This endpoint allows you to submit multiple eligibility checks in a single request for Stedi to process asynchronously. You can submit up to 500 individual eligibility checks within a single batch, and you can submit as many batches as you need to process. To perform synchronous eligibility checks, use the Real-Time Eligibility Check endpoint.
We recommend using this endpoint to perform batches of eligibility checks, such as during periodic refreshes for a patient population or when running weekly eligibility checks for upcoming appointments.
Call this endpoint with a JSON payload containing one or more eligibility checks.
The endpoint returns a synchronous response containing a batchId that you can use to retrieve the results of these checks later, using the Poll Batch Eligibility Checks endpoint.
Stedi translates each eligibility check included in the request to the X12 270 EDI format and sends it to the appropriate payer.
Eligibility checks you submit through this asynchronous endpoint don’t count toward your Stedi account concurrency budget. This allows you to stage thousands of requests through this endpoint while continuing to send real-time eligibility checks in parallel.
The content of your eligibility request depends on your use case and the payer’s requirements. However, a basic batch eligibility check includes the following information in the request body:
Information
Description
controlNumber
An integer used to identify the transaction. It does not need to be globally unique.
A unique identifier for the eligibility check within the batch. Stedi returns this identifier in the response for the Poll Batch Eligibility Checks endpoint so you can correlate benefit responses with the original eligibility check.
provider object, name
You must include the provider’s name - either the firstName and lastName of a specific provider within a practice or the organizationName.
provider object, identifier
You must include an identifier. Most often this is the National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
subscriber and/or dependents objects
At a minimum, our API requires that you supply at least one of these fields in the request: memberId, dateOfBirth, or lastName. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. When all four of memberId, dateOfBirth, firstName, and lastName are provided, payers are required to return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. We recommend always including the patient’s member ID when possible. Learn more about patient information.
encounter object, service dates
You can specify either a single dateOfService or a beginningDateOfService and endDateOfService. The payer defaults to using the current date in their timezone if you don’t include one. We recommend submitting dates up to 12 months in the past or up to the end of the current month. Dates outside of these ranges are likely to be rejected by many payers, since they may have archived older data and they cannot guarantee eligibility for future months. Eligibility also usually starts and ends on month boundaries.
encounter object, service or procedure codes
Specify serviceTypeCodes and/or a procedureCode and productOrServiceIDQualifier to request specific types of benefits information. Medical providers should set items.encounter.serviceTypeCodes to a single value of 30 - Health Benefit Plan Coverage, and dental providers should set it to 35 - Dental Care. Stedi supports all service type codes, but some payers may not support other values. Don’t include multiple service type codes because many payers will either return an error or ignore additional codes entirely. If you do not include any of these fields, Stedi defaults to using 30 (Plan coverage and general benefits) as the only serviceTypeCodes value.
Don’t include the following characters in your request data: ~, *, : and ^. They are reserved for delimiters in the resulting X12 EDI transaction, and X12 doesn’t support using escape sequences to represent delimiters or special characters. Stedi returns a 400 error if you include these restricted characters in your request.
Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP 400 errors.
The X12 Basic character set includes uppercase letters, digits, space, and some special characters. Lowercase letters and special language characters like ñ are not included.
The following special characters are included:
The Extended character set includes the characters listed in Basic, plus lowercase letters and additional special characters, such as @.
The following additional special characters are included:
Stedi automatically replaces backticks (`), also known as backquotes or grave accents, with a single quote (') in subscriber and dependents first and last names. This autocorrection prevents errors when submitting your request to payers and intermediary clearinghouses. Stedi returns a message in the response’s warnings array when it makes this replacement.
Note that objects marked as required are required for all requests, while others are conditionally required depending on the circumstances. When you include a conditionally required object, you must include all of its required properties.
For example, you must always include the provider object in your request, but you only need to include the informationReceiverName object when you need to include additional information about the provider making the request, such as their specific location.
Each entry in this array represents a single eligibility check. You can submit up to 500 eligibility checks in a single request. Warning: If any of the individual checks contain invalid JSON data, such as missing required properties or invalid values, Stedi rejects the entire batch with a 400 status code and returns errors to help you correct the issues.
A unique identifier for the eligibility check within this batch request. Stedi returns this identifier in the response for the Poll Batch Eligibility Checks endpoint.
This is the Payer ID. Visit the Payer Network for a complete list. You can send requests using the Primary Payer ID, the Stedi Payer ID, or any alias listed in the payer record.
