openapi: 3.2.0 info: title: Enhanced Eligibility Eligibility Requests API description: 'Enhanced Eligibility provides real-time eligibility verification for medical benefit inquiries and optional Coverage Discovery workflows when additional coverage needs to be researched asynchronously. Timing guidance: - Real-Time Eligibility is synchronous, but payer and clearinghouse response time dominate the end-to-end latency. - The OI Enterprise gateway times out at 110 seconds for this API. - Request deduplication is customer-configurable and determines whether a request is sent to the clearinghouse or short-circuited by replaying a prior transaction response. - RTCOB and Coverage Insight also use a separate non-configurable 72-hour request cache. When that cache is hit, the path is marked as skipped instead of creating a new downstream submission. - Coverage Discovery is asynchronous because some paths involve chained clearinghouse work and additional connected workflow dependencies. - Most non-Coverage-Insight discovery paths are near real time relative to traditional discovery workflows. - Customers with strict turnaround sensitivity should evaluate Coverage Insight enrollment carefully. - Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. Primary integration patterns: 1. Submit a real-time eligibility request as normalized JSON or as a JSON request body with `x12` set to the X12 270 payload, and receive a normalized JSON response. 2. If enrolled in Coverage Discovery, inspect the real-time response `link` header for related discovery task resources when discovery is automatically triggered from the real-time request/response. 3. For advanced use cases, submit Coverage Discovery requests directly when you already possess a processed canonical eligibility request and, when needed, a processed eligibility response, and want asynchronous follow-up processing using a callback URL or by polling the discovery task resource. 4. When using direct discovery, the X12 workflow is often easier than the canonical JSON workflow because it accepts the processed `x12-270` and `x12-271` rather than requiring mapping into both canonical models. ' version: v0.2.0 servers: - url: https://sandbox-apigw.optum.com description: Sandbox server (uses test data) - url: https://apigw.optum.com description: Production server (uses live data) tags: - name: Eligibility Requests description: 'Submit new real-time eligibility transactions. These endpoints accept either a normalized JSON request or a JSON request body with `x12` set to the X12 270 payload, and return a normalized JSON eligibility response. When a customer is enrolled in integrated Coverage Discovery, these operations may also return related discovery task links in the response headers. ' paths: /rcm/eligibility/v1: post: operationId: postEligibility tags: - Eligibility Requests summary: Submit a new eligibility request security: - oAuth: - create_txn description: "## Overview\nProvided a valid request, this endpoint submits a new real-time transaction for processing.\nThe submitted provider NPI must be a valid NPI and follow standard NPI validation rules. If no valid NPI is identified for the request, the transaction returns `status.value` of `processing_error` with this message: `No valid NPI identified for this request. Please reach out to the Enhanced Eligibility team if assistance is needed.`\nThe response is JSON and includes the raw `x12-271` response string so clients can extract the payer's original EDI response if needed.\nReal-time response time is driven primarily by payer and clearinghouse latency. The OI Enterprise gateway times out at 110 seconds for this API.\nIf your organization is enrolled in deduplication, that feature is evaluated before clearinghouse submission. Deduplication is customer-configurable, including the lookback window and whether prior-month requests are excluded. When a duplicate is found, the clearinghouse is skipped and the transaction `sourceType` is `duplicate`.\n## Coverage Discovery Integration\nIf you are enrolled in Coverage Discovery at the time of the request and your configured discovery conditions are met, the Coverage Discovery workflow will be started automatically. Common examples include real-time responses with `status.value` of `ineligible` or `patient_unknown`, or response-side HMO plan information that qualifies an HMO discovery path. In this scenario, the response `link` header contains one or more related Coverage Discovery task resource paths, e.g.:\n`; title=\"coverage discovery - Task 1\"; rel=\"related\", ; title=\"coverage discovery - Task 2\"; rel=\"related\"`\nParse this header as RFC 8288-style link values. When more than one discovery task is created, multiple related links may be returned in the same header.\nWhen discovery is triggered from this JSON real-time endpoint, the submitted request body is used as the `canonicalEligibilityRequest` later referenced by Coverage Discovery. If response-side facts are needed, the normalized real-time response body is used as `canonicalEligibilityResponse`.\nEach related resource can be retrieved through the `/coverage-discovery/{id}` endpoint.\nIf conditions are not met, the `link` response header will not contain any related `/coverage-discovery` references.