Health Insurance Information
Datasets
US Core 6.1.0 maps each USCDI data element onto a FHIR element.
| Dataset | US Core 6.1.0 target profile(s) |
|---|---|
coverage | US Core Coverage |
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 |
|---|---|---|---|
record_id | Yes | your stable key for this coverage | COV-0001 |
patient_identifier | Yes | patient key | MRN-4471903 |
status | Yes | active, cancelled, draft, entered-in-error fm-status | active |
member_id | Yes, unless subscriber_id is sent | plan member id | HSX9930012 |
subscriber_id | Yes, unless member_id is sent | text | HSX9930012 |
relationship_code | Yes | self, spouse, child, other subscriber-relationship | self |
coverage_type_code | Recommended | Source of Payment Typology Payer Type | 1 Medicare |
payer_org_npi | Yes | 10 digits, Luhn-valid over the 80840 prefix, or your payer id | 9999999979 |
group_number | If available | text | GRP-4410 |
group_name | If available | text | Acme Manufacturing |
plan_number | If available | text | H6776-001 |
plan_name | If available | text | Gold PPO |
period_start | Recommended | date | 2026-01-01 |
period_end | Recommended | date | 2026-12-31 |
is_deleted | If retracting | true retracts this row | true |
- Send at least one of
member_idandsubscriber_id. US Core requires a member id or a subscriber id on every Coverage, so a row with neither cannot become one. - A group or plan name travels with its number: send
group_numberwithgroup_name, andplan_numberwithplan_name.
These resources are served by Patient Access, Provider Access, Payer-to-Payer, and Prior Auth.