Healthcare
- Payers
- Transaction enrollment
- Eligibility checks
- Coordination of benefits
- Claim submission
- Claim status
- Remittances
EDI platform
- Transaction
- Interchange
- File execution
- Fragments
- Mappings
- Events
Poll Batch Eligibility Checks
curl --request GET \
--url https://manager.us.stedi.com/2024-04-01/eligibility-manager/polling/batch-eligibility \
--header 'Authorization: <api-key>'{
"nextPageToken": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"items": [
{
"controlNumber": "000022222",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"status": "ERROR",
"meta": {
"outboundTraceId": "01JCP62EYY1N6PZABF9Q45EN5Y"
},
"errors": [
{
"followupAction": "Please Correct and Resubmit",
"possibleResolutions": "Payer TEST is not configured. Please check our published payer list or contact Stedi support to resolve.",
"code": "79",
"description": "Invalid Participant Identification",
"location": "2100A"
}
],
"tradingPartnerServiceId": "TEST",
"submitterTransactionIdentifier": "ABC123456789"
},
{
"controlNumber": "333344444",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"submitterTransactionIdentifier": "DEF123456799",
"meta": {
"senderId": "030240928",
"submitterId": "117151744",
"applicationMode": "production",
"traceId": "01J2VZA127GH93JT74HJU",
"outboundTraceId": "01J2VZA127GH93JT74HJU"
},
"reassociationKey": "123456789",
"tradingPartnerServiceId": "123456789",
"provider": {
"providerName": "ACME HEALTH SERVICES",
"entityIdentifier": "Provider",
"entityType": "Non-Person Entity",
"npi": "1234567890"
},
"subscriber": {
"memberId": "1234567892",
"firstName": "JANE",
"lastName": "DOE",
"middleName": "A",
"gender": "F",
"entityIdentifier": "Insured or Subscriber",
"entityType": "Person",
"dateOfBirth": "19000101",
"groupNumber": "123456789",
"address": {
"address1": "1234 FIRST ST",
"city": "NEW YORK",
"state": "WV",
"postalCode": "123451111"
}
},
"payer": {
"entityIdentifier": "Payer",
"entityType": "Non-Person Entity",
"lastName": "ABCDE",
"name": "ABCDE",
"federalTaxpayersIdNumber": "123412345",
"contactInformation": {
"contacts": [
{
"communicationMode": "Telephone",
"communicationNumber": "1234567890"
},
{
"communicationMode": "UR",
"communicationNumber": "website.company.com"
}
]
}
},
"planInformation": {
"groupNumber": "12341234",
"groupDescription": "ABCDE",
"priorIdNumber": "1234567890"
},
"planDateInformation": {
"planBegin": "20240101",
"planEnd": "20241231",
"eligibilityBegin": "20220102"
},
"planStatus": [
{
"statusCode": "1",
"status": "Active Coverage",
"planDetails": "Open Access Plus",
"serviceTypeCodes": [
"30"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"MH"
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"planCoverage": "Open Access Plus",
"additionalInformation": [
{
"description": "Complete Care Management"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "6000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "500",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "3000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "250",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "30000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.1",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "7500",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Deductible does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.5",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
],
"serviceTypes": [
"Psychiatric - Inpatient",
"Day Care (Psychiatric)",
"Psychiatric - Outpatient",
"Psychiatric",
"Psychiatric - Room and Board",
"Psychotherapy",
"Anesthesia",
"Diagnostic X-Ray",
"Partial Hospitalization (Psychiatric)",
"Social Work"
],
"inPlanNetworkIndicatorCode": "W",
"inPlanNetworkIndicator": "Not Applicable"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"BC",
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Day Care (Psychiatric)",
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A8"
],
"serviceTypes": [
"Psychiatric - Outpatient"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitPercent": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "CB",
"name": "Coverage Basis",
"serviceTypeCodes": [
"7",
"BB"
],
"serviceTypes": [
"Anesthesia",
"Partial Hospitalization (Psychiatric)"
],
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitAmount": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitPercent": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"4"
],
"serviceTypes": [
"Diagnostic X-Ray"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"4"
],
"serviceTypes": [
"Diagnostic X-Ray"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"BB"
],
"serviceTypes": [
"Partial Hospitalization (Psychiatric)"
],
"benefitAmount": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"MH"
],
"serviceTypes": [
"Mental Health"
],
"additionalInformation": [
{
"description": " Provider is out of network based on NPI ID provided in request."
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "5760",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "500",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "2760",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "250",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "30000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "7500",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Deductible does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
}
]
}
],
"errors": [],
"x12": "ISA*00* *00* *ZZ*STEDI *01*117151744 *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*11234567890~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~"
}
]
}This endpoint retrieves the results of asynchronous eligibility checks you submitted through the asynchronous Batch Eligibility Checks endpoint. It doesn’t return results for real-time eligibility checks.
The response only includes completed checks, so a single polling attempt may not retrieve responses for all checks within the batch, especially if you poll soon after initial submission. Stedi retries checks that fail due to payer processing issues for up to 8 hours.
Polling recommendations
We recommend beginning to poll after 2 minutes, using an exponential backoff with jitter. For example, you might use something similar to the following formula:
wait_time = min(120 * 2^attempt, max_wait) + random(0, 30s)
In this formula:
120: Initial wait time (2 minutes)attempt: Current retry attempt number (0-based)max_wait: Maximum wait time cap (8 hours)random(0, 30s): Random jitter between 0-30s
Pagination
The response includes the results for up to 10 eligibility checks within a single page - each benefit response is represented as one item in the items array. When there are additional pages of results, the response includes the nextPageToken property.
To retrieve the next page of results, call the endpoint with the same batchId and the nextPageToken value in the pageToken query parameter. Repeat this process until the response doesn’t include a nextPageToken property.
Benefit response
Visit Payer benefit response for definitions of key benefit types and information about how to interpret responses.
Network status: The response provides information about the patient’s general in and out-of-network coverage. It does not confirm whether a particular provider is in or out-of-network. To determine network status, you must check directly with the payer. Note that payers may have different networks for different health plans, such as employer-sponsored plans versus Medicare.
Authorizations
A Stedi API Key for authentication.
Query Parameters
The maximum number of check results to return in a page - each check is represented as one item in the items array. You can set this to a maximum of 10 checks. If not specified, the default is 10.
1 < x < 10A token returned by a previous call to this operation in the nextPageToken property. If not specified, Stedi returns the first page of results.
1 - 1024An identifier for a batch of eligibility checks submitted through the Batch Eligibility Check endpoint. Use this to retrieve results for eligibility checks in the batch.
An ISO 8601 formatted string. For example 2023-08-28T00:00:00Z. Stedi returns asynchronous eligibility checks that have completed processing after this time. Completed means that the payer has successfully returned a benefits response, the check has failed due to errors in the request, or that the payer has been unavailable for 8 hours and Stedi will no longer attempt to retry.
Response
Each eligibility check response is included as a separate item in this array. The response shape is identical to the shape of the response for the Real-Time Eligibility Check endpoint, with the addition of two new properties that help you correlate the results with individual eligibility checks.
- batchId contains the batchId Stedi returned from the Batch Eligibility Check endpoint when making the request.
- submitterTransactionIdentifier contains the unique identifier for the eligibility check that you submitted in the request.
Metadata about the response. Stedi uses this data for tracking and troubleshooting.
The sender ID Stedi assigns to this request.
The submitter ID Stedi assigns to this request.
The biller ID Stedi assigns to this request.
The type of data in the request. This is always production.
The unique ID Stedi assigns to this request.
The value provided in the submitterTransactionIdentifier property in the original eligibility check request.
The control number you sent in the original eligibility check request.
Deprecated; do not use.
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.
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.
The provider's last name. This applies to providers that are an individual.
The provider's first name. This applies to providers that are an individual.
The provider's organization name.
The provider's middle name. This applies to providers that are an individual.
The provider's name suffix, such as Jr., Sr., or III.