\n### Callback Solution With Consolidated Real-Time Eligibility and Coverage Discovery Responses\nIf you are enrolled in the consolidated callback capability, you may receive the **Real-Time Eligibility (RTE)** response together with the **Coverage Discovery** response.\nWhen enabled, the abbreviated eligibility transaction will be included in the corresponding Coverage Discovery record.\n\n ⚠️ **Note:** This integrated response is **only available via callback** and **only if your organization is enrolled in this capability**.\n\nRefer to the `/coverage-discovery/{id}` response examples for data model references.\nFor predictable Sandbox canned-response testing, use the Sandbox Mock Scenarios guidance. JSON Sandbox requests continue to use the normal supported Sandbox request values." parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/header-subtenant-id' - in: header name: x-optum-eligibility-disable-value-add schema: type: array items: type: string enum: - deduplication example: deduplication example: deduplication description: (Optional) A comma-delimited list of strings that disable value-added features on a request-by-request basis. `deduplication` disables the customer-configured request deduplication feature for that request only. If you specify a value-added feature that you are not enrolled in, it will be ignored. requestBody: $ref: '#/components/requestBodies/EligibilityRequest' responses: '200': $ref: '#/components/responses/EligibilityResponse' '400': $ref: '#/components/responses/BadRequestError' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/real-time/x12: post: operationId: postEligibilityX12 tags: - Eligibility Requests summary: Submit a new X12 270 eligibility request security: - oAuth: - create_txn description: "## Overview\nProvided a valid request, this endpoint accepts a JSON body whose `x12` field contains the raw EDI X12 270 payload and submits a new real-time transaction for processing.\nThe provider NPI sent in the X12 270 must be a valid NPI and follow standard NPI validation rules. If no valid NPI is identified for the request, the transaction returns `status.value` of `processing_error` with this message: `No valid NPI identified for this request. Please reach out to the Enhanced Eligibility team if assistance is needed.`\nThe response uses the same normalized JSON model returned by the JSON real-time endpoint. Both real-time endpoints return JSON, and that JSON includes the raw `x12-271` response string so clients can extract the payer's original EDI response if needed.\nReal-time response time is driven primarily by payer and clearinghouse latency. The OI Enterprise gateway times out at 110 seconds for this API.\nIf your organization is enrolled in deduplication, that feature is evaluated before clearinghouse submission. Deduplication is customer-configurable, including the lookback window and whether prior-month requests are excluded. When a duplicate is found, the clearinghouse is skipped and the transaction `sourceType` is `duplicate`.\n## Coverage Discovery Integration\nIf you are enrolled in Coverage Discovery at the time of the request and your configured discovery conditions are met, the Coverage Discovery workflow will be started automatically. Common examples include real-time responses with `status.value` of `ineligible` or `patient_unknown`, or response-side HMO plan information parsed from the returned `x12-271`. In this scenario, the response `link` header contains one or more related Coverage Discovery task resource paths, e.g.:\n`; title=\"coverage discovery - Task 1\"; rel=\"related\", ; title=\"coverage discovery - Task 2\"; rel=\"related\"`\nParse this header as RFC 8288-style link values. When more than one discovery task is created, multiple related links may be returned in the same header.\nWhen discovery is triggered from this X12 real-time endpoint, the submitted `x12` value is used to derive the `canonicalEligibilityRequest` used by Coverage Discovery. If response-side facts are needed, the normalized JSON response and its embedded `x12-271` are used as `canonicalEligibilityResponse`.\nEach related resource can be retrieved through the `/coverage-discovery/{id}` endpoint.\nIf conditions are not met, the `link` response header will not contain any related `/coverage-discovery` references.\n### Callback Solution With Consolidated Real-Time Eligibility and Coverage Discovery Responses\nIf you are enrolled in the consolidated callback capability, you may receive the **Real-Time Eligibility (RTE)** response together with the **Coverage Discovery** response.\nWhen enabled, the abbreviated eligibility transaction will be included in the corresponding Coverage Discovery record.\n\n ⚠️ **Note:** This integrated response is **only available via callback** and **only if your organization is enrolled in this capability**.\n\nRefer to the `/coverage-discovery/{id}` response examples for data model references.