coverage

name	coverage
description	Generate Coverage and insurance resources with payer diversity including Medicare, Medicaid, commercial, Tricare, VA, and self-pay. Use when user mentions coverage, insurance, payer, Medicare, Medicaid, benefits, or coordination of benefits. For claims and EOB see the claims-eob skill.
keywords	["coverage","insurance","payer","Medicare","Medicaid","commercial","BCBS","Aetna","UHC","Cigna","Tricare","VA","self-pay","uninsured","workers comp","beneficiary","subscriber","coordination of benefits"]
resource_types	["Coverage","Organization"]
always	false

Coverage and Insurance

Model payer diversity:

• Coverage resource: Include subscriber, beneficiary, payor references.
• Payer types: Medicare (Part A, B, C, D), Medicaid, Commercial (BCBS, Aetna, UHC, Cigna), Tricare, VA, Self-pay/uninsured, Workers' Comp.
• Class: group, plan, subplan, class, subclass, sequence.
• Include Coverage.type codes from http://terminology.hl7.org/CodeSystem/v3-ActCode: EHCPOL (employee healthcare), PUBLICPOL (public policy), SUBSIDIZ, MANDPOL.
• Period: coverage start/end dates, with some patients having gaps in coverage.
• Include patients with multiple coverages (primary/secondary coordination).