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 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 Health Care Provider Taxonomy Code.
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.
The Social Security Number (SSN).
The Federal Taxpayer Identification Number (also known as an EIN).
The Payor Identification.
The pharmacy processor number.
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 contact information.
The first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3When 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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
15, 41, 43, 44, 45, 46, 47, 48, 50, 51, 79, 97, T4 Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly 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.
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.
The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed.
The member ID for the subscriber's insurance policy.
The subscriber's first name.
The subscriber's last name.
The subscriber's middle name or initial.
The name suffix, such as Jr., Sr., or III.
Code indiciating the patient's gender. Can be F - Female, M - Male, or U - Unknown.
M, F, U The entity type for the subscriber. It can technically be set to Person or Non-Person Entity. In practice, our customers only receive Person.
The subscriber's unique health identifier.
The subscriber's date of birth, formatted as YYYYMMDD.
The status of the subscriber'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.
The subscriber'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 subscriber'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.
Context that identifies the exact military unit. Used to report military service data.
The subscriber'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 format of the military service date and time period. Can be set to D8 - Date or RD8 - Range of Dates.
The military service date, formatted as YYYYMMDD.
The military service start date, formatted as YYYYMMDD.
The military service end date, formatted as YYYYMMDD.
The subscriber's Social Security Number (SSN).
The group number associated with the subscriber's insurance policy.
The plan number associated with the subscriber's insurance policy.
The network identification number associated with the subscriber's insurance policy.
Group name
Plan name
Plan network name
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.
Indicates the status of the insured. A Y value indicates the insured is a subscriber. When set to N, the insured is a dependent.
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.
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 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 first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Information 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.
The provider's last name. This applies to providers that are an individual.
The provider's first name. This applies to providers that are an individual.
The provider's organization name.
The provider's middle name. This applies to providers that are an individual.
The provider's name suffix, such as Jr., Sr., or III.
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 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 Health Care Provider Taxonomy Code.
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.
The Social Security Number (SSN).
The Federal Taxpayer Identification Number (also known as an EIN).
The Payor Identification.
The pharmacy processor number.
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 contact information.
The first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3When 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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
15, 41, 43, 44, 45, 46, 47, 48, 50, 51, 79, 97, T4 Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly 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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
15, 33, 35, 42, 43, 45, 47, 48, 49, 51, 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 69, 70, 71, 72, 73, 74, 75, 76, 78, 98, AA, AE, AF, AG, AO, CI, E8, IA, MA Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly 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.
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).
The full name of the traceTypeCode. For example Current Transaction Trace Numbers.
The unique trace number assigned to the transaction.
The identifier of the organization that assigned the trace number.
Identifies a subdivision within the organization that assigned the trace number.
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.
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.
The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed.
The member ID for the subscriber's insurance policy.
The dependent's first name.
The dependent's last name.
The dependent's middle name or initial.
The name suffix, such as Jr., Sr., or III.
Code indiciating the patient's gender. Can be F - Female, M - Male, or U - Unknown.
M, F, U The entity identifier for the patient. It can be set to IL - Insured or Subscriber, or 03 - Dependent.
The entity type for the dependent. It can technically be set to Person or Non-Person Entity. In practice, our customers only receive Person.
The dependent's unique health identifier.
The dependent's date of birth, formatted as YYYYMMDD.
The status of the dependent's information, used to report military service data.
A, C, L, O, P, S, T, Unknown The dependent's employment status code, used to report military service data.
AE, AO, AS, AT, AU, CC, DD, HD, IR, LX, PE, RE, RM, RR, RU, Unknown The dependent's government service affiliation code, used to report military service data.
A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, Q, R, S, U, W, Unknown Context that identifies the exact military unit. Used to report military service data.
The dependent's military service rank code.
A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, C6, C7, C8, C9, E1, F1, F2, F3, F4, G1, G4, L1, L2, L3, L4, L5, L6, M1, M2, M3, M4, M5, M6, P1, P2, P3, P4, P5, R1, R2, S1, S2, S3, S4, S5, S6, S7, S8, S9, SA, SB, SC, T1, V1, W1, Unknown The format of the military service date and time period.
