Eligibility checks verify a patient’s coverage with a specific payer. But what if you don’t know the patient’s insurance details or you’re not sure whether they have coverage at all? In these situations, you can use an insurance discovery check to find a patient’s active coverage using only their demographic data.

You may need to perform an insurance discovery check when a patient provides outdated insurance details, doesn’t have their insurance card, or can’t provide insurance details in an urgent care situation. You may also want to use insurance discovery checks to simplify patient onboarding by reducing the amount of information new patients must provide to schedule an appointment.

Once you identify active coverage through an insurance discovery check, we recommend performing a coordination of benefits (COB) check to determine whether the patient has active coverage with additional payers and which payer is responsible for paying claims (primacy).

​
How insurance discovery checks work

Here’s how insurance discovery checks work:

  1. Submit an insurance discovery request with as much patient demographic information as possible to increase the chances of finding matching coverage. You’ll also include information like the provider’s NPI and the date of service, similar to an eligibility check.
  2. Stedi uses the demographic information you provide to determine if the patient has active coverage with one or more payers. This process involves submitting real-time eligibility checks to supported payers in order to find a match.
  3. When the insurance discovery check is complete, Stedi returns an array of potential active coverages along with subscriber details and complete benefits information. Results will typically also contain a confidence score to indicate how likely it is that the plan is a match for the patient information you provided, but this won’t happen in all circumstances.

You should always review the results to ensure the returned subscriber information for each active health plan matches the demographic information for the patient. You generally shouldn’t need to perform a followup standard eligibility check, since the insurance discovery check includes all of the information that would be included in a standard eligibility check.

​
Enrollment requirements

You should submit a transaction enrollment request for each provider for whom you plan to submit insurance discovery checks. To enroll your providers, please download the enrollment spreadsheet template and add one row for each provider. You’ll be required to provide the following information:

  • National Provider Identifier (NPI)
  • Tax Identification Number (TIN)
  • Medicaid Provider ID (if applicable)
  • Practice Location State

You can email the completed template to enrollments@stedi.com, or drop it in your shared Slack channel.

​
Submit an insurance discovery check

You can submit an insurance discovery check using the Insurance Discovery Check endpoint.

There is no cost for limited insurance discovery checks while the API is in beta. If you are interested in pricing when the product is generally available, please reach out to the Stedi team.

​
Required patient information

At a minimum, you must provide the patient’s first name, last name, and date of birth (DOB) in each insurance discovery check.

However, the more demographic information you provide, the more likely Stedi is to find matching coverage. Generally, the more common the patient’s name, the more important it is to include more demographic information. Regardless, we strongly recommend providing as much of the following additional patient information as possible:

  • Current address - especially the patient’s ZIP code, as this helps narrow down the list of probable payers
  • Previous addresses
  • Social Security Number (SSN) - this significantly increases the likelihood of a match and the confidence level
  • Phone number
  • Gender

​
Request

The following example is the request payload for an insurance discovery check. It includes all of the recommended patient demographic information to increase the likelihood of finding matching coverage.

{
  "provider": {
    "npi": "1234567890"
  },
  "subscriber": {
    "firstName": "John",
    "lastName": "Smith",
    "middleName": "Robert",
    "dateOfBirth": "1980-01-01",
    "ssn": "123456789",
    "gender": "M",
    "address": {
      "address1": "123 Main St",
      "city": "Springfield",
      "state": "IL",
      "postalCode": "62701"
    }
  },
  "encounter": {
    "beginningDateOfService": "2024-03-26",
    "endDateOfService": "2024-03-26"
  }
}

​
Response

Stedi’s synchronous response to the Insurance Discovery Check endpoint can take up to 120 seconds to return, though it’s often faster.

The synchronous response can have one of two status values:

  • COMPLETE - Stedi has completed the insurance discovery search for the patient. If Stedi finds coverage for the patient, the items array will contain the results. If Stedi doesn’t find any coverage for the patient, the items array will be empty.
  • PENDING - Stedi is still processing the insurance discovery search for the patient. You can use the discoveryId in the response to retrieve the results asynchronously.

The following example response shows a PENDING insurance discovery search. In this case, you would use the discoveryId to retrieve the results asynchronously.

Insurance discovery check in progress
{
  "discoveryId": "12345678-abcd-4321-efgh-987654321abc",
  "meta": {
    "applicationMode": "production",
    "traceId": "1-abcdef12-123456789abcdef123456789"
  },
  "status": "PENDING",
  "items": []
}

The following example response shows the results of a COMPLETE insurance discovery check. The items array contains one result, which indicates potential active coverage for the patient. You should review the subscriber information in the result to ensure it matches the patient information you provided.

Payer names and IDs aren’t normalized, so you’ll need to handle matching these results to Stedi’s Payer Network or your own internal payer list.

To learn how to interpret the benefits information returned for the patient, visit Interpret Benefit Response.

Insurance discovery check completed
{
  "discoveryId": "12345678-abcd-4321-efgh-987654321abc",
  "items": [
    {
      "provider": {
        "providerName": "provider",
        "entityType": "Non-Person Entity",
        "npi": "1234567890"
      },
      "subscriber": {
        "memberId": "987654321000",
        "firstName": "John",
        "lastName": "Doe",
        "middleName": "Smith",
        "gender": "M",
        "dateOfBirth": "19900115",
        "groupNumber": "123456-78",
        "planNumber": "123456-EXMPL9876",
        "groupDescription": "Individual On-Exchange",
        "address": {
          "address1": "123 Main Street",
          "city": "ANYTOWN",
          "state": "CA",
          "postalCode": "12345"
        }
      },
      "payer": {
        "name": "EXAMPLE INSURANCE CO"
      },
      "planInformation": {
        "planNumber": "123456-EXMPL9876",
        "groupNumber": "123456-78",
        "groupDescription": "Individual On-Exchange"
      },
      "planDateInformation": {
        "planBegin": "20250101",
        "eligibilityBegin": "20250101",
        "service": "20250301"
      },
      "benefitsInformation": [
        {
          "inPlanNetworkIndicatorCode": "W",
          "benefitsRelatedEntities": [
            {
              "entityIdentifier": "Primary Care Provider",
              "entityIdentification": "XX",
              "entityName": "Dough",
              "entityIdentificationValue": "1234567890",
              "entityFirstname": "Jane",
              "entityType": "Person"
            }
          ],
          "additionalInformation": [
            {
              "description": "To determine if a prior authorization is required, please check the health plan's website."
            }
          ],
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicator": "Not Applicable",
          "name": "Active Coverage",
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Medical Care"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "W",
          "serviceTypeCodes": [
            "1"
          ],
          "inPlanNetworkIndicator": "Not Applicable",
          "code": "1"
        },
        {
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "4"
          ],
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "code": "A",
          "serviceTypeCodes": [
            "4"
          ],
          "name": "Co-Insurance",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM"
        },
        {
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "4"
          ],
          "serviceTypes": [
            "Diagnostic X-Ray"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "I"
        },
        {
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Diagnostic Lab"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "5"
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "benefitAmount": "20",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "5"
          ],
          "serviceTypes": [
            "Diagnostic Lab"
          ],
          "timeQualifier": "Visit",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "5"
          ],
          "name": "Non-Covered",
          "code": "I",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Diagnostic Lab"
          ]
        },
        {
          "serviceTypeCodes": [
            "12"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1"
        },
        {
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "12"
          ]
        },
        {
          "name": "Non-Covered",
          "serviceTypes": [
            "Durable Medical Equipment Purchase"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "12"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "code": "1",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "13"
          ]
        },
        {
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes",
          "benefitPercent": "0.5",
          "timeQualifier": "Visit",
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "code": "A",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "13"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "13"
          ],
          "serviceTypes": [
            "Ambulatory Service Center Facility"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "18"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ]
        },
        {
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ],
          "serviceTypeCodes": [
            "18"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM"
        },
        {
          "serviceTypeCodes": [
            "18"
          ],
          "serviceTypes": [
            "Durable Medical Equipment Rental"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "name": "Non-Covered"
        },
        {
          "serviceTypeCodes": [
            "33"
          ],
          "serviceTypes": [
            "Chiropractic"
          ],
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Limited to 26 visits per year (visits in excess of 26 require prior authorization)."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "code": "1"
        },
        {
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "code": "A",
          "name": "Co-Insurance",
          "serviceTypes": [
            "Chiropractic"
          ],
          "serviceTypeCodes": [
            "33"
          ],
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM"
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Chiropractic"
          ],
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "33"
          ]
        },
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "48"
          ],
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan"
        },
        {
          "code": "A",
          "coverageLevel": "Family",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "48"
          ]
        },
        {
          "serviceTypeCodes": [
            "48"
          ],
          "serviceTypes": [
            "Hospital - Inpatient"
          ],
          "code": "I",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No"
        },
        {
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1",
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "50"
          ]
        },
        {
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "50"
