UnitedHealthcare Interoperability API — Patient Access

naftiko: 1.0.0-alpha2
info:
  label: UnitedHealthcare Interoperability API — Patient Access
  description: 'UnitedHealthcare Interoperability API — Patient Access. 3 operations. Lead operation: UnitedHealthcare List
    Coverage. Self-contained Naftiko capability covering one Unitedhealthcare business surface.'
  tags:
  - Unitedhealthcare
  - Patient Access
  created: '2026-05-19'
  modified: '2026-05-19'
binds:
- namespace: env
  keys:
    UNITEDHEALTHCARE_API_KEY: UNITEDHEALTHCARE_API_KEY
capability:
  consumes:
  - type: http
    namespace: interoperability-patient-access
    baseUri: https://api.uhc.com/fhir/R4
    description: UnitedHealthcare Interoperability API — Patient Access business capability. Self-contained, no shared references.
    resources:
    - name: Coverage
      path: /Coverage
      operations:
      - name: listcoverage
        method: GET
        description: UnitedHealthcare List Coverage
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: patient
          in: query
          type: string
          description: Patient resource ID
          required: true
        - name: status
          in: query
          type: string
          description: Coverage status filter (active, cancelled, draft)
    - name: ExplanationOfBenefit
      path: /ExplanationOfBenefit
      operations:
      - name: listexplanationofbenefit
        method: GET
        description: UnitedHealthcare List Explanation of Benefits
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: patient
          in: query
          type: string
          description: Patient resource ID to retrieve EOBs for
          required: true
        - name: _lastUpdated
          in: query
          type: string
          description: Filter by last updated date (FHIR date parameter)
        - name: type
          in: query
          type: string
          description: Filter by claim type (professional, institutional, pharmacy)
        - name: _count
          in: query
          type: integer
          description: Maximum number of results to return
    - name: Patient-id
      path: /Patient/{id}
      operations:
      - name: getpatient
        method: GET
        description: UnitedHealthcare Get Patient Demographics
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: id
          in: path
          type: string
          description: FHIR Patient resource ID (member ID)
          required: true
    authentication:
      type: bearer
      token: '{{env.UNITEDHEALTHCARE_API_KEY}}'
  exposes:
  - type: rest
    namespace: interoperability-patient-access-rest
    port: 8080
    description: REST adapter for UnitedHealthcare Interoperability API — Patient Access. One Spectral-compliant resource
      per consumed operation, prefixed with /v1.
    resources:
    - path: /v1/coverage
      name: coverage
      description: REST surface for Coverage.
      operations:
      - method: GET
        name: listcoverage
        description: UnitedHealthcare List Coverage
        call: interoperability-patient-access.listcoverage
        with:
          patient: rest.patient
          status: rest.status
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/explanationofbenefit
      name: explanationofbenefit
      description: REST surface for ExplanationOfBenefit.
      operations:
      - method: GET
        name: listexplanationofbenefit
        description: UnitedHealthcare List Explanation of Benefits
        call: interoperability-patient-access.listexplanationofbenefit
        with:
          patient: rest.patient
          _lastUpdated: rest._lastUpdated
          type: rest.type
          _count: rest._count
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/patient/{id}
      name: patient-id
      description: REST surface for Patient-id.
      operations:
      - method: GET
        name: getpatient
        description: UnitedHealthcare Get Patient Demographics
        call: interoperability-patient-access.getpatient
        with:
          id: rest.id
        outputParameters:
        - type: object
          mapping: $.
  - type: mcp
    namespace: interoperability-patient-access-mcp
    port: 9090
    transport: http
    description: MCP adapter for UnitedHealthcare Interoperability API — Patient Access. One tool per consumed operation,
      routed inline through this capability's consumes block.
    tools:
    - name: unitedhealthcare-list-coverage
      description: UnitedHealthcare List Coverage
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: interoperability-patient-access.listcoverage
      with:
        patient: tools.patient
        status: tools.status
      outputParameters:
      - type: object
        mapping: $.
    - name: unitedhealthcare-list-explanation-benefits
      description: UnitedHealthcare List Explanation of Benefits
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: interoperability-patient-access.listexplanationofbenefit
      with:
        patient: tools.patient
        _lastUpdated: tools._lastUpdated
        type: tools.type
        _count: tools._count
      outputParameters:
      - type: object
        mapping: $.
    - name: unitedhealthcare-get-patient-demographics
      description: UnitedHealthcare Get Patient Demographics
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: interoperability-patient-access.getpatient
      with:
        id: tools.id
      outputParameters:
      - type: object
        mapping: $.