D8, RD8 The military service date, formatted as YYYYMMDD.
The military service start date, formatted as YYYYMMDD.
The military service end date, formatted as YYYYMMDD.
The dependent's Social Security Number (SSN).
The group number associated with the subscriber's insurance policy.
The plan number associated with the subscriber's insurance policy.
The network identification 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.
Indicates the status of the insured. A Y value indicates the insured is a subscriber. When set to N, the insured is a dependent.
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.
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 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 first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Information 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.
The provider's last name. This applies to providers that are an individual.
The provider's first name. This applies to providers that are an individual.
The provider's organization name.
The provider's middle name. This applies to providers that are an individual.
The provider's name suffix, such as Jr., Sr., or III.
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 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 Health Care Provider Taxonomy Code.
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.
The Social Security Number (SSN).
The Federal Taxpayer Identification Number (also known as an EIN).
The Payor Identification.
The pharmacy processor number.
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 contact information.
The first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3When 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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
15, 41, 43, 44, 45, 46, 47, 48, 50, 51, 79, 97, T4 Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly 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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
15, 33, 35, 42, 43, 45, 47, 48, 49, 51, 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 77, 98, AA, AE, AF, AG, AO, CI, E8, IA, MA Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly 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.
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 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 business name. Used when the payer is not a person.
The payer's middle name or initial. Used when the payer is an individual (not commonly used).
The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used).
Deprecated; The payer's identification number for the entity receiving the benefits information.
The payer's federal taxpayer's identification number.
The payer's National Association of Insurance Commissioners (NAIC) identification number.
The payer's National Provider Identifier (NPI).
The payer's Centers for Medicare and Medicaid Services PlanID.
The payor identification.
The payer's contact information.
The name of the contact person.
The contact information.
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.
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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
04, 41, 42, 79, 80, T4 Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Resubmission allowed, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly The payer's Electronic Transmitter Identification Number (ETIN).
Additional identification for the subscriber's healthcare plan.
The state license number
The Medicare provider number
The Medicaid provider number
The facility ID number
The personal identification number (PIN)
The plan number
The plan description
The group or policy number
The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer.
The case number
The family unit number
The group number
The group description
The referral number
The alternative list ID - identifies a list of alternative drugs with the associated formulary status for the patient.
The class of contract code - used to identify the applicable class of contract for claims processing.
The coverage list ID - identifies a list of drugs that have coverage limitations for the patient.
The contract number of a contract between the payer and the provider that requested the eligibility check.
The medical record identification number
The electronic device pin number
The submitter identification number
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.
The health insurance claim number
The drug formulary number
The prior authorization 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 identity card number, used when the Identity Card Number is different than the Member Identification Number.
The National Provider Identifier (NPI) assigned by the Centers for Medicare and Medicaid Services
The issue number
The insurance policy number
The user identification
The medical assistance category
The eligibility category
The plan network identification number
The plan, group, or plan network name
The facility network identification number
The Medicaid recipient identification number
The prior identifier number
The social security number
The federal taxpayer's identification number
The agency claim number, only used when the information source is a Property and Casualty payer.
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.
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.
Can be formatted as 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.
Can be formatted as a single date, or as a range of dates in YYYYMMDD-YYYYMMDD format.
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.
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
The error type, AAA.
The error description.
The location of the error within the original X12 EDI response.
Information to help you correct the error.
The error code.
04, 15, 33, 35, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 97, 98, AA, AE, AF, AG, AO, CI, E8, IA, MA, T4 Allowed actions you can take, based on the rejection reason code. For example Please Correct and Resubmit.
Please Correct and Resubmit, Resubmission Not Allowed, Please Resubmit Original Transaction, Resubmission allowed, Do Not Resubmit; Inquiry Initiated to a Third Party, Please Wait 30 Days and Resubmit, Please Wait 10 Days and Resubmit, Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly The transaction set acknowledgment code provided in in the X12 EDI 999 response.
