POST
/
change
/
medicalnetwork
/
eligibility
/
v3
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "submitterTransactionIdentifier": "123456789",
  "controlNumber": "123456789",
  "tradingPartnerServiceId": "AHS",
  "encounter": {
    "serviceTypeCodes": [
      "MH"
    ]
  },
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1234567891"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "memberId": "123456789"
  }
}'
{
  "meta": {
    "senderId": "1234567890",
    "submitterId": "AV11110000",
    "applicationMode": "production",
    "traceId": "123456789"
  },
  "controlNumber": "214976898",
  "reassociationKey": "123456789",
  "tradingPartnerServiceId": "123456789",
  "provider": {
    "providerName": "ACME HEALTH SERVICES",
    "entityIdentifier": "Provider",
    "entityType": "Non-Person Entity",
    "npi": "1234567890"
  },
  "subscriber": {
    "memberId": "1234567890",
    "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": "Company Name",
    "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*          *01*123456789      *ZZ*AV12341234     *111111*1234*^*00501*123456782*0*P*>~GS*HB*123456789*1110111*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*1*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDF*****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*1234567890~REF*6P*00001111*Company Name~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*215026712~"
}

This endpoint is a direct replacement for the Change Healthcare (CHC) Check Eligibility API.

  • Call this endpoint with a JSON payload in the CHC Medical Network Eligibility V3 format.
  • Stedi automatically maps CHC payer IDs to our payer IDs.
  • Stedi translates the JSON to the X12 EDI 270 format and sends it to the payer or peer clearinghouse via our real-time EDI connections.
  • The endpoint returns a synchronous API response in the CHC Eligibility V3 response JSON format.

Visit Check eligibility for a full how-to guide.

​
Timeout

Requests to payers typically time out at 1 minute, though Stedi’s API can keep connections open longer than that if needed.

​
Automatic repairs

Stedi automatically applies various repairs to help your requests meet X12 HIPAA specifications, resulting in fewer payer rejections.

​
Required information

The fields you include in your eligibility request depend on your use case and the payer’s requirements. However, each eligibility check must include at least the following information in the request body:

InformationDescription
controlNumberA 9-digit, unsigned numeric value that that identifies the transaction. It does not need to be unique. This value is returned in the response as controlNumber.
tradingPartnerServiceIdYou can find the payer ID in our list of supported payers. You can also use the same payer IDs you used for CHC eligibility checks.
provider object, nameYou must include the provider’s name - either the firstName and lastName of a specific provider within a practice or the organizationName.
provider object, identifierYou 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 dependent objectsYou must include enough information for the payer to identify the patient in their system. Every payer can return benefits information when you provide the patient’s first name, last name, date of birth, and member ID. We recommend always including the member ID in requests when possible. Learn more
encounter object, service datesYou can specify either a single dateOfService or a beginningDateOfService and endDateOfService. Stedi defaults to using the current date 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.
encounter object, service or procedure codesSpecify either serviceTypeCodes or a procedureCode and productOrServiceIDQualifier to request specific types of benefits information. We don’t know which payers support multiple service type codes, so we recommend including no more than one in each request. If you do not include any of these fields, Stedi defaults to using 30 (Plan coverage and general benefits) as the only serviceTypeCodes value.

Authorizations

Authorization
string
headerrequired

API key authentication via the 'Authorization' header

Body

application/json
submitterTransactionIdentifier
string

An internal ID or other value that you use to track the eligibility check within your company's business system. You can use any string value up to 50 characters.

controlNumber
string
required

An integer used to identify the transaction. It does not need to be globally unique. This value is returned in the response as controlNumber.

tradingPartnerServiceId
string
required

This is the Payer ID. Visit the Payer Network for a complete list.

tradingPartnerName
string

The payer's name, such as Cigna or Aetna.

provider
object
required

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).

portalUsername
string

The username that the provider uses to log in to the payer's portal. This is not commonly used.

portalPassword
string

The password that the provider uses to log in to the payer's portal. This is not commonly used.

informationReceiverName
object

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.

subscriber
object
required

The person who is the primary policyholder for the insurance plan. You only need to supply the fields necessary for your use case and for the provider to identify the subscriber in their system. All payers must be able to search for patients when you provide all of the following information: member ID, first name, last name, date of birth. 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.

dependents
object[]

One or more dependents for which you want to retrieve benefits information. The patient qualifies as a dependent for eligibility checks when the patient is listed as a dependent on the subscriber’s insurance plan AND the payer cannot uniquely identify the patient 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.

encounter
object

Details about the eligibility or benefit information you are requesting for the patient. If you don't specify service date (either a single day or a range of dates), Stedi defaults to using the current date. 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.

Response

200 - application/json
meta
object

Meta data about the response

controlNumber
string

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

reassociationKey
string

Deprecated; do not use.

tradingPartnerServiceId
string

The Payer ID you sent in the original eligibility check request.

provider
object

Provider

subscriber
object

ResponseMember

subscriberTraceNumbers
object[]

Loop: 2100C and 2100D, Segment: TRN, Notes: Subscriber Trace Numbers

dependents
object[]

Loop: 2100D, Notes: Dependent Details

payer
object

Payer

planInformation
object

PlanInformation

planDateInformation
object

PlanDateInformation

planStatus
object[]

Loop: 2110C and 2110D, Segments: EB, Notes: Subscriber/Dependent Eligibility Benefit Information - Deprecated please use benefitsInformation

benefitsInformation
object[]

Loop: 2110C and 2110D, Segments: NM1, PER, PRV, N3, N4, EB, H SD, MSG, LS, LE, REF, DTP, Notes: Subscriber/Dependent Eligibility Benefit Information

errors
object[]
status
string
transactionSetAcknowledgement
string
implementationTransactionSetSyntaxError
string
x12
string

The raw X12 EDI 271 Eligibility Benefit Response from the payer.

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