An object containing information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. You must provide the organizationName (if the entity is an organization) or firstName and lastName (if the provider is an individual). You must also provide an identifier - this is typically the provider's National Provider ID (npi).
The provider's National Provider Identifier (NPI). This identifier is required for all healthcare providers. If the provider doesn't have an NPI, you can use another identifier instead, such as the serviceProviderNumber or ssn.
The provider's service provider number. Only include when the provider doesn't have an NPI. This is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.
The provider's Federal Taxpayer Identification Number (also known as an EIN). Only include this value here when the provider doesn't have an NPI. If you need to supply the EIN for a provider that has an NPI, use the informationReceiverName.federalTaxpayerIdentificationNumber property instead.
The provider's Social Security Number (SSN). Only include when the provider doesn't have an NPI. This is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. Don't use this for Federally-administered programs, such as Medicare.
The provider's pharmacy processor number. Only include when the provider doesn't have an NPI. This is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.
Deprecated; The submitter's Employer's Identification Number (EIN). Only use when an employer is checking the eligibility and benefits of their employees.
This shape is deprecated: This property is no longer used.
Communicate the provider's role in the type of benefits specified in the request. For example, you could set this to RF if the provider is also the referring provider. You can use one of the following: AD - Admitting, AT - Attending, BI - Billing, CO - Consulting, CV - Covering, H - Hospital, HH - Home Health Care, LA - Laboratory, OT - Other Physician, P1 - Pharmacist, P2 - Pharmacy, PC - Primary Care Physician, PE - Performing, R - Rural Health Clinic, RF - Referring, SB - Submitting, SK - Skilled Nursing Facility, SU - Supervising
The provider's Taxonomy Code. Only used when the provider's taxonomy code is relevant to the eligibility/benefit inquiry. For example, an institutional provider such as a hospital may need to use a taxonomy code to specify a specific unit or department.
Provide additional information to identify the entity making the eligibility request. For example, if a provider has multiple locations, you may need to provide the address of the specific location. This is also where you can include the Federal Taxpayers Identification Number (EIN) for providers with an NPI.
The address of the entity requesting the information. This is required when the provider has multiple locations and you need to identify the specific location making the request. You must include at least the address1 and city properties in this object.
The primary policyholder for the insurance plan or a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave dependents empty. At a minimum, our API requires that you supply at least one of these fields in the request: memberId, dateOfBirth, or lastName. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. When you provide all four of memberId, dateOfBirth, firstName, and lastName, payers are required to return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. We recommend always including the patient’s member ID when possible.
The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date.
The Medicaid Recipient Identification Number. You can provide this number to identify the subscriber when it is the primary number the payer knows a member by (such as for Medicare or Medicaid). Do not supply this value unless it is different from the memberId.
Identify the dollar amount the subscriber will apply toward their spend down amount, if required. For some Medicaid programs, individuals must pay a certain amount towards their healthcare cost (spend down) before coverage starts.
The subscriber's Social Security Number (SSN). Many commercial and government payers ignore this property due to concerns about member privacy. However, some Medicaid programs support alternative searches using the patient's Social Security Number, instead of the member ID.
The subscriber's identification card number. Include this property when this number is different than the subscriber's member ID. This is common in Medicaid.
Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role. You can use 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
Use this for providers that are not requesting the eligibility check. This is the type of providerIdentifier you are providing. Set to HPI when the National Provider ID is mandated for use. If identifying a type of specialty associated with services provided to the subscriber, use code PXC. Otherwise, you can set to the following: 9K- Servicer, D3- National Council for Prescription Drug Programs Pharmacy Number, EI- Employer's Identification Number, HPI- Centers for Medicare and Medicaid Services National Provider Identifier, PXC- Health Care Provider Taxonomy Code, SY- Social Security Number, TJ- Federal Taxpayer's Identification Number
The provider identifier you specified in the referenceIdentificationQualifier property. For example, the provider's National Provider ID or Federal Taxpayer Identification number. If you set the referenceIdentificationQualifier to PXC, then this property should contain the provider's taxonomy code.
Deprecated; The date the subscriber's identification card was issued, expressed in YYYYMMDD format.
This shape is deprecated: This property is no longer used.
Deprecated; The date the subscriber's identification card expires, expressed in YYYYMMDD format.
This shape is deprecated: This property is no longer used.
Deprecated; The date the subscriber's identification card was issued, expressed in YYYYMMDD format.
This shape is deprecated: This property is no longer used.
Deprecated; The date the subscriber's insurance plan was issued, expressed in YYYYMMDD format.
This shape is deprecated: This property is no longer used.
Deprecated; The date the subscriber's insurance plan was issued, expressed in YYYYMMDD format.
This shape is deprecated: This property is no longer used.
The type of diagnosis code you are providing. You can set to BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, BF- International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or ABF- International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
Use this object when you need to provide an identification number other than or in addition to the member ID. For example, you may provide the patient account number. Don't include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID.
The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card.
The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer.
A dependent for which you want to retrieve benefits information. You can only submit one dependent per eligibility check. An individual qualifies as a dependent for eligibility checks when they are listed as a dependent on the subscriber’s insurance plan AND the payer cannot uniquely identify them through information outside the subscriber’s policy. For example, if the dependent has their own member ID number, you should identify them in the subscriber object instead. Each payer has different requirements, so you should supply the fields necessary for each payer to identify the dependent in their system. However, we strongly recommend including the dependent's date of birth in the request when available because many payers return errors without it.
The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date.
Only use for property and casualty use cases when the property and casualty patient identifier is a member ID and would be used in an 837 healthcare claim submission.
The dependent's date of birth (DOB) in YYYYMMDD format. We strongly recommend including the DOB in your request. Many payers need this information to identify the patient in their system and will immediately return an error when it's not provided.
Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role. You can use 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 type of providerIdentifier you are using. Use for providers that are not requesting the eligiblity check, such as the referring provider. Set to HPI when the National Provider ID is mandated for use. If identifying a type of specialty associated with services provided to the dependent, use code PXC. Otherwise, you can set to the following: 9K- Servicer, D3- National Council for Prescription Drug Programs Pharmacy Number, EI- Employer's Identification Number, HPI- Centers for Medicare and Medicaid Services National Provider Identifier, PXC- Health Care Provider Taxonomy Code, SY- Social Security Number, TJ- Federal Taxpayer's Identification Number
The provider identifier you specified in the referenceIdentificationQualifier property. For example, the provider's National Provider ID or Federal Taxpayer Identification number. If you set the referenceIdentificationQualifier to PXC, then this property should contain the provider's taxonomy code.
The type of diagnosis code you are providing. You can set to BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, BF- International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or ABF- International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
Use this object when you need to provide an identification number other than or in addition to the member ID. For example, you may provide the patient account number. Don't include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID.
The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card.
The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer.
Details about the eligibility or benefit information you are requesting for the patient. If you don't specify a service date (either a single day or a range of dates), the payer defaults to using the current date in their timezone. If you don't specify either serviceTypeCodes or a procedureCode and productOrServiceIDQualifier, Stedi defaults to using 30 (Plan coverage and general benefits) as the only serviceTypeCodes value. We recommend submitting dates up to 12 months in the past or up to the end of the current month. Dates outside of these ranges are likely to be rejected by many payers, since they may have archived older data and they cannot guarantee eligibility for future months. Note that payers can have different rules for future dates of service - for example, some payers may only return benefits information for dates up to the end of the current calendar month, but others may support dates further into the future.
One or more codes classifying the type of services for which you want to receive benefits information. If you do not specify a service type code or a procedureCode and productOrServiceIDQualifier, Stedi defaults to using 30 - Health Benefit Plan Coverage. Visit Service Type Codes for a complete list. Note that not all payers support all service type codes, and not all payers support multiple service type codes in the same request. We recommend including one service type code per request unless you're sure the payer supports multiple.
The type of information you provided in the priorAuthorizationOrReferralNumber property. You can set this to 9F - Referral Number or G1 - Prior Authorization Number.
Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, 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.
Diagnosis code pointers in order of importance to the service. These pointers are an index to the ICD-10 codes you included in the subscriber.healthCareCodeInformation or dependents.healthCareCodeInformation object arrays. The pointer values can be from 1 - 8 (integer numbers). If you are including diagnosis codes, you must set at least one pointer here for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total). Don't put ICD-10 codes here.
Use only when you need to send multiple procedure codes in a single request. Otherwise, use the encounter.procedureCode and encounter.productOrServiceIDQualifier properties.
Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, 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.
A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests.
An identifier for this batch of eligibility checks. You can use this identifier to retrieve the results of this batch using the Poll Batch Eligibility Checks endpoint.