The implementation transaction set error code provided in IK502 of the 999 transaction.
The raw X12 EDI 271 Eligibility Benefit Response from the payer.
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 for more information about benefit types, details about how to interpret the response, and additional examples.
The eligibility or benefit information code. Visit Eligibility and benefit codes for a complete list and descriptions of common codes.
The name of the benefit information code. For example, Deductible.
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.
The name of the coverage level code. For example Individual.
Codes identifying the type of services. For example, 7 - Anesthesia. Visit 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.
Code identifying the type of insurance policy. For example MC - Medicaid.
The name of the insurance type code. For example Medicaid.
The specific product name or special program name for an insurance plan. For example Gold 1-2-3.
Code indicating the time period for the benefit information. For example 23 - Calendar Year.
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 to learn more.
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 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 codes.
Code indicating the type of quantity for the benefit. For example VS - Visits.
The name of the quantity qualifier code. For example, Visits.
The quantity of the benefit, qualified by the type specified in quantityQualifier. For example, 10 when the quantityQualifier is Visits.
Code indicating whether the benefit is subject to prior authorization or certification. can be Y - Yes, N - No or U - Unknown.
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 in-plan network indicator code. For example, Yes.
The loop header identifier number in the LS segment of the original X12 EDI transaction.
The loop trailer identifier number in the LE segment of the original X12 EDI transaction.
Identifies relevant medical procedures by their standard codes and modifiers (if applicable).
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 name of the productOrServiceIdQualifierCode. For example, American Dental Association.
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 diagnosis code pointer.
Identifying information specific to this type of benefit.
The delivery or usage pattern for the benefits.
Code specifying the type of quantity. Can be set to DY - Days, FL - Units, HS - Hours, MN - Month, or VS - Visits.
The name of the quantityQualifierCode. For example, Days.
The quantity of the benefit. For example, 10 when the quantityQualifier is Visits.
The name of the unitForMeasurementQualifierCode. For example, Days.
Specifies the sampling frequency, based on the unit of measure. For example every 2 months or once per 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 timePeriodQualifierCode. For example, Calendar Year.
The number of periods in the time period. For example, 12 when the timePeriodQualifier is Hour.
Code specifying the unit of measurement for the quantity. Can be set to DA - Days, MO - Months, VS - Visit, WK - Week, or YR` - Years.
Code that specifies the routine shipments, deliveries, or calendar pattern. For example 9 - Last Working Day of Period.
The name of the deliveryOrCalendarPatternCode. For example, Last Working Day of Period.
Code that specifies the time for routine shipments or deliveries. For example E - P.M.
The name of the deliveryPatternTimeCode. For example, P.M..
A free-form message containing additional information about the benefits in the response.
Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response.
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 codeListQualifierCode. For example Mutually Defined when the code is set to ZZ.
The specific industry code.
The name of the industryCode. For example Pharmacy when the code is 01.
The code category. Always set to 44 - Nature of Injury.
Description of injured body parts.
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.
A single date, formatted as YYYYMMDD.
The beginning date of a range, formatted as YYYYMMDD.
The end date of a range, formatted as YYYYMMDD.
Only included when multiple plans apply to the patient or multiple plan periods apply.
Only included when multiple plans apply to the patient or multiple plan periods apply.
A single date, formatted as YYYYMMDD.
The beginning date of a range, formatted as YYYYMMDD.
The end date of a range, formatted as YYYYMMDD.
Identify another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Code identifying an organizational entity, a physical location, property or an individual. Can be set to 1I - Preferred Provider Organization (PPO), 1P - Provider, 2B - Third-Party Administrator, 13 - Contracted Service Provider, 36 - Employer, 73 - Other Physician, FA - Facility, GP - Gateway Provider, GW - Group, I3 - Independent Physicians Association (IPA), IL - Insured or Subscriber, LR - Legal Representative, OC - Origin Carrier, P3 - Primary Care Provider, P4 - Prior Insurance Carrier, P5 - Plan Sponsor, PR - Payer, PRP - Primary Payer, SEP - Secondary Payer, TTP - Tertiary Payer, VER - Party Performing Verification, VN - Vendor, VY - Organization Completing Configuration Change, X3 - Utilization Management Organization, Y2 - Managed Care Organization.