          ],
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "benefitPercent": "0.5",
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27"
        },
        {
          "serviceTypeCodes": [
            "50"
          ],
          "serviceTypes": [
            "Hospital - Outpatient"
          ],
          "planCoverage": "Gold Plan",
          "code": "I",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "51"
          ],
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "name": "Active Coverage"
        },
        {
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "51"
          ],
          "timeQualifier": "Visit",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "benefitPercent": "0.5",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM"
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "51"
          ]
        },
        {
          "coverageLevel": "Family",
          "code": "A",
          "benefitPercent": "0.5",
          "serviceTypeCodes": [
            "51"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "serviceTypes": [
            "Hospital - Emergency Accident"
          ],
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicator": "No",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "52"
          ],
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "code": "A",
          "serviceTypeCodes": [
            "52"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "serviceTypeCodes": [
            "52"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "1"
        },
        {
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "52"
          ],
          "serviceTypes": [
            "Hospital - Emergency Medical"
          ],
          "code": "A",
          "planCoverage": "Gold Plan",
          "benefitPercent": "0.5"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "53"
          ],
          "code": "1",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ]
        },
        {
          "timeQualifier": "Visit",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "53"
          ],
          "coverageLevelCode": "FAM",
          "benefitPercent": "0.5",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ],
          "code": "A",
          "name": "Co-Insurance"
        },
        {
          "name": "Non-Covered",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypeCodes": [
            "53"
          ],
          "code": "I",
          "serviceTypes": [
            "Hospital - Ambulatory Surgical"
          ]
        },
        {
          "serviceTypeCodes": [
            "62"
          ],
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "code": "1"
        },
        {
          "timeQualifierCode": "27",
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "serviceTypeCodes": [
            "62"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifier": "Visit"
        },
        {
          "serviceTypes": [
            "MRI/CAT Scan"
          ],
          "serviceTypeCodes": [
            "62"
          ],
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "serviceTypeCodes": [
            "65"
          ],
          "serviceTypes": [
            "Newborn Care"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "65"
          ],
          "benefitPercent": "0.5",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Newborn Care"
          ],
          "coverageLevel": "Family",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "name": "Co-Insurance"
        },
        {
          "name": "Non-Covered",
          "code": "I",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "65"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "serviceTypes": [
            "Newborn Care"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Covered in accordance with ACA guidelines."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "68"
          ]
        },
        {
          "code": "B",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "benefitAmount": "0",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "68"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Payment"
        },
        {
          "serviceTypeCodes": [
            "68"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypes": [
            "Well Baby Care"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "code": "1",
          "serviceTypes": [
            "Maternity"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Maternity"
          ],
          "timeQualifier": "Visit",
          "coverageLevel": "Family",
          "name": "Co-Insurance",
          "timeQualifierCode": "27"
        },
        {
          "serviceTypeCodes": [
            "69"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "serviceTypes": [
            "Maternity"
          ]
        },
        {
          "code": "1",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "86"
          ],
          "name": "Active Coverage",
          "serviceTypes": [
            "Emergency Services"
          ]
        },
        {
          "benefitPercent": "0.5",
          "code": "A",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "86"
          ],
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "serviceTypes": [
            "Emergency Services"
          ],
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit"
        },
        {
          "inPlanNetworkIndicator": "No",
          "code": "1",
          "name": "Active Coverage",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "86"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Emergency Services"
          ]
        },
        {
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "code": "A",
          "serviceTypeCodes": [
            "86"
          ],
          "serviceTypes": [
            "Emergency Services"
          ],
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "N",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicator": "No",
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypes": [
            "Pharmacy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "88"
          ],
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypeCodes": [
            "88"
          ],
          "coverageLevel": "Family",
          "name": "Co-Payment",
          "serviceTypes": [
            "Pharmacy"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "timeQualifierCode": "27",
          "code": "B",
          "benefitAmount": "10",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevelCode": "FAM",
