Coverage

Coverage refers to the high-level identifiers and descriptors of a health fund plan, such as the patient's details on their health fund membership card.

Coverage examples may include:

Medicare card details
NDIS participant details
Private health insurance membership details

Note: Coverage pertains only to the patient's membership details, and does not include eligibility.

ℹ️
Context
In Halaxy, Coverage is referred to as claim details added to the patient's claim for a specific funder. You can find this in the patient profile under the Funding tab.

Endpoints

Endpoint	Operation	Description
`GET` `/main/Coverage`	List Coverage	Return a collection of claim details
`GET` `/main/Coverage/{id}`	Get Coverage	Return an individual record of claim details
`POST` `/main/Coverage/`	Create Coverage	Create claim details
`PATCH` `/main/Coverage/{id}`	Update Coverage	Update specific fields in existing patient claim details

Schema

Property	Description
id	`string` The identifier of this coverage record
beneficiary	`Reference(Patient)` required The person who receives the benefit for the coverage In Halaxy, if there is noclaimant, the patient is the default beneficiary. See article about Medicare claimants. See also: Patient
subscriber	`Reference(Patient)` required The person receiving the treatment under the coverage See also: Patient
subscriberID	`string` The patient's claim details (e.g. membership number, card number, reference number)
dependent	`string` An individual reference number (IRN) on the membership card, typically a single digit number before the cardholder's name
period	`period` The time period when the coverage was valid start: `date` end: `date`
status	`enum` The status of the coverage `"active"` `"cancelled"`
payor	`Reference(Organization)` or `Reference(Patient)` required The issuer of the coverage policy - if Organization, this is the funder (FD) ID. See also: Patient, Organization
coverage patient anonymous	`HALAXY API EXTENSION` Indicates whether the patient's name is anonymized or displayed on invoices where this coverage is used. If `true`, the patient's name is anonymized on the invoice. If `false`, the patient's real name is displayed on the invoice.
coverage payer	`HALAXY API EXTENSION` Determines who is billed on the invoice. For invoices billed to third-party organizations, you can also determine how invoices are generated for fees associated with the coverage funder. code / display 29 - "Patient" 30 - "Organisation (new invoice)" 31 - "Organisation (existing invoice, same patient)" 32 - "Organisation (existing invoice, any patient)" Note: In Halaxy, this refers to the Payer field in the Funder settings. See article:Guide to funders
coverage organisation	`HALAXY API EXTENSION` `Reference(Organization)` The paying organization for this coverage `"reference": "/main/Organization/OG-12345678"` `"type": "Organization"` See also: Organization
attachments	File attachments to the referral (`POST` only) contentType `enum` required The format of the file attachment Supported formats: `application/msword` `application/vnd.ms-excel` `application/vnd.openxmlformats-officedocument.wordprocessingml.document` `application/vnd.openxmlformats-officedocument.spreadsheetml.sheet` `application/pdf` `image/jpeg` `image/png` data required File must be encoded into base64 format Maximum file size: 20MB title `string` required The file name

Schema (Medicare / DVA)

Property Description

Property	Description
identifier	The business identifier of the health fund that the coverage is under. This is used for globally-recognized health systems. Medicare `code": "MC"` `"display": "Patient's Medicare number"` `"text": "Patient's Medicare number"` `"value":` The patient's Medicare card number DVA `code": "DVAU"` `"display": "DVA Number"` `"text": "DVA Number"` `"value":` The patient's DVA card number

identifier

The business identifier of the health fund that the coverage is under. This is used for globally-recognized health systems.

Medicare

code": "MC"

"display": "Patient's Medicare number"

"text": "Patient's Medicare number"

"value": The patient's Medicare card number

DVA

code": "DVAU"

"display": "DVA Number"

"text": "DVA Number"

"value": The patient's DVA card number