The type of entity. Can be 1 - Person or 2 - Non-Person Entity.
The last name (if the entity is a person) or the business name (if the entity is an organization).
The first name of the entity, if the entity is a person.
The middle name or initial of the entity, if the entity is a person.
The name suffix, such as Sr. Jr. or III.
Code identifying the type of value provided in entityIdentificationValue. For example, FI - Federal Taxpayer's Identification Number.
The identification number for the entity, qualified by the code in entityIdentification.
Code specifying the relationship between the entity and the patient. Can be set to 01 - Parent, 02 - Child, 27 - Domestic Partner, 41 - Spouse, 48 - Employee, 65 - Other, or 72 - Unknown.
The first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3The provider code.
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.
All other entities associated with the eligibility or benefits.
Code identifying an organizational entity, a physical location, property or an individual. Can be set to 1I - Preferred Provider Organization (PPO), 1P - Provider, 2B - Third-Party Administrator, 13 - Contracted Service Provider, 36 - Employer, 73 - Other Physician, FA - Facility, GP - Gateway Provider, GW - Group, I3 - Independent Physicians Association (IPA), IL - Insured or Subscriber, LR - Legal Representative, OC - Origin Carrier, P3 - Primary Care Provider, P4 - Prior Insurance Carrier, P5 - Plan Sponsor, PR - Payer, PRP - Primary Payer, SEP - Secondary Payer, TTP - Tertiary Payer, VER - Party Performing Verification, VN - Vendor, VY - Organization Completing Configuration Change, X3 - Utilization Management Organization, Y2 - Managed Care Organization.
The type of entity. Can be 1 - Person or 2 - Non-Person Entity.
The last name (if the entity is a person) or the business name (if the entity is an organization).
The first name of the entity, if the entity is a person.
The middle name or initial of the entity, if the entity is a person.
The name suffix, such as Sr. Jr. or III.
Code identifying the type of value provided in entityIdentificationValue. For example, FI - Federal Taxpayer's Identification Number.
The identification number for the entity, qualified by the code in entityIdentification.
Code specifying the relationship between the entity and the patient. Can be set to 01 - Parent, 02 - Child, 27 - Domestic Partner, 41 - Spouse, 48 - Employee, 65 - Other, or 72 - Unknown.
The first line of the address.
1 - 55The second line of the address.
1 - 55The city.
2 - 30The state code. For example, TN for Tennessee or WA for Washington.
2The United States postal code, excluding punctuation and blanks.
3 - 15The country code. Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3The country subdivision code. Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3The provider code.
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.
Identify the Nature of Injury Code or a Facility Type Code.
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 codeListQualifierCode. For example Mutually Defined when the code is set to ZZ.
The specific industry code.
The name of the industryCode. For example Pharmacy when the code is 01.
The code category. Always set to 44 - Nature of Injury.
Description of injured body parts.
The batchId Stedi returned from the Batch Eligibility Check endpoint.
The unique identifier for the eligibility check that you submitted in the original batch request.
A Stedi-generated token that you can submit in the pageToken query parameter to retrieve the next page of results. If there are no more results, this property is not included in the response.
1 - 1024Was this page helpful?