          "additionalInformation": [
            {
              "description": "per prescription"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "88"
          ],
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "serviceTypes": [
            "Pharmacy"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "1",
          "serviceTypeCodes": [
            "98"
          ],
          "additionalInformation": [
            {
              "description": "PCP"
            }
          ],
          "name": "Active Coverage"
        },
        {
          "additionalInformation": [
            {
              "description": "per visit"
            },
            {
              "description": "PCP"
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevelCode": "FAM",
          "timeQualifierCode": "27",
          "serviceTypeCodes": [
            "98"
          ],
          "benefitAmount": "15",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "timeQualifier": "Visit",
          "name": "Co-Payment",
          "planCoverage": "Gold Plan",
          "code": "B"
        },
        {
          "code": "I",
          "serviceTypeCodes": [
            "98"
          ],
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "PCP"
            }
          ]
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Specialist"
            },
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "98"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "per visit"
            },
            {
              "description": "Specialist"
            }
          ],
          "benefitAmount": "30",
          "coverageLevel": "Family",
          "code": "B",
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "timeQualifierCode": "27",
          "coverageLevelCode": "FAM",
          "name": "Co-Payment",
          "serviceTypeCodes": [
            "98"
          ]
        },
        {
          "additionalInformation": [
            {
              "description": "Specialist"
            }
          ],
          "serviceTypes": [
            "Professional (Physician) Visit - Office"
          ],
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "98"
          ],
          "planCoverage": "Gold Plan",
          "code": "I",
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "A4"
          ],
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Psychiatric"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider"
            }
          ]
        },
        {
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "serviceTypes": [
            "Psychiatric"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "serviceTypeCodes": [
            "A4"
          ],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "code": "A"
        },
        {
          "serviceTypeCodes": [
            "A4"
          ],
          "name": "Non-Covered",
          "serviceTypes": [
            "Psychiatric"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "inPlanNetworkIndicator": "No"
        },
        {
          "name": "Active Coverage",
          "code": "1",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family",
          "code": "A"
        },
        {
          "inPlanNetworkIndicator": "No",
          "inPlanNetworkIndicatorCode": "N",
          "code": "I",
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "A6"
          ],
          "serviceTypes": [
            "Psychotherapy"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "code": "1",
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "A7"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage"
        },
        {
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A7"
          ],
          "timeQualifierCode": "27",
          "name": "Co-Insurance",
          "code": "A",
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "benefitPercent": "0.5"
        },
        {
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "serviceTypeCodes": [
            "A7"
          ],
          "serviceTypes": [
            "Psychiatric - Inpatient"
          ],
          "name": "Non-Covered",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "code": "1",
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ],
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "A8"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y",
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "serviceTypeCodes": [
            "A8"
          ],
          "benefitPercent": "0.5",
          "name": "Co-Insurance",
          "planCoverage": "Gold Plan",
          "code": "A",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ]
        },
        {
          "serviceTypes": [
            "Psychiatric - Outpatient"
          ],
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "serviceTypeCodes": [
            "A8"
          ],
          "code": "I",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "AD"
          ],
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "code": "1"
        },
        {
          "inPlanNetworkIndicator": "Yes",
          "serviceTypeCodes": [
            "AD"
          ],
          "planCoverage": "Gold Plan",
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "code": "A",
          "timeQualifier": "Visit",
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicatorCode": "Y",
          "benefitPercent": "0.5",
          "name": "Co-Insurance"
        },
        {
          "code": "I",
          "serviceTypeCodes": [
            "AD"
          ],
          "serviceTypes": [
            "Occupational Therapy"
          ],
          "name": "Non-Covered",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "1",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Speech Therapy"
          ],
          "serviceTypeCodes": [
            "AF"
          ],
          "planCoverage": "Gold Plan",
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "AF"
          ],
          "coverageLevelCode": "FAM",
          "serviceTypes": [
            "Speech Therapy"
          ],
          "code": "A",
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "timeQualifier": "Visit",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "planCoverage": "Gold Plan",
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "AF"
          ],
          "serviceTypes": [
            "Speech Therapy"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "serviceTypeCodes": [
            "AG"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Limited to 150 days per year."
            }
          ],
