xCaliber healthCare Data Mesh

Insurances

Source Object: Insurances

Overview and Usage: The "Insurances" source object in athena EHR is a repository for patient insurance information, offering a comprehensive record of insurance policies and details. Developers can use this source object to create applications that assist healthcare providers in managing insurance-related aspects efficiently. Key data fields include:

  • Expiration Date: Specifies the date when the insurance policy is set to expire.
  • Insurance ID Number: Contains the unique identification number associated with the insurance policy.
  • Insurance Package ID: Represents the identifier for the insurance package linked to the patient.
  • Insurance Phone: Stores contact information for the insurance provider.
  • Insurance Policyholder: Holds details about the primary policyholder, including name and contact information.
  • Issue Date: Records the date the insurance policy was issued.
  • Policy Number: Specifies the unique number associated with the insurance policy.
  • Sequence Number: Represents a sequential number or code associated with the insurance policy.
  • Update Appointments: A field that may indicate whether insurance updates are needed for appointments.
  • Validate Insurance ID Number: A field that might be used to verify the accuracy of the insurance ID number.
  • Copays: Contains data related to copay amounts and types.
  • Coinsurance Percent: Indicates the percentage of medical costs shared between the patient and the insurance provider.
  • Eligibility Status: Represents the current eligibility status of the insurance policy.

Developers can leverage the "Insurances" source object to build applications that streamline the management of patient insurance information, automate eligibility checks, and enhance billing and claims processing. Additionally, this data can be utilized to ensure accurate coverage verification, facilitate communication with insurance providers, and support administrative tasks related to healthcare services.

