version: "1.0.1" 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).