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Insurance Discovery Check

Submit an insurance discovery check in JSON format

POST/insurance-discovery/check/v1

Insurance discovery checks search for a patient's active coverage using only their demographic data.

Insurance discovery supports both medical and dental use cases. To scope the search to dental payers only, set encounter.serviceTypeCodes to ["35"]. Otherwise, Stedi defaults to searching for medical coverage.

  1. Call this endpoint with as much patient demographic information as possible.
  2. Stedi searches for active coverage for the patient.
  3. The endpoint returns an array of potential active coverages along with subscriber details and benefits information.

We recommend using insurance discovery checks as a backup when eligibility checks fail or aren't possible. They're only available for basic Health Benefit Plan Coverage (service type code 30) or Dental Benefit Plan Coverage (service type code 35), so don't rely on them as your primary method for verifying patient coverage. For example: If you're looking for specific psychotherapy visit benefits, send a subsequent eligibility check with a mental health service type code.

Authorizations

Authorization
RequiredHeader

A production Stedi API Key for authentication.

Body

application/json
dependent
Object

Demographic information for the patient when they are a dependent on a health plan.

  • We strongly recommend providing as much information as possible to improve the probability of finding matching coverage. We especially recommend including the dependent's Social Security Number and their address - particularly their state and, if known, their ZIP Code.
  • You should provide information for both the subscriber and the dependent in the request when possible.
  • If you only have the dependent's information, you should identify them in the subscriber object instead and leave this object empty. Note that some payers require information about both the dependent and the subscriber, so providing only the dependent's information limits Stedi's ability to return coverage matches for those payers.
Show attributes
encounter
Object

Specify the date range and type of coverage.

  • Set either a single dateOfService or a beginningDateOfService and endDateOfService. If you don't specify a service date, Stedi defaults to the current date.
  • Set serviceTypeCodes to ["35"] to narrow the search to dental payers. Omit it to default to searching medical payers.
Show attributes
provider
ObjectRequired

Information about the provider requesting the insurance discovery check.

Show attributes
subscriber
ObjectRequired

Demographic information for the patient when they are the health plan subscriber. We strongly recommend providing as much information as possible to improve the probability of finding matching coverage.

We especially recommend including the subscriber's Social Security Number and their address - particularly their state and, if known, their ZIP Code.

Show attributes

Response

application/json
coveragesFound
Integer

The number of potential coverage matches for the patient. This will be 0 if Stedi didn't find any matching coverage.

discoveryId
String

A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the Insurance Discovery Check Results endpoint.

errors
Array of Objects

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.

Any errors that occur at the payer, provider, subscriber, or dependents levels are also included in this array, allowing you to review all errors in a central location. If there are no AAA errors, this array will be empty.

Array item
items
Array of Objects

An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check status is COMPLETE. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information.

Array item
meta
Object

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

Show attributes
status
String

The status of the discovery check. This is either PENDING or COMPLETE. - If the status is COMPLETE, the items array will contain any potential coverage matches Stedi found for the patient. - If the status is PENDING, the check is still in progress. You can immediately begin polling the Insurance Discovery Check Results endpoint to retrieve the results asynchronously.

Possible values
PENDING
COMPLETE
ERROR
warnings
Array of Objects

Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests.

Array item
Testing: Send mock requests
Insurance Discovery Check Results