Mapping Table

Data FieldExample ValueSource Data Field DescriptionSource Field Data TypeSource Data Field CardinalityMapped FHIR++ ResourceMapped FHIR Data FieldAugmented MappingAssociated Coding SystemAssociated FHIR Data Field ExtensionMapping Context
expirationdate-Set the date that the insurance will expire. This is usually a date within the next year and not in the past.String0..1Coverageperiod.end---Top Level
insuranceidnumber-The insurance policy ID number (as presented on the insurance card itself).String0..1Coverageidentifier[*].valuesystem=insurance-id-number--Top Level
insurancepackageid-The athenaNet insurance package ID.Integer1..1Coverageidentifier[*].valuesystem=insurance-package-id--Top Level
insurancephone-The phone number for the insurance company. Note: This defaults to the insurance package phone number. If this is set, it will override it. Likewise if blanked out, it will go back to default.String0..1Coverageextensions[*].valueString--insurance-phoneTop Level
insurancepolicyholder-Name of the entity who holds this insurance policy. Required if entity type is set to non-person.String0..1RelatedPersonpolicyHolder.display---Contained
insurancepolicyholderaddress1-The first address line of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.line[1]--sourceContained
insurancepolicyholderaddress2-The second address line of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.line[2]--abnormal-hl7-codeContained
insurancepolicyholdercity-The city of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.city--abnormal-hl7-nameContained
insurancepolicyholdercountrycodeThe country code (3 letter) of the insurance policy holder. Either this or insurancepolicyholdercountryiso3166 are acceptable. Defaults to USA.String0..1RelatedPersonpolicyHolder.extension[*].valueString--analyte-dateContained
insurancepolicyholdersex-The sex of the insurance policy holder. Except for self-pay, required for new policies.String0..1RelatedPersonpolicyHolder.extension[*].valueCode--http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsexContained
insurancepolicyholderssn-The SSN of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueCode--http://hl7.org/fhir/sid/us-ssnContained
insurancepolicyholderstate-The state of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.state--descriptionContained
insurancepolicyholderzip-The zip of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.postalCode--facility-idContained
issuedatedSet the date that the insurance was issued. This is usually a date in the past year and not in the future.String0..1Coverageperiod.start---Top Level
relationshiptoinsuredid-This patient's relationship to the policy holder (as an ID). See \u003Ca href="/workflows/patient-relationship-mapping"\u003E the mapping\u003C/a\u003E. Please note that if this is set to 12, Entity Type must be set to 2.Integer0..1Coveragerelationship.id---Top Level
departmentid-If set, we will use the department id in an attempt to add to the local patient.Integer1..1Coverageextension[*].valueInteger--department-idTop Level
insurancepolicyholdercountryiso3166-The \u003Ca href="http://en.wikipedia.org/wiki/ISO\_3166-1\_alpha-2"\u003EISO 3166\u003C/a\u003E country code of the insurance policy holder. Either this or insurancepolicyholdercountrycode are acceptable. Defaults to US.String0..1RelatedPersonpolicyHolder.extension[*].valueAddress.country--policy-holder/countryContained
insurancepolicyholderdob-The DOB of the insurance policy holder (mm/dd/yyyy).String0..1RelatedPersonpolicyHolder.extension[*].valueString--policy-holder/dobContained
insurancepolicyholderfirstname-The first name of the insurance policy holder. Except for self-pay, required for new policies.String0..1RelatedPersonpolicyHolder.extension[*].valueHumanName.given[1]--policy-holder/nameContained
insurancepolicyholderlastname-The last name of the insurance policy holder. Except for self-pay, required for new policies.String0..1RelatedPersonpolicyHolder.extension[*].valueHumanName.family--policy-holder/nameContained
insurancepolicyholdermiddlename-The middle name of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueHumanName.given[2]--policy-holder/nameContained
insurancepolicyholdersuffix-The suffix of the insurance policy holder.String0..1RelatedPersonpolicyHolder.extension[*].valueHumanName.suffix--policy-holder/nameContained
insuredentitytypeid--String0..1Coverageextension[*].valueString--insured-entity-type-idTop Level
policynumber-The insurance group number. This is sometimes present on an insurance card.String0..1Coverageclass[1].value---Top Level
sequencenumber-1 = primary, 2 = secondary. Must have a primary before a secondary. This field is required if the insurance package is not a case policy.Integer0..1Coverageextension[*].valueInteger--sequence-numberTop Level
updateappointments-If set to true, automatically updates all future appointments to use this insurance as primary or secondary, respective to the sequence number.Boolean0..1Coverageextension[*].valueBoolean--update-appointmentsTop Level
validateinsuranceidnumber-BETA FIELD: If true, this makes sure that you have entered a valid INSURANCEIDNUMBER. If you didn't it will error. Setting this is probably a good thing and means you shouldn't have to do a ton of validation on the ID number.Boolean0..1Coverageextension[*].valueBoolean--validate-insurance-id-numberTop Level
copays-Details about the copays for this insurance package. If you've just POSTed a new insurance you will have to wait for the auto eligbility check before these populate.Object0..1Coverage---Top Level
copays.copayamount-The amount of the copay.Number0..1CoveragecostToBeneficiary[*].value.valueMoney--Top Level
copays.copaytype-what the copay amount applies to.String0..1CoveragecostToBeneficiary[*].type--Top Level
coinsurancepercent-The coinsurance percentage for this insurance. If you've just POSTed a new insurance you will have to wait for the auto eligbility check before this field populates.Number0..1Coverageextension[*].valueInteger--coinsurance-percentTop Level
note-The athenaNet insurance notes.String0..1Coverageextension[*].valueString--noteTop Level
insuredreferringprovider-The referring provider that is associated with the insurance.String0..1Coverageextension[*].valueString--referring-providerTop Level
insuranceproducttype-The athenaNet insurance product type.String0..1Coverageextension[*].valueString--product-typeTop Level
eligibilitylastchecked-Date the eligibility was last checked.String0..1Coverageextension[*].valueString--eligibility-last-checkedTop Level
eligibilitymessage-The message, usually from our engine, of the eligibility check.String0..1Coverageextension[*].valueString--eligibility-messageTop Level
eligibilityreason-The source of the current status. athena is our eligibility engine.String0..1Coverageextension[*].valueString--eligibility-reasonTop Level
eligibilitystatus-Current eligibility status of this insurance package.String0..1Coverageextension[*].valueString--eligibility-statusTop Level
insuredidnumber-The insurance policy ID number of insured.String0..1Coverageextension[*].valueString--insured-id-numberTop Level