Resources
FHIR resources Payerbox exposes, tagged by the API surface(s) that use them.
The authoritative list per deployment is in the Capability Statement (/fhir/metadata). The table below is the design intent across surfaces.
Member and coverage
| Resource | Patient Access | Provider Access | Payer-to-Payer | Provider Directory | Prior Auth |
|---|
| Patient | ✓ | ✓ | ✓ | | ✓ |
| Coverage | ✓ | ✓ | ✓ | | ✓ |
| RelatedPerson | ✓ | ✓ | ✓ | | |
| Group | | ✓ | ✓ | | |
| Consent | ✓ | ✓ | ✓ | | |
Clinical (US Core)
| Resource | Patient Access | Provider Access | Payer-to-Payer | Prior Auth |
|---|
| AllergyIntolerance | ✓ | ✓ | ✓ | ✓ |
| Condition | ✓ | ✓ | ✓ | ✓ |
| Observation | ✓ | ✓ | ✓ | ✓ |
| MedicationRequest | ✓ | ✓ | ✓ | ✓ |
| MedicationStatement | ✓ | ✓ | ✓ | |
| Procedure | ✓ | ✓ | ✓ | |
| DiagnosticReport | ✓ | ✓ | ✓ | |
| Immunization | ✓ | ✓ | ✓ | |
| CarePlan | ✓ | ✓ | ✓ | |
| Goal | ✓ | ✓ | ✓ | |
| Encounter | ✓ | ✓ | ✓ | ✓ |
| ServiceRequest | ✓ | ✓ | ✓ | ✓ |
| DocumentReference | ✓ | ✓ | ✓ | ✓ |
| Device | ✓ | ✓ | ✓ | |
| Location | ✓ | ✓ | ✓ | ✓ |
Claims, EOB, prior auth
| Resource | Patient Access | Provider Access | Payer-to-Payer | Prior Auth |
|---|
| Claim | ✓ (PA only, from 2027) | ✓ | ✓ | ✓ |
| ClaimResponse | ✓ (PA only, from 2027) | ✓ | ✓ | ✓ |
| ExplanationOfBenefit | ✓ | ✓ (no remittance / cost-sharing) | ✓ (no remittance / cost-sharing) | |
| Task | | ✓ | ✓ | ✓ |
Provider directory (Plan Net)
| Resource | Provider Directory | Patient Access (MA-PD) |
|---|
| Practitioner | ✓ | |
| PractitionerRole | ✓ | |
| Organization | ✓ | |
| OrganizationAffiliation | ✓ | |
| Location | ✓ | |
| HealthcareService | ✓ | |
| InsurancePlan | ✓ | ✓ |
| Endpoint | ✓ | |
| Resource | Patient Access (MA-PD) |
|---|
| MedicationKnowledge | ✓ |
| InsurancePlan | ✓ (with formulary extension) |
DTR (Questionnaire workflow)
| Resource | Used by |
|---|
| Questionnaire | DTR $questionnaire-package |
| QuestionnaireResponse | DTR completion → PAS submission |
| Library | DTR CQL bundle |
| ValueSet, CodeSystem | DTR Questionnaire constraints |
Audit and operations
| Resource | Used by |
|---|
| AuditEvent | BALP audit log; produced for every member-data access |
| OperationOutcome | Error responses across all surfaces |
| Subscription | Optional — for notifications |
| Bundle | Transaction, batch, search results, and PAS Request/Response |
Each resource above is constrained by the relevant IG profile when interacting with a specific surface. For example, Patient on Patient Access conforms to us-core-patient; Practitioner on Provider Directory conforms to plannet-Practitioner.
The CapabilityStatement at <base>/fhir/metadata lists the exact supportedProfile for each resource per surface.
