---
description: >-
  Columns for coverage, mapped from the USCDI v3.1 Health Insurance
  Information data class to US Core 6.1.0 FHIR.
---

> For the complete documentation index, see [llms.txt](https://www.health-samurai.io/docs/payerbox/llms.txt).
> Use it to discover all available pages before guessing URLs.

---

# Health Insurance Information

## Datasets

[US Core 6.1.0](https://hl7.org/fhir/us/core/STU6.1/) maps each [USCDI](https://isp.healthit.gov/united-states-core-data-interoperability-uscdi#uscdi-v3-1) element to FHIR.

| Dataset | US Core 6.1.0 target profile(s) |
|---|---|
| [`coverage`](#coverage) | [US Core Coverage](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-coverage.html) |

## coverage

One row per coverage. A member with more than one plan, or a plan year that changed mid-year, produces more than one row.

| Column | Required | Format / values | Example |
|---|---|---|---|
| `patient_identifier` | Yes | patient key | `MRN-4471903` |
| `status` | Yes | `active`, `cancelled`, `draft`, `entered-in-error` [fm-status](https://hl7.org/fhir/R4/valueset-fm-status.html) | `active` |
| `member_id` | Recommended | plan member id | `HSX9930012` |
| `subscriber_id` | Recommended | text | `HSX9930012` |
| `relationship_code` | Yes | `self`, `spouse`, `child`, `other` [subscriber-relationship](https://terminology.hl7.org/CodeSystem-subscriber-relationship.html) | `self` |
| `coverage_type_code` | Recommended | Source of Payment Typology [Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion) | `1` Medicare |
| `payer_org_npi` | Yes | 10 digits, or your payer id | `1234567893` |
| `group_number` | If available | text | `GRP-4410` |
| `plan_number` | If available | text | `H6776-001` |
| `period_start` | Recommended | date | `2026-01-01` |
| `period_end` | Recommended | date | `2026-12-31` |

These resources are served by [Patient Access](../../interop-apis/patient-access.md), [Provider Access](../../interop-apis/provider-access.md), [Payer-to-Payer](../../interop-apis/payer-to-payer.md), and [Prior Auth](../../prior-auth/README.md).