coverage

A patient's insurance/payor coverage record, sourced from the provider's billing/insurance data.

Fields

Field	Type	Required	Description
identifiers	Identifier[]	no (defaults [])	Business identifiers, e.g. a policy/coverage number.
patientRef	SourceRef	yes	The patient this coverage belongs to.
status	string enum	yes	One of active, cancelled, draft, entered-in-error.
payorName	string	no	Free-text name of the payor/insurer.
type	string	no	Free-text coverage type, e.g. a payor-specific plan category.

Example payload

{
  "identifiers": [{ "system": "urn:michels:coverage", "value": "COV-5001" }],
  "patientRef": {
    "sourceSystem": "michels",
    "resourceType": "patient",
    "sourceId": "pat-1"
  },
  "status": "active",
  "payorName": "Example Krankenkasse",
  "type": "public"
}

As a change-feed event

{
  "sequence": 58,
  "resourceType": "coverage",
  "canonicalId": "2b6e4c1a-8f3d-4a7b-9c2e-5d1f8a4b7c0e",
  "operation": "create",
  "version": 1,
  "occurredAt": "2026-07-13T09:00:00.000Z",
  "orgSlug": "default",
  "record": {
    "identifiers": [{ "system": "urn:michels:coverage", "value": "COV-5001" }],
    "patientRef": {
      "sourceSystem": "michels",
      "resourceType": "patient",
      "sourceId": "pat-1"
    },
    "status": "active",
    "payorName": "Example Krankenkasse",
    "type": "public"
  }
}

From the Records API

curl -H "Authorization: Bearer $ROSETTA_SYNC_TOKEN" \
  "https://sync.example.com/api/v1/records/coverage/2b6e4c1a-8f3d-4a7b-9c2e-5d1f8a4b7c0e"

{
  "id": "2b6e4c1a-8f3d-4a7b-9c2e-5d1f8a4b7c0e",
  "resourceType": "coverage",
  "version": 1,
  "payload": {
    "identifiers": [{ "system": "urn:michels:coverage", "value": "COV-5001" }],
    "patientRef": {
      "sourceSystem": "michels",
      "resourceType": "patient",
      "sourceId": "pat-1"
    },
    "status": "active",
    "payorName": "Example Krankenkasse",
    "type": "public"
  },
  "updatedAt": "2026-07-13T09:00:00.000Z",
  "orgSlug": "default",
  "identifiers": [{ "system": "urn:michels:coverage", "value": "COV-5001" }]
}

Consumption notes

• status meanings: active and draft are self-explanatory; cancelled means the coverage no longer applies; entered-in-error means the record itself was a mistake at the source and should be treated as a retraction, not as an inactive coverage.
• payorName and type are free text from the source system — do not validate them against a fixed enum.
• patientRef is a source reference; correlate it to the canonical patient whose identifiers contain the matching business identifier.