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "code": "1",
          "name": "Active Coverage",
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "serviceTypeCodes": [
            "AG"
          ],
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "planCoverage": "Gold Plan",
          "name": "Co-Insurance",
          "coverageLevelCode": "FAM",
          "code": "A",
          "coverageLevel": "Family",
          "benefitPercent": "0.5",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "27",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Visit"
        },
        {
          "inPlanNetworkIndicatorCode": "N",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "AG"
          ],
          "serviceTypes": [
            "Skilled Nursing Care"
          ],
          "inPlanNetworkIndicator": "No",
          "name": "Non-Covered",
          "code": "I"
        },
        {
          "name": "Active Coverage",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "serviceTypeCodes": [
            "BZ"
          ],
          "planCoverage": "Gold Plan",
          "additionalInformation": [
            {
              "description": "Covered in accordance with ACA guidelines."
            }
          ],
          "code": "1"
        },
        {
          "coverageLevelCode": "FAM",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "BZ"
          ],
          "inPlanNetworkIndicator": "Yes",
          "name": "Co-Payment",
          "coverageLevel": "Family",
          "timeQualifierCode": "27",
          "code": "B",
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "benefitAmount": "0"
        },
        {
          "serviceTypes": [
            "Physician Visit - Office: Well"
          ],
          "code": "I",
          "serviceTypeCodes": [
            "BZ"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "name": "Non-Covered",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "1",
          "inPlanNetworkIndicatorCode": "Y",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypes": [
            "Mental Health"
          ],
          "additionalInformation": [
            {
              "description": "Prior authorization may be required. Covered No Limit."
            }
          ],
          "serviceTypeCodes": [
            "MH"
          ]
        },
        {
          "serviceTypeCodes": [
            "MH"
          ],
          "code": "A",
          "serviceTypes": [
            "Mental Health"
          ],
          "coverageLevel": "Family",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "timeQualifier": "Visit",
          "benefitPercent": "0.5",
          "name": "Co-Insurance",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifierCode": "27"
        },
        {
          "inPlanNetworkIndicator": "No",
          "planCoverage": "Gold Plan",
          "serviceTypes": [
            "Mental Health"
          ],
          "name": "Non-Covered",
          "code": "I",
          "serviceTypeCodes": [
            "MH"
          ],
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "code": "1",
          "serviceTypes": [
            "Physical Therapy"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "PT"
          ]
        },
        {
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "name": "Co-Payment",
          "timeQualifierCode": "27",
          "coverageLevel": "Family",
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "benefitAmount": "15",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "code": "B",
          "serviceTypeCodes": [
            "PT"
          ],
          "serviceTypes": [
            "Physical Therapy"
          ],
          "timeQualifier": "Visit"
        },
        {
          "serviceTypeCodes": [
            "PT"
          ],
          "name": "Non-Covered",
          "serviceTypes": [
            "Physical Therapy"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "code": "I",
          "inPlanNetworkIndicatorCode": "N"
        },
        {
          "serviceTypeCodes": [
            "UC"
          ],
          "serviceTypes": [
            "Urgent Care"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Active Coverage",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "code": "1",
          "planCoverage": "Gold Plan"
        },
        {
          "serviceTypes": [
            "Urgent Care"
          ],
          "timeQualifierCode": "27",
          "serviceTypeCodes": [
            "UC"
          ],
          "coverageLevelCode": "FAM",
          "timeQualifier": "Visit",
          "benefitAmount": "10",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Co-Payment",
          "planCoverage": "Gold Plan",
          "coverageLevel": "Family",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "code": "B",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "UC"
          ],
          "serviceTypes": [
            "Urgent Care"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicatorCode": "N",
          "additionalInformation": [
            {
              "description": "Covered No Limit."
            }
          ],
          "inPlanNetworkIndicator": "No",
          "code": "1"
        },
        {
          "benefitAmount": "10",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "per visit"
            }
          ],
          "code": "B",
          "inPlanNetworkIndicatorCode": "N",
          "timeQualifier": "Visit",
          "serviceTypeCodes": [
            "UC"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "name": "Co-Payment",
          "serviceTypes": [
            "Urgent Care"
          ],
          "coverageLevel": "Family",
          "timeQualifierCode": "27"
        },
        {
          "name": "Deductible",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "0",
          "code": "C",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "planCoverage": "Gold Plan",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "30"
          ],
          "name": "Deductible",
          "code": "C",
          "timeQualifierCode": "29",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "timeQualifier": "Remaining",
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "Y"
        },
        {
          "coverageLevelCode": "FAM",
          "name": "Deductible",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "coverageLevel": "Family",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "0",
          "serviceTypeCodes": [
            "30"
          ],
          "code": "C",
          "inPlanNetworkIndicator": "Yes",
