Authenticate using SMART App Launch (patient-facing) or SMART Backend Services (system-level), obtaining a token with the appropriate scopes for Coverage resource access (verify required scopes in the CARIN Blue Button IG).
Query for the patient's Coverage resources: GET [base]/Coverage?patient=[id]&status=active (or omit status filter if historical coverage is needed).
Parse the returned Coverage resources against the CARIN Blue Button Coverage profile; key elements include Coverage.subscriber, Coverage.subscriberId, Coverage.beneficiary (patient), Coverage.payor (the insurance company), Coverage.class (group and plan information), Coverage.period, and Coverage.relationship.
Extract payer-specific plan identifiers from Coverage.class slices (group, plan, subPlan) to understand the patient's benefit plan hierarchy.
Link Coverage resources to ExplanationOfBenefit resources by matching Coverage.id to EOB.insurance.coverage for claims analysis.
Validate the returned Coverage resources against the CARIN Blue Button Coverage profile to confirm conformance before downstream processing.
Known gotchas
CARIN Blue Button Coverage profiles use specific slicing on Coverage.class for group and plan identifiers — a generic FHIR Coverage parser may not extract these slices correctly without IG-aware logic.
Coverage.payor references an Organization resource; confirm whether the Organization is included in the response Bundle or must be fetched separately via the referenced URL.
Active coverage at query time does not guarantee claims will be available; EOB queries may return data for coverage periods that differ from the currently active Coverage resource period.
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp