Coverage Areas

Datasets

Part of the Payer Plans group of the Drug Formulary feed, built to Da Vinci PDex US Drug Formulary STU 2.1.0. The feed's data conventions apply.

Dataset	US Drug Formulary STU 2.1.0 target profile
`coverage_areas`	Insurance Plan Location (Location)

coverage_areas

One row per geographic area a plan is offered in. A plan sold in one state has one area; a plan sold county by county has one per county. payer_plans and formularies point at these rows through coverage_area_ids.

Column	Required	Format / values	Example
`coverage_area_id`	Yes	your stable key for the area; `payer_plans` and `formularies` reference it	`AREA-NY`
`name`	Yes	text; how the area is known	`New York State`
`aliases`	If renamed	earlier names, `;`-separated
`status`	Recommended	`active`, `suspended`, `inactive` location-status	`active`
`type_codes`	If available	roles of the location, `;`-separated, from ServiceDeliveryLocationRoleType
`phone`	If available	10 digits; a number for the area, such as a regional member line; several `;`-separated	`8885551002`
`fax`	If available	10 digits; several `;`-separated
`email`	If available	email addresses, `;`-separated
`url`	If available	web addresses, `;`-separated	`https://example.org/areas/ny`
`address_line1`	If available	text
`address_line2`	If available	text
`city`	If available	text
`state`	Yes, unless `region_geojson` is sent	2-letter USPS state the area lies in	`NY`
`zip`	If available	5 digits, as a string
`latitude`	If available	decimal, WGS84; a point inside the area	`42.9538`
`longitude`	If available	decimal, WGS84	`-75.5268`
`region_geojson`	If a boundary	the area's boundary as a GeoJSON Feature or geometry, the whole document in one cell, quoted per RFC 4180	`{"type":"Polygon","coordinates":[[[-74.3,40.5],[-73.7,40.5],[-73.7,40.9],[-74.3,40.9],[-74.3,40.5]]]}`
`managing_org_npi`	Recommended	10 digits; the organization responsible for the area, usually the plan sponsor; key from `organizations`	`9999999993`
`last_updated`	Recommended	datetime the area last changed in your system	`2026-10-01T09:00:00-05:00`
`is_deleted`	If retracting	`true` retracts this row	`true`

The profile requires an address or a boundary. A state-wide area needs only state; a nationwide area sends state blank and a boundary. A county or service area sends region_geojson, and the address columns describe where it lies.
name is mandatory and is what a member's app shows. Name the area, not the plan: New York State, Bronx County, United States.
latitude and longitude are one FHIR element: send both or neither.
type_codes is must-support in the profile but describes the function of a physical site, which a coverage area rarely has. Leave it blank unless your source classifies areas.
Not collected: endpoint, hoursOfOperation, operationalStatus, partOf, and further identifiers beyond coverage_area_id.
region_geojson is the boundary itself, not a link to it. Payerbox encodes the cell and publishes it as the data of the boundary attachment the IG defines, typed application/geo+json, so the Location is self-contained for bulk export and offline clients. The cell must be valid JSON; a cell that does not parse is rejected. Because GeoJSON contains commas and double quotes, the cell has to be enclosed in double quotes with every inner quote doubled, which every CSV writer does when told to quote the field.
Keep boundaries as simple as the use allows. A state or county outline of a few hundred points is fine; a parcel-level polygon of tens of thousands is not what a member's app needs and makes the file hard to handle.

These resources are served by Patient Access.