Benefit response

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Poll Batch Checks

Poll Batch Eligibility Checks

A free-form message containing additional information about the benefits in the response.

The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.

The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.

The United States postal code, excluding punctuation and blanks.

The state code. For example, TN for Tennessee or WA for Washington.

The `batchId` Stedi returned from the [Batch Eligibility Check](https://www.stedi.com/docs/api-reference/healthcare/post-healthcare-batch-eligibility) endpoint.

Information about the subscriber or dependents' healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, copays, etc.), out of pocket maximums, and more. Payers typically return at least the following properties: `code`, `coverageLevelCode`, `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`. However, the exact properties returned in this object are up to the payer's discretion. Visit [Payer benefit response](https://www.stedi.com/docs/healthcare/benefit-response) for more information about benefit types, details about how to interpret the response, and additional examples.

The control number you sent in the original eligibility check request.

Information about dependents listed in the original eligibility check request. Note that a dependent submitted in the request may be returned in the `subscriber` object. When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information.

When a payer rejects your eligibility check, the response contains one or more 'AAA' errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)

The implementation transaction set error code provided in `IK502` of the 999 transaction.

Deprecated; please use `benefitsInformation`.

The unique identifier for the eligibility check that you submitted in the original batch request.

A unique identifier the payer may assign to the transaction. Note that Stedi doesn't support setting a subscriber trace number in the eligibility check request because there is no need to include a trace number for real-time queries.

An ID for the payer you identified in the original eligibility check request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer.

The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://www.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5).

Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer.

The raw X12 EDI [271 Eligibility Benefit Response](https://www.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer.

Identifying information specific to this type of benefit.

Dates associated with the benefits. All properties may either be expressed as a single date, formatted as YYYYMMDD or as a range of dates, formatted as YYYYMMDD-YYYYMMDD. Dates listed only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided.

Only included when multiple plans apply to the patient or multiple plan periods apply.

Code indicating whether the benefit is subject to prior authorization or certification. can be `Y` - Yes, `N` - No or `U` - Unknown.

The monetary benefit amount, such as a patient's co-pay or deductible. This value is expressed as a decimal, such as 100.00. The payer will always send a value in this property when the `benefitsInformation.code` = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or `Y` - Spend Down. For those codes, this value represents the patient's portion of responsibility. The payer will **never** send this value when `benefitsInformation.code` = `A` - Co-Insurance. This property can contain zero when the patient has no responsibility. Learn more about [patient responsibility](https://www.stedi.com/docs/healthcare/benefit-response#patient-responsibility) codes.

The percentage of the benefit, such as co-insurance. The payer will always send a value in this property when `benefitsInformation.code` = `A` - Co-Insurance. For this code, this value represents the patient's portion of the responsibility. The percentage is expressed as a decimal, such as `0.80` represents 80%. The payer will **never** send a value in this property when `benefitsInformation.code` = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or `Y` - Spend Down. This property can contain zero when the patient has no responsibility. Learn more about [patient responsibility](https://www.stedi.com/docs/healthcare/benefit-response#patient-responsibility) codes.

The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For example, `10` when the `quantityQualifier` is `Visits`.

The delivery or usage pattern for the benefits.

The eligibility or benefit information code. Visit [Eligibility and benefit codes](https://www.stedi.com/docs/healthcare/benefit-response#eligibility-and-benefit-type-codes) for a complete list and descriptions of common codes.

The name of the coverage level code. For example `Individual`.

Code indicating the level of coverage for the patient. Can be set to `CHD` - Children Only, `DEP` - Dependents Only, `ECH` - Employee and Children, `EMP` - Employee Only, `ESP` - Employee and Spouse, `FAM` - Family, `IND` - Individual, `SPC` - Spouse and Children, or `SPO` - Spouse Only.

Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response.

The loop header identifier number in the `LS` segment of the original X12 EDI transaction.

The name of the in-plan network indicator code. For example, `Yes`.

Code indicating whether the benefit is in-network or out-of-network. Can be `Y` - Yes, `N` - No, `U` - Unknown, or `W` - Not Applicable (when benefits are the same regardless or the plan network does not apply to the benefit). Note that this **does not indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly.

The name of the insurance type code. For example `Medicaid`.

Code identifying the type of insurance policy. For example `MC` - Medicaid.

The name of the benefit information code. For example, `Deductible`.

The specific product name or special program name for an insurance plan. For example `Gold 1-2-3`.

The name of the quantity qualifier code. For example, `Visits`.

Code indicating the type of quantity for the benefit. For example `VS` - Visits.

Codes identifying the type of services. For example, `7` - Anesthesia. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. Note that the word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals.

The full name of the listed `serviceTypeCodes`. For example `Psychiatric`, `Social Work`, etc. This may be empty if the payer sends unrecognized codes in the response.

The name of the time period qualifier code. For example `Calendar Year`.  Note that for the patient's deductible, `Calendar Year` indicates the patient's total deductible amount for the year, while `Remaining` indicates the amount left to meet the deductible. Visit [Payer benefit response](https://www.stedi.com/docs/healthcare/benefit-response#deductible) to learn more.

Code indicating the time period for the benefit information. For example `23` - Calendar Year.

The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction.

The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`.

Code that specifies the routine shipments, deliveries, or calendar pattern. For example `9` - Last Working Day of Period.

The name of the `deliveryPatternTimeCode`. For example, `P.M.`.

Code that specifies the time for routine shipments or deliveries. For example `E` - P.M.

The number of periods in the time period. For example, `12` when the `timePeriodQualifier` is `Hour`.

The quantity of the benefit. For example, `10` when the `quantityQualifier` is `Visits`.

The name of the `quantityQualifierCode`. For example, `Days`.

Code specifying the type of quantity. Can be set to `DY` - Days, `FL` - Units, `HS` - Hours, `MN` - Month, or `VS` - Visits.

Specifies the sampling frequency, based on the unit of measure. For example `every 2 months` or `once per calendar year`.

The name of the `timePeriodQualifierCode`. For example, `Calendar Year`.

Code specifying the time period for the benefit information. Can be set to `6` - Hour, `7` - Day, `21` - Years, `22` - Service Year, `23` - Calendar Year, `24` - Year to Date, `25` - Contract, `26` - Episode, `27` - Visit, `28` - Outlier, `29` - Remaining, `30` - Exceeded, `31` - Not Exceeded, `32` - Lifetime, `33` - Lifetime Remaining, `34` - Month, or `35` - Week.

The name of the `unitForMeasurementQualifierCode`. For example, `Days`.

Code specifying the unit of measurement for the quantity. Can be set to `DA` - Days, `MO` - Months, `VS` - Visit, `WK - Week, or `YR` - Years.

Identifies relevant medical procedures by their standard codes and modifiers (if applicable).

The procedure code. Many payers do not support eligibility checks for specific procedure codes. If the payer does not support procedure codes, they return a generic benefits response for the service type code `30`.

Procedure modifiers that provides additional information related to the performance of the service.

The product or service ID. This value represents the end of the range of applicable procedure codes. The beginning of the range is listed in `procedureCode`.

The name of the `productOrServiceIdQualifierCode`. For example, `American Dental Association`.

Identifies the external code list used to provide the specified procedure or service codes. Can be set to `AD` - American Dental Association, `CJ` - Current Procedural Terminology (CPT) codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually Defined

The type of communication number provided. Can be `ED` - Electronic Data Interchange Access Number, `EM` - Electronic Mail, `FX` - Facsimile, `TE` - Telephone, or `UR` - Uniform Resource Locator (URL).

The communication number referenced in `communicationMode`. It includes the country or area code when applicable. Note that phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`.

The end date of a range, formatted as YYYYMMDD.

The beginning date of a range, formatted as YYYYMMDD.

Identify the Nature of Injury Code or a Facility Type Code.

The code category. Always set to `44` - Nature of Injury.

The name of the `codeListQualifierCode`. For example `Mutually Defined` when the code is set to `ZZ`.

Identifies a specific industry code list. Can be `GR` - National Council on Compensation Insurance (NCCI) Nature of Injury Code, `NI` - Nature of Injury Code, or `ZZ` - Mutually Defined.

The name of the `industryCode`. For example `Pharmacy` when the code is `01`.

When a payer rejects your eligibility check, the response contains one or more AAA errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)

Allowed actions you can take, based on the rejection reason code. For example `Please Correct and Resubmit`.

The location of the error within the original X12 EDI response.

Information to help you correct the error.

Metadata about the response. Stedi uses this data for tracking and troubleshooting.

The type of data in the request. This is always `production`.

The biller ID Stedi assigns to this request.

The value provided in the `submitterTransactionIdentifier` property in the original eligibility check request.

The sender ID Stedi assigns to this request.

The submitter ID Stedi assigns to this request.

The unique ID Stedi assigns to this request.

Information about the patient's healthcare diagnosis.

The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed.

The type of diagnosis code provided. It can be `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis.

Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer's tax ID. Most payers also include contact information.

When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `payer` level include issues with payer enrollment and that the payer's system is down or experiencing issues. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)

The payer's Centers for Medicare and Medicaid Services PlanID.

Deprecated; The payer's identification number for the entity receiving the benefits information.

The entity identifier code for the payer. Can be set to `2B` - Third-Party Administrator, `36` - Employer, `GP` - Gateway Provider, `P5` Plan Sponsor, or `PR` - Payer.

The entity type qualifier for the payer. Can be set to `1` - Person (not commonly used) or `2` - Non-Person Entity (most common).

The payer's Electronic Transmitter Identification Number (ETIN).

The payer's federal taxpayer's identification number.

The payer's first name. Used when the payer is an individual (not commonly used).

The payer's last name. Used when the payer is an individual (not commonly used).

The payer's middle name or initial. Used when the payer is an individual (not commonly used).

The payer's National Association of Insurance Commissioners (NAIC) identification number.

The payer's business name. Used when the payer is not a person.

The payer's National Provider Identifier (NPI).

National Provider Identifier (NPI)

The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used).

Contains the dates associated with the subscriber's insurance plan. This information is used to determine the patient's eligibility for benefits. All dates are formatted as YYYYMMDD (for single dates) or as YYYYMMDD-YYYYMMDD (for date ranges). The provided dates apply to every every benefit within the patient's health plan unless specifically noted within a `benefitsInformation.benefitsDateInformation` object. Properties contain a single date unless otherwise noted. Most payers return either `plan` or `planBegin` and `planEnd`, but the exact dates returned depend on the payer's discretion and the patient's insurance plan.

Formatted as YYYYMMDD (for single dates) or as YYYMMDD-YYYYMMDD (for date ranges).

Can be formatted as a single date or as a range of dates in YYYYMMDD-YYYYMMDD format.

Can be formatted either a single date, or as a range of dates in YYYYMMDD-YYYYMMDD format.

Can be formatted as a single date, or as a range of dates in YYYYMMDD-YYYYMMDD format.

Additional identification for the subscriber's healthcare plan.

The agency claim number, only used when the information source is a Property and Casualty payer.

The alternative list ID - identifies a list of alternative drugs with the associated formulary status for the patient.

The National Provider Identifier (NPI) assigned by the Centers for Medicare and Medicaid Services

The class of contract code - used to identify the applicable class of contract for claims processing.

The contract number of a contract between the payer and the provider that requested the eligibility check.

The coverage list ID - identifies a list of drugs that have coverage limitations for the patient.

The facility network identification number

The federal taxpayer's identification number

The identity card number, used when the Identity Card Number is different than the Member Identification Number.

The identification card serial number. The Identification Card Serial Number uniquely identifies the identification card when multiple cards have been or will be issued to a member, such as a replacement card.

The Medicaid recipient identification number

The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer.

The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response.

Social Security Number (SSN)

The provider's taxonomy code. Can be set to `AD` - Admitting, `AT` - Attending, `BI` - Billing, `CO` - Consulting, `CV` - Covering, `H` - Hospital, `HH` - Home Health Care, `LA` - Laboratory, `OT` - Other Physician, `P1` - Pharmacist, `P2` - Pharmacy, `PC` - Primary Care Physician, `PE` - Performing, `R` - Rural Health Clinic, `RF` - Referring, `SB` - Submitting, `SK` - Skilled Nursing Facility, or `SU` - Supervising.

Information about the primary policyholder for the insurance plan listed in the original eligibility check request. The response will always include either the subscriber's name or member ID for identification, but most payers will also return the subscriber's date of birth and other identifying information.

When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)

The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date.

The patient's date of birth, formatted as YYYMMDD.

The format of the date and time period. Can be set to `D8` - Date or `RD8` - Range of Dates.

Context that identifies the exact military unit. Used to report military service data.

The patient's employment status code, used to report military service data. Can be set to `AE` - Active Reserve, `AO` - Active Military - Overseas, `AS` - Academy Student, `AT` - Presidential Appointee, `AU` - Active Military - USA, `CC` - Contractor, `DD` - Dishonorably Discharged, `HD` - Honorably Discharged, `IR` - Inactive Reserves, `LX` - Leave of Absence: Military, `PE` - Plan to Enlist, `RE` - Recommissioned, `RM` - Retired Military - Overseas, `RR`- Retired Without Recall, or `RU` - Retired Military - USA.

The end of a time period, formatted as YYYYMMDD.

The entity identifier for the patient. It can be set to `IL` - Insured or Subscriber, or `03` - Dependent.

The entity type for the patient. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`.

The patient's government service affiliation code, used to report military service data. Can be set to `A` - Air Force, `B` - Air Force Reserves, `C` - Army, `D` - Army Reserves, `E` - Coast Guard, `F` - Marine Corps, `G` - Marine Corps Reserves, `H` - National Guard, `I` - Navy, `J` - Navy Reserves, `K` - Other, `L`- Peace Corp, `M` - Regular Armed Forces, `N` - Reserves, `O` - U.S. Public Health Service, `Q` - Foreign Military, `R` - American Red Cross, `S` - Department of Defense, `U` - United States Organization, `W` - Military Sealift Command.

The group number associated with the subscriber's insurance policy.

The status of the patient's information, used to report military service data. Can be set to `A` - Partial, `C` - Current, `L` - Latest, `O` - Oldest, `P` - Prior, `S` - Second Most Current, or `T` - Third Most Current.

Indicates the status of the insured. A `Y` value indicates the insured is a subscriber. When set to `N`, the insured is a dependent.

Code identifying the reason for the changes to patient identifying information, such as name, date of birth, or address. Set to `25` - Change in Identifying Data Elements.

The maintenance type code. Used to acknowledge a change in the identifying elements for the patient from those submitted in the original eligibility check request. It can also be included when the payer used the birth sequence number from the original request to locate the subscriber in their system. Set to `001` - Change.

The member ID for the subscriber's insurance policy.

The patient's military service rank code. Can be set to `A1` - Admiral, `A2` - Airman, `A3` - Airman First Class, `B1` - Basic Airman, `B2` - Brigadier General, `C1` - Captain, `C2` - Chief Master Sergeant, `C3` - Chief Petty Officer, `C4` - Chief Warrant, `C5` - Colonel, `C6` - Commander, `C7` - Commodore, `C8` - Corporal, `C9` - Corporal Specialist 4, `E1` - Ensign, `F1` - First Lieutenant, `F2` - First Sergeant, `F3` - First Sergeant-Master Sergeant, `F4` - Fleet Admiral, `G1` - General, `G4` - Gunnery Sergeant, `L1` - Lance Corporal, `L2` - Lieutenant, `L3` - Lieutenant Colonel, `L4` - Lieutenant Commander, `L5` - Lieutenant General, `L6` - Lieutenant Junior Grade, `M1` - Major, `M2` - Major General, `M3` - Master Chief Petty Officer, `M4` - Master Gunnery Sergeant Major, `M5` - Master Sergeant, `M6` - Master Sergeant Specialist 8, `P1` - Petty Officer First Class, `P2` - Petty Officer Second Class, `P3` - Petty Officer Third Class, `P4` - Private, `P5` - Private First Class, `R1` - Rear Admiral, `R2` - Recruit, `S1` - Seaman, `S2` - Seaman Apprentice, `S3` - Seaman Recruit, `S4` - Second Lieutenant, `S5` - Senior Chief Petty Officer, `S6` - Senior Master Sergeant, `S7` - Sergeant, `S8` - Sergeant First Class Specialist 7, `S9` - Sergeant Major Specialist 9, `SA` - Sergeant Specialist 5, `SB` - Staff Sergeant, `SC` - Staff Sergeant Specialist 6, `T1` - Technical Sergeant, `V1` - Vice Admiral, `W1` - Warrant Officer.

The network identification number associated with the subscriber's insurance policy.

The plan number associated with the subscriber's insurance policy.

The name of the `relationToSubscriberCode`. For example `Self` when the code is set to `18`.

For the subscriber, this is set to `18` for Self. For dependents, it can be set to `01` - Spouse, `19` - Child, `20` Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship.

The patient's Social Security Number (SSN).

The start of a time period, formatted as YYYYMMDD.

The name suffix, such as Jr., Sr., or III.

Code indiciating the patient's gender. Can be `F` - Female, `M` - Male, or `U` - Unknown.

Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. This object will always include at least one identifier, such as the provider's NPI, tax ID, or EIN.

When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `provider` level include missing or incorrect information and issues with the provider's NPI registration with the payer. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)

Deprecated; The Employer's Identification Number (EIN). Only used when an employer is checking the eligibility and benefits of their employees.
This shape is deprecated: This property is no longer used.

A code identifying the type of provider. Can be `Provider`, `Third-Party Administrator`, `Employer`, `Hospital`, `Facility`, `Gateway Provider`, `Plan Sponsor`, or `Payer`.

The type of entity. Can be `Person` or `Non-Person Entity`.

The Federal Taxpayer Identification Number (also known as an EIN).

The provider's middle name. This applies to providers that are an individual.

The provider's National Provider Identifier (NPI).

A code that communicates the provider's role in the type of benefits information in the response. Can be one of the following: `AD` - Admitting, `AT` - Attending, `BI` - Billing, `CO` - Consulting, `CV` - Covering, `H` - Hospital, `HH` - Home Health Care, `LA` - Laboratory, `OT` - Other Physician, `P1` - Pharmacist, `P2` - Pharmacy, `PC` - Primary Care Physician, `PE` - Performing, `R` - Rural Health Clinic, `RF` - Referring, `SB` - Submitting, `SK` - Skilled Nursing Facility, `SU` - Supervising.

The provider's first name. This applies to providers that are an individual.

The provider's last name. This applies to providers that are an individual.

The service provider number. This is an identification number assigned by the payer.

The Centers for Medicare and Medicaid Services (CMS) Plan ID.

The provider's name suffix, such as Jr., Sr., or III.

The unique trace number assigned to the transaction by either the payer, the provider, or the clearinghouse.

The identifier of the organization that assigned the trace number.

The unique trace number assigned to the transaction.

Identifies a subdivision within the organization that assigned the trace number.

The full name of the `traceTypeCode`. For example `Current Transaction Trace Numbers`.

The code that identifies the type of trace number. Can be set to `1` - Current Transaction Trace Numbers (refers to trace numbers assigned by the payer) or `2` - Referenced Trace Numbers (refers to numbers sent in the original eligibility check request).

Describes one specific validation failure for an input member.

A detailed description of the validation failure.

A JSONPointer expression to the structure member whose value failed to satisfy the modeled constraints.

httpApiKeyAuth

A standard error for input validation failures.
This should be thrown by services when a member of the input structure
falls outside of the modeled or documented constraints.

The server response when the authorizer failed to authenticate the caller.

//// Errors
The server response when the specified resource cannot be found after an API request passes authentication and authorization.

Healthcare

EDI platform

Poll Batch Eligibility Checks

Benefit response

Authorizations

Query Parameters

Response

Healthcare

EDI platform

​Benefit response

Authorizations

Query Parameters

Response

Benefit response