WellCare Member Care Coordination

naftiko: "1.0.0-alpha1"

info:
  label: "WellCare Member Care Coordination"
  description: >-
    Unified care coordination capability combining WellCare FHIR Patient Access
    and Provider Directory APIs. Enables care managers, app developers, and
    member-facing apps to access a member's complete health record alongside
    in-network provider and facility information for coordinated care delivery
    across Medicaid and Medicare Advantage plans.
  tags:
    - Healthcare
    - FHIR
    - Care Coordination
    - Patient Access
    - Provider Directory
    - Managed Care
    - Medicaid
    - Medicare
  created: "2026-05-03"
  modified: "2026-05-03"

binds:
  - namespace: env
    keys:
      WELLCARE_PATIENT_ACCESS_TOKEN: WELLCARE_PATIENT_ACCESS_TOKEN
      WELLCARE_PROVIDER_DIRECTORY_TOKEN: WELLCARE_PROVIDER_DIRECTORY_TOKEN

capability:
  consumes:
    - import: wellcare-patient-access
      location: ./shared/fhir-patient-access.yaml
    - import: wellcare-provider-directory
      location: ./shared/fhir-provider-directory.yaml

  exposes:
    - type: rest
      port: 8080
      namespace: wellcare-care-coordination-api
      description: "Unified REST API for WellCare member care coordination."
      resources:
        - path: /v1/members/{id}
          name: member-profile
          description: "Member demographic and identity."
          operations:
            - method: GET
              name: get-member
              description: "Get member profile by FHIR Patient ID."
              call: "wellcare-patient-access.get-patient"
              with:
                id: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/members/{id}/coverage
          name: member-coverage
          description: "Member insurance coverage and enrollment."
          operations:
            - method: GET
              name: get-member-coverage
              description: "Get coverage for a member."
              call: "wellcare-patient-access.list-coverage"
              with:
                patient: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/members/{id}/claims
          name: member-claims
          description: "Member claims history."
          operations:
            - method: GET
              name: get-member-claims
              description: "Get EOB claims for a member."
              call: "wellcare-patient-access.list-explanation-of-benefit"
              with:
                patient: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/members/{id}/conditions
          name: member-conditions
          description: "Member clinical conditions."
          operations:
            - method: GET
              name: get-member-conditions
              description: "Get conditions for a member."
              call: "wellcare-patient-access.list-conditions"
              with:
                patient: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/members/{id}/medications
          name: member-medications
          description: "Member active medications."
          operations:
            - method: GET
              name: get-member-medications
              description: "Get medication requests for a member."
              call: "wellcare-patient-access.list-medication-requests"
              with:
                patient: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/members/{id}/encounters
          name: member-encounters
          description: "Member care encounters."
          operations:
            - method: GET
              name: get-member-encounters
              description: "Get care encounters for a member."
              call: "wellcare-patient-access.list-encounters"
              with:
                patient: "rest.id"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/providers
          name: network-providers
          description: "In-network providers."
          operations:
            - method: GET
              name: search-providers
              description: "Search in-network providers by specialty or name."
              call: "wellcare-provider-directory.search-practitioners"
              with:
                name: "rest.name"
                specialty: "rest.specialty"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/facilities
          name: network-facilities
          description: "In-network facilities."
          operations:
            - method: GET
              name: search-facilities
              description: "Search in-network hospitals and clinics."
              call: "wellcare-provider-directory.search-organizations"
              with:
                name: "rest.name"
                type: "rest.type"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/locations
          name: care-locations
          description: "Care delivery locations."
          operations:
            - method: GET
              name: search-locations
              description: "Find care locations by ZIP code."
              call: "wellcare-provider-directory.search-locations"
              with:
                address-postalcode: "rest.postalcode"
              outputParameters:
                - type: object
                  mapping: "$."

        - path: /v1/plans
          name: insurance-plans
          description: "Insurance plan information."
          operations:
            - method: GET
              name: search-plans
              description: "Search insurance plans."
              call: "wellcare-provider-directory.search-insurance-plans"
              with:
                name: "rest.name"
                type: "rest.type"
              outputParameters:
                - type: object
                  mapping: "$."

    - type: mcp
      port: 9090
      namespace: wellcare-care-coordination-mcp
      transport: http
      description: "MCP server for AI-assisted WellCare member care coordination."
      tools:
        - name: get-member-profile
          description: "Get a WellCare member's demographic profile and contact information."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.get-patient"
          with:
            id: "tools.patient_id"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-coverage
          description: "Get insurance coverage and enrollment details for a WellCare member."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-coverage"
          with:
            patient: "tools.patient_id"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-claims-history
          description: "Get historical claims and EOB data for a WellCare member. Supports up to 5 years of history."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-explanation-of-benefit"
          with:
            patient: "tools.patient_id"
            type: "tools.claim_type"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-active-conditions
          description: "Get active diagnoses and conditions for a WellCare member."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-conditions"
          with:
            patient: "tools.patient_id"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-medications
          description: "Get current and historical medication prescriptions for a WellCare member."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-medication-requests"
          with:
            patient: "tools.patient_id"
            status: "tools.status"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-immunization-history
          description: "Get immunization records and history for a WellCare member."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-immunizations"
          with:
            patient: "tools.patient_id"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-member-care-encounters
          description: "Get care visit and encounter history for a WellCare member."
          hints:
            readOnly: true
            openWorld: false
          call: "wellcare-patient-access.list-encounters"
          with:
            patient: "tools.patient_id"
          outputParameters:
            - type: object
              mapping: "$."

        - name: search-in-network-providers
          description: "Search for in-network WellCare providers by name or specialty."
          hints:
            readOnly: true
            openWorld: true
          call: "wellcare-provider-directory.search-practitioners"
          with:
            name: "tools.provider_name"
            specialty: "tools.specialty"
            identifier: "tools.npi"
          outputParameters:
            - type: object
              mapping: "$."

        - name: find-network-facilities
          description: "Search for in-network hospitals, clinics, and healthcare facilities."
          hints:
            readOnly: true
            openWorld: true
          call: "wellcare-provider-directory.search-organizations"
          with:
            name: "tools.facility_name"
            type: "tools.facility_type"
          outputParameters:
            - type: object
              mapping: "$."

        - name: find-care-locations-near-zip
          description: "Find WellCare in-network care delivery locations near a ZIP code."
          hints:
            readOnly: true
            openWorld: true
          call: "wellcare-provider-directory.search-locations"
          with:
            address-postalcode: "tools.zip_code"
          outputParameters:
            - type: object
              mapping: "$."

        - name: get-plan-information
          description: "Get WellCare insurance plan details including network and benefit information."
          hints:
            readOnly: true
            openWorld: true
          call: "wellcare-provider-directory.search-insurance-plans"
          with:
            name: "tools.plan_name"
            type: "tools.plan_type"
          outputParameters:
            - type: object
              mapping: "$."