          "timeQualifierCode": "23",
          "planCoverage": "Gold Plan"
        },
        {
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "30"
          ],
          "code": "C",
          "name": "Deductible",
          "timeQualifierCode": "29",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Remaining",
          "coverageLevel": "Family",
          "benefitAmount": "0"
        },
        {
          "serviceTypeCodes": [
            "30"
          ],
          "name": "Deductible",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "coverageLevelCode": "IND",
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Individual",
          "code": "C",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicatorCode": "N",
          "benefitAmount": "0"
        },
        {
          "timeQualifierCode": "29",
          "benefitAmount": "0",
          "name": "Deductible",
          "coverageLevel": "Individual",
          "planCoverage": "Gold Plan",
          "code": "C",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "IND",
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevelCode": "FAM",
          "code": "C",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "No",
          "timeQualifierCode": "23",
          "name": "Deductible",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Family"
        },
        {
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "name": "Deductible",
          "inPlanNetworkIndicator": "No",
          "coverageLevelCode": "FAM",
          "timeQualifier": "Remaining",
          "planCoverage": "Gold Plan",
          "code": "C"
        },
        {
          "coverageLevel": "Individual",
          "inPlanNetworkIndicator": "Yes",
          "benefitAmount": "3000",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypeCodes": [
            "30"
          ],
          "planCoverage": "Gold Plan",
          "timeQualifier": "Calendar Year",
          "code": "G",
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "coverageLevelCode": "IND"
        },
        {
          "code": "G",
          "coverageLevel": "Individual",
          "timeQualifier": "Remaining",
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "timeQualifierCode": "29",
          "coverageLevelCode": "IND",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "serviceTypeCodes": [
            "30"
          ],
          "benefitAmount": "2000",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ]
        },
        {
          "serviceTypeCodes": [
            "30"
          ],
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "inPlanNetworkIndicatorCode": "Y",
          "timeQualifier": "Calendar Year",
          "timeQualifierCode": "23",
          "benefitAmount": "6000",
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan",
          "inPlanNetworkIndicator": "Yes",
          "coverageLevel": "Family"
        },
        {
          "code": "G",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "benefitAmount": "5000",
          "timeQualifierCode": "29",
          "inPlanNetworkIndicator": "Yes",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Out of Pocket (Stop Loss)",
          "planCoverage": "Gold Plan",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Remaining"
        },
        {
          "coverageLevelCode": "IND",
          "benefitAmount": "0",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifier": "Calendar Year",
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "code": "G",
          "coverageLevel": "Individual",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "benefitAmount": "0",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "code": "G",
          "coverageLevel": "Individual",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "IND",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan"
        },
        {
          "code": "G",
          "inPlanNetworkIndicator": "No",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "timeQualifierCode": "23",
          "inPlanNetworkIndicatorCode": "N",
          "benefitAmount": "0",
          "timeQualifier": "Calendar Year",
          "coverageLevel": "Family",
          "name": "Out of Pocket (Stop Loss)",
          "serviceTypeCodes": [
            "30"
          ],
          "coverageLevelCode": "FAM",
          "planCoverage": "Gold Plan"
        },
        {
          "benefitAmount": "0",
          "serviceTypes": [
            "Health Benefit Plan Coverage"
          ],
          "planCoverage": "Gold Plan",
          "name": "Out of Pocket (Stop Loss)",
          "inPlanNetworkIndicator": "No",
          "code": "G",
          "inPlanNetworkIndicatorCode": "N",
          "coverageLevel": "Family",
          "serviceTypeCodes": [
            "30"
          ],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "coverageLevelCode": "FAM"
        }
      ],
      "confidence": {
        "score": 0.8,
        "level": "REVIEW_NEEDED",
        "reason": "This record was identified as a low confidence match due to a DOB partial match"
      }
    }
  ],
  "meta": {
    "applicationMode": "production",
    "traceId": "1-abcdef12-123456789abcdef123456789"
  },
  "status": "COMPLETE"
}

​
Retrieve results asynchronously

If the synchronous insurance discovery response indicates that the search is still PENDING, you can use the discoveryId to retrieve the complete results asynchronously from the Insurance Discovery Check Results endpoint.

You can begin polling immediately after receiving the PENDING status response from the synchronous endpoint. Like the synchronous endpoint, the Insurance Discovery Check Results endpoint can take up to 120 seconds to return a response.

It’s unlikely for the insurance discovery process to take more than a few minutes, so it’s rare to have to poll the asynchronous endpoint more than once. However, if you receive a PENDING status, you can poll the endpoint immediately again, and continue this polling process until the status changes to COMPLETE.

​
Coordination of benefits (COB) checks

Insurance discovery checks aren’t guaranteed to return all of a patient’s active health plans, so a follow-up COB check can help you determine whether the patient has active coverage with additional payers and which payer is responsible for paying claims (primacy).

Once you receive the results of an insurance discovery check, we recommend performing COB checks for the patient using one of their active plans.

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