openapi: 3.0.3
info:
  title: Clever Care Health Plan FHIR R4 Drug Formulary Patient Access API
  version: 4.0.1
  description: HL7 FHIR R4 (4.0.1) API for Clever Care Health Plan, implementing the CMS Interoperability and Patient Access final rule (CMS-9115-F). Patient Access resources (Patient, ExplanationOfBenefit, Coverage) are secured with SMART-on-FHIR / OAuth 2.0 and OpenID Connect; Provider Directory and Drug Formulary resources are public and rate limited. ExplanationOfBenefit conforms to the CARIN Blue Button (C4BB) profiles. Served from the "Clever Care FHIR Server" on WSO2 Open Healthcare. This OpenAPI is generated by API Evangelist from the server's published FHIR CapabilityStatement (/r4/metadata) and public api-docs; it is a faithful transcription of the server's declared resources and interactions, not a provider-published spec.
  x-generated-by: api-evangelist-enrichment-pipeline
  x-source: https://fhir.clevercarehealthplan.com/r4/metadata
  x-fhir-version: 4.0.1
  contact:
    name: Clever Care Health Plan
    url: https://clevercarehealthplan.com/fhir-api-developer-resources/
servers:
- url: https://fhir.clevercarehealthplan.com/r4
  description: FHIR R4 production base URL
tags:
- name: Patient Access
  description: Secured (OpenID Connect / OAuth 2.0) member data resources
paths:
  /Patient:
    get:
      operationId: searchPatient
      summary: Search Patient
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - $ref: '#/components/parameters/id'
      - $ref: '#/components/parameters/lastUpdated'
      - $ref: '#/components/parameters/profile'
      responses:
        '200':
          $ref: '#/components/responses/Bundle'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '403':
          $ref: '#/components/responses/OperationOutcome'
  /Patient/{id}:
    get:
      operationId: readPatient
      summary: Read Patient by id
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          $ref: '#/components/responses/Resource'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '404':
          $ref: '#/components/responses/OperationOutcome'
  /ExplanationOfBenefit:
    get:
      operationId: searchExplanationOfBenefit
      summary: Search ExplanationOfBenefit (CARIN Blue Button)
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - name: patient
        in: query
        required: true
        description: Patient reference (required).
        schema:
          type: string
      - $ref: '#/components/parameters/id'
      - $ref: '#/components/parameters/lastUpdated'
      - $ref: '#/components/parameters/profile'
      - name: identifier
        in: query
        required: false
        schema:
          type: string
      - name: service-date
        in: query
        required: false
        schema:
          type: string
      - name: type
        in: query
        required: false
        schema:
          type: string
      responses:
        '200':
          $ref: '#/components/responses/Bundle'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '403':
          $ref: '#/components/responses/OperationOutcome'
  /ExplanationOfBenefit/{id}:
    get:
      operationId: readExplanationOfBenefit
      summary: Read ExplanationOfBenefit by id
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          $ref: '#/components/responses/Resource'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '404':
          $ref: '#/components/responses/OperationOutcome'
  /Coverage:
    get:
      operationId: searchCoverage
      summary: Search Coverage
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - $ref: '#/components/parameters/id'
      - $ref: '#/components/parameters/lastUpdated'
      - $ref: '#/components/parameters/profile'
      responses:
        '200':
          $ref: '#/components/responses/Bundle'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '403':
          $ref: '#/components/responses/OperationOutcome'
  /Coverage/{id}:
    get:
      operationId: readCoverage
      summary: Read Coverage by id
      tags:
      - Patient Access
      security:
      - smartOnFhir:
        - patient/*.cruds
        - user/*.cruds
      parameters:
      - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          $ref: '#/components/responses/Resource'
        '401':
          $ref: '#/components/responses/OperationOutcome'
        '404':
          $ref: '#/components/responses/OperationOutcome'
components:
  schemas:
    Bundle:
      type: object
      description: FHIR R4 Bundle (type searchset).
      properties:
        resourceType:
          type: string
          enum:
          - Bundle
        type:
          type: string
        total:
          type: integer
        link:
          type: array
          items:
            type: object
            properties:
              relation:
                type: string
              url:
                type: string
        entry:
          type: array
          items:
            type: object
            properties:
              fullUrl:
                type: string
              resource:
                type: object
    OperationOutcome:
      type: object
      description: FHIR R4 OperationOutcome error envelope.
      properties:
        resourceType:
          type: string
          enum:
          - OperationOutcome
        issue:
          type: array
          items:
            type: object
            properties:
              severity:
                type: string
                enum:
                - fatal
                - error
                - warning
                - information
              code:
                type: string
              diagnostics:
                type: string
  parameters:
    id:
      name: _id
      in: query
      description: Filter by logical id of the resource.
      required: false
      schema:
        type: string
    lastUpdated:
      name: _lastUpdated
      in: query
      description: Filter by last modification date (prefixes eq,ne,gt,lt,ge,le).
      required: false
      schema:
        type: string
    profile:
      name: _profile
      in: query
      description: Filter by conformance to a named HL7 profile.
      required: false
      schema:
        type: string
    resourceId:
      name: id
      in: path
      description: Logical id of the resource.
      required: true
      schema:
        type: string
  responses:
    Bundle:
      description: A FHIR searchset Bundle of matching resources.
      content:
        application/fhir+json:
          schema:
            $ref: '#/components/schemas/Bundle'
    OperationOutcome:
      description: A FHIR OperationOutcome describing an error.
      content:
        application/fhir+json:
          schema:
            $ref: '#/components/schemas/OperationOutcome'
    Resource:
      description: A single FHIR resource.
      content:
        application/fhir+json:
          schema:
            type: object
  securitySchemes:
    smartOnFhir:
      type: oauth2
      description: SMART-on-FHIR OAuth 2.0 (PKCE S256), OpenID Connect enabled.
      flows:
        authorizationCode:
          authorizationUrl: https://fhir-portal.clevercarehealthplan.com/oauth2/authorize
          tokenUrl: https://fhir-portal.clevercarehealthplan.com/oauth2/token
          refreshUrl: https://fhir-portal.clevercarehealthplan.com/oauth2/token
          scopes:
            openid: OpenID Connect authentication
            launch/patient: Launch in patient context
            patient/*.cruds: Patient-scoped access to permitted resources
            user/*.cruds: User-scoped access to permitted resources
        clientCredentials:
          tokenUrl: https://fhir-portal.clevercarehealthplan.com/oauth2/token
          scopes:
            openid: OpenID Connect authentication
            user/*.cruds: User-scoped access to permitted resources