curl --request GET \
--url https://manager.us.stedi.com/2024-04-01/eligibility-manager/polling/batch-eligibility \
--header 'Authorization: <api-key>'{
"nextPageToken": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"items": [
{
"controlNumber": "000022222",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"status": "ERROR",
"meta": {
"outboundTraceId": "01JCP62EYY1N6PZABF9Q45EN5Y"
},
"errors": [
{
"followupAction": "Please Correct and Resubmit",
"possibleResolutions": "Payer TEST is not configured. Please check our published payer list or contact Stedi support to resolve.",
"code": "79",
"description": "Invalid Participant Identification",
"location": "2100A"
}
],
"tradingPartnerServiceId": "TEST",
"submitterTransactionIdentifier": "ABC123456789"
},
{
"controlNumber": "333344444",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"submitterTransactionIdentifier": "DEF123456799",
"meta": {
"senderId": "030240928",
"submitterId": "117151744",
"applicationMode": "production",
"traceId": "01J2VZA127GH93JT74HJU",
"outboundTraceId": "01J2VZA127GH93JT74HJU"
},
"reassociationKey": "123456789",
"tradingPartnerServiceId": "123456789",
"provider": {
"providerName": "ACME HEALTH SERVICES",
"entityIdentifier": "Provider",
"entityType": "Non-Person Entity",
"npi": "1234567890"
},
"subscriber": {
"memberId": "1234567892",
"firstName": "JANE",
"lastName": "DOE",
"middleName": "A",
"gender": "F",
"entityIdentifier": "Insured or Subscriber",
"entityType": "Person",
"dateOfBirth": "19000101",
"groupNumber": "123456789",
"address": {
"address1": "1234 FIRST ST",
"city": "NEW YORK",
"state": "WV",
"postalCode": "123451111"
}
},
"payer": {
"entityIdentifier": "Payer",
"entityType": "Non-Person Entity",
"lastName": "ABCDE",
"name": "ABCDE",
"federalTaxpayersIdNumber": "123412345",
"contactInformation": {
"contacts": [
{
"communicationMode": "Telephone",
"communicationNumber": "1234567890"
},
{
"communicationMode": "UR",
"communicationNumber": "website.company.com"
}
]
}
},
"planInformation": {
"groupNumber": "12341234",
"groupDescription": "ABCDE",
"priorIdNumber": "1234567890"
},
"planDateInformation": {
"planBegin": "20240101",
"planEnd": "20241231",
"eligibilityBegin": "20220102"
},
"planStatus": [
{
"statusCode": "1",
"status": "Active Coverage",
"planDetails": "Open Access Plus",
"serviceTypeCodes": [
"30"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"MH"
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"planCoverage": "Open Access Plus",
"additionalInformation": [
{
"description": "Complete Care Management"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "6000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "500",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "3000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "250",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "30000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.1",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "7500",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Deductible does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.5",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
],
"serviceTypes": [
"Psychiatric - Inpatient",
"Day Care (Psychiatric)",
"Psychiatric - Outpatient",
"Psychiatric",
"Psychiatric - Room and Board",
"Psychotherapy",
"Anesthesia",
"Diagnostic X-Ray",
"Partial Hospitalization (Psychiatric)",
"Social Work"
],
"inPlanNetworkIndicatorCode": "W",
"inPlanNetworkIndicator": "Not Applicable"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"BC",
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Day Care (Psychiatric)",
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A8"
],
"serviceTypes": [
"Psychiatric - Outpatient"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitAmount": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "02"
}
]
},
{
"code": "B",
"name": "Co-Payment",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifierCode": "27",
"timeQualifier": "Visit",
"benefitAmount": "20",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitPercent": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "CB",
"name": "Coverage Basis",
"serviceTypeCodes": [
"7",
"BB"
],
"serviceTypes": [
"Anesthesia",
"Partial Hospitalization (Psychiatric)"
],
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitAmount": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
],
"benefitPercent": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Office"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"4"
],
"serviceTypes": [
"Diagnostic X-Ray"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"4"
],
"serviceTypes": [
"Diagnostic X-Ray"
],
"benefitPercent": "0",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "Mutually Defined",
"industryCode": "Outpatient Hospital"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"BB"
],
"serviceTypes": [
"Partial Hospitalization (Psychiatric)"
],
"benefitAmount": "0",
"authOrCertIndicator": "Y",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"MH"
],
"serviceTypes": [
"Mental Health"
],
"additionalInformation": [
{
"description": " Provider is out of network based on NPI ID provided in request."
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "5760",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "500",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "2760",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "250",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "30000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "29",
"timeQualifier": "Remaining",
"benefitAmount": "7500",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
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{
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}