AmeriHealth Caritas Claims & EOB

naftiko: 1.0.0-alpha2
info:
  label: AmeriHealth Caritas Claims & EOB
  description: >-
    Naftiko capability wrapping the AmeriHealth Caritas Patient Access
    FHIR R4 resources that surface a member's coverage and claims:
    Coverage, Claim, and ExplanationOfBenefit (CARIN Blue Button). Read-
    only; bearer-token-authorized; one tool per FHIR resource.
  tags:
    - AmeriHealth Caritas
    - Claims
    - EOB
    - Coverage
    - CARIN Blue Button
    - FHIR
  created: '2026-05-23'
  modified: '2026-05-23'
binds:
  - namespace: env
    keys:
      AHC_PATIENT_BEARER_TOKEN: AHC_PATIENT_BEARER_TOKEN
capability:
  consumes:
    - type: http
      namespace: ahc-claims-eob
      baseUri: https://api-ext.amerihealthcaritas.com/0500/patient-api
      description: AmeriHealth Caritas FHIR claims & coverage surface.
      resources:
        - name: Coverage
          path: /Coverage
          operations:
            - name: searchCoverage
              method: GET
              description: Search Coverage for a patient
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
        - name: Claim
          path: /Claim
          operations:
            - name: searchClaim
              method: GET
              description: Search Claim resources for a patient
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
        - name: ExplanationOfBenefit
          path: /ExplanationOfBenefit
          operations:
            - name: searchExplanationOfBenefit
              method: GET
              description: Search ExplanationOfBenefit (CARIN BB) for a patient
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
      authentication:
        type: bearer
        token: '{{env.AHC_PATIENT_BEARER_TOKEN}}'
  exposes:
    - type: rest
      namespace: ahc-claims-eob-rest
      port: 8080
      description: REST adapter for claims & EOB.
      resources:
        - path: /v1/coverage
          name: coverage
          description: Search Coverage for a patient
          operations:
            - method: GET
              name: searchCoverage
              description: Search Coverage
              call: ahc-claims-eob.searchCoverage
              with:
                patient: rest.patient
              outputParameters:
                - type: object
                  mapping: $.
        - path: /v1/claims
          name: claims
          description: Search Claim for a patient
          operations:
            - method: GET
              name: searchClaims
              description: Search Claim
              call: ahc-claims-eob.searchClaim
              with:
                patient: rest.patient
              outputParameters:
                - type: object
                  mapping: $.
        - path: /v1/eob
          name: explanation-of-benefit
          description: Search ExplanationOfBenefit for a patient
          operations:
            - method: GET
              name: searchExplanationOfBenefit
              description: Search ExplanationOfBenefit
              call: ahc-claims-eob.searchExplanationOfBenefit
              with:
                patient: rest.patient
              outputParameters:
                - type: object
                  mapping: $.
    - type: mcp
      namespace: ahc-claims-eob-mcp
      port: 9090
      transport: http
      description: MCP adapter for claims & EOB.
      tools:
        - name: search-coverage
          description: Search Coverage for a patient
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ahc-claims-eob.searchCoverage
          with:
            patient: tools.patient
        - name: search-claim
          description: Search Claim for a patient
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ahc-claims-eob.searchClaim
          with:
            patient: tools.patient
        - name: search-explanation-of-benefit
          description: Search ExplanationOfBenefit (CARIN BB) for a patient
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ahc-claims-eob.searchExplanationOfBenefit
          with:
            patient: tools.patient