef: 'Patient/pt_abc123',
  relationship: 'child',
  payorIds: ['org_ins_bluecross'],
  period: {
    start: '2024-01-01',
    end: '2024-12-31',
  },
  class: [
    { type: 'group', value: 'GRP-100', name: 'Employer Group Plan' },
    { type: 'plan', value: 'PLN-GOLD', name: 'Gold PPO' },
  ],
  dependent: '1',
  order: 1,
});

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Search Coverages

// All coverages for a patient
const { data } = await clinik.coverages.search({
  patientId: 'pt_abc123',
});

// Active coverages only
const { data: active } = await clinik.coverages.search({
  patientId: 'pt_abc123',
  status: 'active',
});

// Filter by type
const { data: dental } = await clinik.coverages.search({
  patientId: 'pt_abc123',
  type: 'dental',
});

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Update a Coverage

const { data: updated } = await clinik.coverages.update('cov_abc123', {
  status: 'cancelled',
});

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Coverage Types

TypeDescription
medicalMedical/health insurance
dentalDental insurance
visionVision insurance
pharmacyPharmacy benefits