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 Field | Example Value | Source Data Field Description | Source Field Data Type | Source Data Field Cardinality | Mapped FHIR++ Resource | Mapped FHIR Data Field | Augmented Mapping | Associated Coding System | Associated FHIR Data Field Extension | Mapping Context |
---|---|---|---|---|---|---|---|---|---|---|
expirationdate | - | Set the date that the insurance will expire. This is usually a date within the next year and not in the past. | String | 0..1 | Coverage | period.end | - | - | - | Top Level |
insuranceidnumber | - | The insurance policy ID number (as presented on the insurance card itself). | String | 0..1 | Coverage | identifier[*].value | system=insurance-id-number | - | - | Top Level |
insurancepackageid | - | The athenaNet insurance package ID. | Integer | 1..1 | Coverage | identifier[*].value | system=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. | String | 0..1 | Coverage | extensions[*].valueString | - | - | insurance-phone | Top Level |
insurancepolicyholder | - | Name of the entity who holds this insurance policy. Required if entity type is set to non-person. | String | 0..1 | RelatedPerson | policyHolder.display | - | - | - | Contained |
insurancepolicyholderaddress1 | - | The first address line of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.line[1] | - | - | source | Contained |
insurancepolicyholderaddress2 | - | The second address line of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.line[2] | - | - | abnormal-hl7-code | Contained |
insurancepolicyholdercity | - | The city of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.city | - | - | abnormal-hl7-name | Contained |
insurancepolicyholdercountrycode | The country code (3 letter) of the insurance policy holder. Either this or insurancepolicyholdercountryiso3166 are acceptable. Defaults to USA. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueString | - | - | analyte-date | Contained | |
insurancepolicyholdersex | - | The sex of the insurance policy holder. Except for self-pay, required for new policies. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueCode | - | - | http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex | Contained |
insurancepolicyholderssn | - | The SSN of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueCode | - | - | http://hl7.org/fhir/sid/us-ssn | Contained |
insurancepolicyholderstate | - | The state of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.state | - | - | description | Contained |
insurancepolicyholderzip | - | The zip of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.postalCode | - | - | facility-id | Contained |
issuedate | d | Set the date that the insurance was issued. This is usually a date in the past year and not in the future. | String | 0..1 | Coverage | period.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. | Integer | 0..1 | Coverage | relationship.id | - | - | - | Top Level |
departmentid | - | If set, we will use the department id in an attempt to add to the local patient. | Integer | 1..1 | Coverage | extension[*].valueInteger | - | - | department-id | Top 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. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueAddress.country | - | - | policy-holder/country | Contained |
insurancepolicyholderdob | - | The DOB of the insurance policy holder (mm/dd/yyyy). | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueString | - | - | policy-holder/dob | Contained |
insurancepolicyholderfirstname | - | The first name of the insurance policy holder. Except for self-pay, required for new policies. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueHumanName.given[1] | - | - | policy-holder/name | Contained |
insurancepolicyholderlastname | - | The last name of the insurance policy holder. Except for self-pay, required for new policies. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueHumanName.family | - | - | policy-holder/name | Contained |
insurancepolicyholdermiddlename | - | The middle name of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueHumanName.given[2] | - | - | policy-holder/name | Contained |
insurancepolicyholdersuffix | - | The suffix of the insurance policy holder. | String | 0..1 | RelatedPerson | policyHolder.extension[*].valueHumanName.suffix | - | - | policy-holder/name | Contained |
insuredentitytypeid | - | - | String | 0..1 | Coverage | extension[*].valueString | - | - | insured-entity-type-id | Top Level |
policynumber | - | The insurance group number. This is sometimes present on an insurance card. | String | 0..1 | Coverage | class[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. | Integer | 0..1 | Coverage | extension[*].valueInteger | - | - | sequence-number | Top Level |
updateappointments | - | If set to true, automatically updates all future appointments to use this insurance as primary or secondary, respective to the sequence number. | Boolean | 0..1 | Coverage | extension[*].valueBoolean | - | - | update-appointments | Top 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. | Boolean | 0..1 | Coverage | extension[*].valueBoolean | - | - | validate-insurance-id-number | Top 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. | Object | 0..1 | Coverage | - | - | - | Top Level | |
copays.copayamount | - | The amount of the copay. | Number | 0..1 | Coverage | costToBeneficiary[*].value.valueMoney | - | - | Top Level | |
copays.copaytype | - | what the copay amount applies to. | String | 0..1 | Coverage | costToBeneficiary[*].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. | Number | 0..1 | Coverage | extension[*].valueInteger | - | - | coinsurance-percent | Top Level |
note | - | The athenaNet insurance notes. | String | 0..1 | Coverage | extension[*].valueString | - | - | note | Top Level |
insuredreferringprovider | - | The referring provider that is associated with the insurance. | String | 0..1 | Coverage | extension[*].valueString | - | - | referring-provider | Top Level |
insuranceproducttype | - | The athenaNet insurance product type. | String | 0..1 | Coverage | extension[*].valueString | - | - | product-type | Top Level |
eligibilitylastchecked | - | Date the eligibility was last checked. | String | 0..1 | Coverage | extension[*].valueString | - | - | eligibility-last-checked | Top Level |
eligibilitymessage | - | The message, usually from our engine, of the eligibility check. | String | 0..1 | Coverage | extension[*].valueString | - | - | eligibility-message | Top Level |
eligibilityreason | - | The source of the current status. athena is our eligibility engine. | String | 0..1 | Coverage | extension[*].valueString | - | - | eligibility-reason | Top Level |
eligibilitystatus | - | Current eligibility status of this insurance package. | String | 0..1 | Coverage | extension[*].valueString | - | - | eligibility-status | Top Level |
insuredidnumber | - | The insurance policy ID number of insured. | String | 0..1 | Coverage | extension[*].valueString | - | - | insured-id-number | Top Level |