\n## Sandbox Mock Testing\nIn the Sandbox environment, you can optionally send `x-optum-rcmelig-mock-scenarios` to trigger a canned X12 mock response. This header is Sandbox-only, the value must be an exact case-sensitive match, and the payer id in `NM1*PR*2 ... PI*` must align to the selected scenario." parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/header-subtenant-id' - in: header name: x-optum-rcmelig-mock-scenarios required: false schema: type: string description: (Sandbox only) Optional canned-response selector for X12 mock testing. The value must be an exact case-sensitive scenario string. - in: header name: x-optum-eligibility-disable-value-add schema: type: array items: type: string enum: - deduplication example: deduplication example: deduplication description: (Optional) A comma-delimited list of strings that disable value-added features on a request-by-request basis. `deduplication` disables the customer-configured request deduplication feature for that request only. If you specify a value-added feature that you are not enrolled in, it will be ignored. requestBody: $ref: '#/components/requestBodies/EligibilityRequestX12' responses: '200': $ref: '#/components/responses/EligibilityResponseX12' '400': $ref: '#/components/responses/BadRequestError' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' 5XX: $ref: '#/components/responses/UnexpectedError' components: schemas: EligibilityRequest: type: object description: Standalone JSON representation of a standard 270 eligibility request. This schema is fully inlined into this spec so the API definition stands on its own. required: - subscriber - encounter properties: submitterTransactionIdentifier: type: string description: BHT03 controlNumber: type: string minLength: 9 maxLength: 9 description: 'Segment: ISA, Element: ISA13, Notes: Optional. If omitted, Enhanced Eligibility generates the Interchange Control Number. When supplied, it must be exactly 9 positive unsigned numeric characters.' example: '123456789' tradingPartnerServiceId: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI' example: serviceId tradingPartnerName: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name' provider: type: object properties: organizationName: type: string minLength: 0 maxLength: 60 description: 'Loop: 2100B Segment: NM1, Element: NM103' example: provider_name firstName: type: string minLength: 0 maxLength: 35 description: 'Loop: 2100B Segment: NM1, Element: NM104' lastName: type: string minLength: 0 maxLength: 60 description: 'Loop: 2100B Segment: NM1, Element: NM103' npi: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=XX Centers for Medicare and Medicaid Services National Provider Identifier. The submitted value must be a valid NPI and follow standard NPI validation rules.' example: '1234567893' serviceProviderNumber: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=SV Service Provider Number' example: '54321' payorId: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=PI Payor Identification' taxId: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=FI Federal Taxpayer''s Identification Number' ssn: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=34 Social Security Number' pharmacyProcessorNumber: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=PP Pharmacy Processor Number' servicesPlanID: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=XV Centers for Medicare and Medicaid Services PlanID' employersId: type: string minLength: 0 maxLength: 80 description: 'Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=24 Employer''s Identification Number' providerCode: type: string description: 'Loop: 2100B Segment: PRV, Element: PRV01' example: AD enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string description: 'Loop: 2100B Segment: PRV, Element: PRV03' example: 54321g providerType: type: string description: 'Loop: 2100B Segment: NM1, Element: NM101' enum: - payer - third-party administrator - employer - hospital - facility - gateway provider - plan sponsor - provider portalUsername: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: User Identification REF01=JD' portalPassword: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: Personal Identification Number (PIN) REF01=4A' informationReceiverName: type: object properties: stateLicenceNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=0B State License Number' medicareProviderNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1C Medicare Provider Number' medicaidProviderNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1D Medicaid Provider Number' facilityIdNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1J Facility ID Number' contactNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=CT Contact Number' devicePinNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=EL Electronic Device Pin Number' submitterIdNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=EO Submitter Identification Number' nationalProviderIdentifier: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=HPI Centers for Medicare and Medicaid Services National Provider Identifier' providerPlanNetworkIdNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=N5 Provider Plan Network Identification Number' facilityNetworkIdNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=N7 Facility Network Identification Number' priorIdentifierNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=Q4 Prior Identifier Number' socialSecurityNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number' federalTaxpayerIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=TJ Federal Taxpayer''s Identification Number' informationReceiverAdditionalIdentifierState: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100B, Segment: REF, Element: REF03, Notes: REF01=0B REF02=stateLicenceNumber' address: type: object properties: address1: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N301, Notes: Required, Address Information' example: 123 address1 address2: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N302, Notes: Address Information' city: type: string minLength: 0 maxLength: 30 description: 'Segment: N4, Element: N401, Notes: Required, city' example: city1 state: type: string minLength: 0 maxLength: 2 description: 'Segment: N4, Element: N402, Notes: state example: TN, WA' example: wa postalCode: type: string minLength: 0 maxLength: 15 description: 'Segment: N4, Element: N403' example: '981010000' countryCode: type: string description: 'Segment: N4, Element: N404' locationIdentifier: type: string description: 'Segment: N4, Element: N406' countrySubDivisionCode: type: string description: 'Segment: N4, Element: N407, Notes: Country SubDivision Code' subscriber: type: object properties: birthSequenceNumber: type: string minLength: 0 maxLength: 9 pattern: ^[0-9]+$ description: 'Loop: 2100C Segment: INS, Element: INS17, Notes: Birth Sequence Number' caseNumber: type: string minLength: 0 maxLength: 50 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2100C Segment: REF, Element: REF02, Notes: REF01=3H Case Number' medicaidRecipientIdentificationNumber: type: string minLength: 0 maxLength: 80 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2110C Segment: REF, Element: REF02, Notes: REF01=NQ Medicaid Recipient Identification Number' spendDownAmount: type: string minLength: 0 maxLength: 18 description: 'Loop: 2110C Segment: ATM, Element: ATM02, Notes: ATM01=R Spend Down' spendDownTotalBilledAmount: type: string minLength: 0 maxLength: 18 description: 'Loop: 2110C Segment: ATM, Element: ATM02, Notes: ATM01=PB Billed Amount' coverageLevelCode: type: string minLength: 0 maxLength: 3 description: 'Loop: 2110C Segment: EQ, Element: EQ03, Notes: Retired, Not Used' memberId: type: string minLength: 0 maxLength: 80 pattern: ^[A-Za-z0-9-]+$ description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM109, Notes: NM108=MI' example: '0000000000' firstName: type: string minLength: 0 maxLength: 35 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM104' example: johnOne middleName: type: string minLength: 0 maxLength: 25 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM105' lastName: type: string minLength: 0 maxLength: 60 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM103' example: doeOne suffix: type: string minLength: 0 maxLength: 10 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM107' gender: type: string minLength: 0 maxLength: 1 description: 'Loop: 2100C and 2100D, Segment: DMG, Element: DMG03' example: M enum: - M - F dateOfBirth: type: string description: 'Loop: 2100C and 2100D, Segment: DMG, Element: DMG02, Notes: date of birth in YYYYMMDD' example: '18800102' ssn: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number' groupNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=6P Group Number' example: '1111111111' idCard: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=HJ Identity Card Number' providerCode: type: string description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV01' enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU referenceIdentificationQualifier: type: string description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV02' enum: - 9K - D3 - EI - HPI - PXC - SY - TJ providerIdentifier: type: string minLength: 0 maxLength: 50 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV03, Notes: Provider Identifier' beginningCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired' endCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired' idCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=D8 Retired' planIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=D8 Retired' beginningPlanIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired' endPlanIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired' healthCareCodeInformation: type: array minItems: 0 maxItems: 8 description: 'Loop: 2100C and 2100D, Segment: HI, Notes: Health Care Diagnosis' items: type: object properties: diagnosisTypeCode: type: string description: 'Loop: 2100C and 2100D, Segment: HI, Element: HI01-1, Notes: Diagnosis Type Code' enum: - BK - ABK - BF - ABF diagnosisCode: type: string minLength: 0 maxLength: 30 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2100C and 2100D, Segment: HI, Element: HI01-2, Notes: Diagnosis Code' address: type: object properties: address1: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N301, Notes: Required, Address Information' example: 123 address1 address2: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N302, Notes: Address Information' city: type: string minLength: 0 maxLength: 30 description: 'Segment: N4, Element: N401, Notes: Required, city' example: city1 state: type: string minLength: 0 maxLength: 2 description: 'Segment: N4, Element: N402, Notes: state example: TN, WA' example: wa postalCode: type: string minLength: 0 maxLength: 15 description: 'Segment: N4, Element: N403' example: '981010000' countryCode: type: string description: 'Segment: N4, Element: N404' locationIdentifier: type: string description: 'Segment: N4, Element: N406' countrySubDivisionCode: type: string description: 'Segment: N4, Element: N407, Notes: Country SubDivision Code' additionalIdentification: type: object properties: planNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=18 Plan Number' policyNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1L Group or Policy Number' memberIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1W Member Identification Number' contractNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=CT Contract Number' medicalRecordIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EA Medical Record Identification Number' patientAccountNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EJ Patient Account Number' healthInsuranceClaimNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=F6 Health Insurance (HIC) Number' identificationCardSerialNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=GH Identification Card Serial Number' insurancePolicyNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=IG Insurance Policy Number' planNetworkIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=N6 Plan Network Identification Number' agencyClaimNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=Y4 Agency Claim Number' dependents: type: array minItems: 1 description: 'Loop: 2000D, Notes: Dependent Detail' items: type: object properties: birthSequenceNumber: type: string minLength: 0 maxLength: 9 pattern: ^[0-9]+$ description: 'Loop: 2100D Segment: INS, Element: INS17, Notes: Birth Sequence Number' individualRelationshipCode: type: string description: 'Loop: 2100D Segment: INS, Element: INS02' enum: - '01' - '19' - '34' issueNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100D Segment: REF, Element: REF02, Notes: REF01=IF Issue Number' eligibilityCategory: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100D Segment: REF, Element: REF02, Notes: REF01=MRC Eligibility Category' memberId: type: string minLength: 2 maxLength: 80 pattern: ^[A-Za-z0-9-]+$ description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM109, Notes: NM108=MI' example: '0000000000' firstName: type: string minLength: 0 maxLength: 35 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM104' example: janeOne middleName: type: string minLength: 0 maxLength: 25 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM105' lastName: type: string minLength: 0 maxLength: 60 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM103' example: doeOne suffix: type: string minLength: 0 maxLength: 10 description: 'Loop: 2100C and 2100D, Segment: NM1, Element: NM107' gender: type: string minLength: 0 maxLength: 1 description: 'Loop: 2100C and 2100D, Segment: DMG, Element: DMG03' example: F enum: - M - F dateOfBirth: type: string description: 'Loop: 2100C and 2100D, Segment: DMG, Element: DMG02, Notes: date of birth in YYYYMMDD' example: '18160421' ssn: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number' groupNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=6P Group Number' example: '1111111111' idCard: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=HJ Identity Card Number' providerCode: type: string description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV01' enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU referenceIdentificationQualifier: type: string description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV02' enum: - 9K - D3 - EI - HPI - PXC - SY - TJ providerIdentifier: type: string minLength: 0 maxLength: 50 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2100C and 2100D, Segment: PRV, Element: PRV03, Notes: Provider Identifier' beginningCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired' endCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired' idCardIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=D8 Retired' planIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=D8 Retired' beginningPlanIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired' endPlanIssueDate: type: string description: 'Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired' healthCareCodeInformation: type: array minItems: 0 maxItems: 8 description: 'Loop: 2100C and 2100D, Segment: HI, Notes: Health Care Diagnosis' items: type: object properties: diagnosisTypeCode: type: string description: 'Loop: 2100C and 2100D, Segment: HI, Element: HI01-1, Notes: Diagnosis Type Code' enum: - BK - ABK - BF - ABF diagnosisCode: type: string minLength: 0 maxLength: 30 pattern: ^[A-Za-z0-9]+$ description: 'Loop: 2100C and 2100D, Segment: HI, Element: HI01-2, Notes: Diagnosis Code' address: type: object properties: address1: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N301, Notes: Required, Address Information' example: 123 address1 address2: type: string minLength: 0 maxLength: 55 description: 'Segment: N3, Element: N302, Notes: Address Information' city: type: string minLength: 0 maxLength: 30 description: 'Segment: N4, Element: N401, Notes: Required, city' example: city1 state: type: string minLength: 0 maxLength: 2 description: 'Segment: N4, Element: N402, Notes: state example: TN, WA' example: wa postalCode: type: string minLength: 0 maxLength: 15 description: 'Segment: N4, Element: N403' example: '981010000' countryCode: type: string description: 'Segment: N4, Element: N404' locationIdentifier: type: string description: 'Segment: N4, Element: N406' countrySubDivisionCode: type: string description: 'Segment: N4, Element: N407, Notes: Country SubDivision Code' additionalIdentification: type: object properties: planNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=18 Plan Number' policyNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1L Group or Policy Number' memberIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1W Member Identification Number' contractNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=CT Contract Number' medicalRecordIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EA Medical Record Identification Number' patientAccountNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EJ Patient Account Number' healthInsuranceClaimNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=F6 Health Insurance (HIC) Number' identificationCardSerialNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=GH Identification Card Serial Number' insurancePolicyNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=IG Insurance Policy Number' planNetworkIdentificationNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=N6 Plan Network Identification Number' agencyClaimNumber: type: string minLength: 0 maxLength: 50 description: 'Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=Y4 Agency Claim Number' encounter: type: object required: - dateOfService properties: beginningDateOfService: type: string description: 'Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=RD8, Date Expressed in Format YYYYMMDD.' endDateOfService: type: string description: 'Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=RD8, Date Expressed in Format YYYYMMDD.' dateOfService: type: string description: 'Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=D8, Date Expressed in Format YYYYMMDD.' serviceTypeCodes: type: array minItems: 0 maxItems: 99 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ01, Notes: Service Type Codes.' items: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '30' - '32' - '33' - '34' - '35' - '36' - '37' - '38' - '39' - '40' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '83' - '84' - '85' - '86' - '87' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AC - AD - AE - AF - AG - AH - AI - AJ - AK - AL - AM - AN - AO - AQ - AR - B1 - B2 - B3 - BA - BB - BC - BD - BE - BF - BG - BH - BI - BJ - BK - BL - BM - BN - BP - BQ - BR - BS - BT - BU - BV - BW - BX - BY - BZ - C1 - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CO - CP - CQ - DG - DM - DS - GF - GN - GY - IC - MH - NI - 'ON' - PT - PU - RN - RT - TC - TN - UC priorAuthorizationOrReferralNumber: type: string description: 'Loop: 2110C and 2110D, Segment: REF, Element: REF02, Notes: Prior Authorization or Referral Number' referenceIdentificationQualifier: type: string description: 'Loop: 2110C and 2110D, Segment: REF, Element: REF01, Notes: Prior Authorization or Referral Number' enum: - 9F - G1 industryCode: type: string description: 'Loop: 2110C and 2110D, Segment: III, Element: III02, Notes: III01=ZZ Industry Code' enum: - '01' - '02' - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '71' - '72' - '81' - '99' productOrServiceIDQualifier: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1, Notes: Composite Medical Procedure Identifier - Product or Service ID Qualifier' enum: - AD - CJ - HC - ID - IV - N4 - ZZ procedureCode: type: string minLength: 0 maxLength: 48 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-2, Notes: Composite Medical Procedure Identifier - Procedure Code' procedureModifiers: type: array minItems: 0 maxItems: 4 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier' items: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier' diagnosisCodePointer: type: array minItems: 0 maxItems: 4 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer' items: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer' medicalProcedures: type: array minItems: 0 maxItems: 98 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1-3, Notes: Composite Medical Procedure Identifier' items: type: object properties: productOrServiceIDQualifier: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1, Notes: Composite Medical Procedure Identifier - Product or Service ID Qualifier' enum: - AD - CJ - HC - ID - IV - N4 - ZZ procedureCode: type: string minLength: 0 maxLength: 48 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-2, Notes: Composite Medical Procedure Identifier - Procedure Code' procedureModifiers: type: array minItems: 0 maxItems: 4 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier' items: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier' diagnosisCodePointer: type: array minItems: 0 maxItems: 4 description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer' items: type: string description: 'Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer' TransactionMedicare: type: object description: 'Medicare eligibility transaction derived from an X12 271 response (005010X279A1). This model represents the normalized API view of the payer response. ' properties: id: type: string description: System-generated transaction identifier example: 9fb77454-8c58-4345-aa50-43f133e06d20 correlationId: type: string description: 'Correlation identifier provided by the consumer in the request header and echoed back in the response. Not derived from X12. ' example: corr-8b7c2f3a-1c9e-4d3b-a6f5-112233445566 sourceType: type: string enum: - new - historical - duplicate - autosubmit description: How the transaction was created. `new` means the transaction was submitted through the Real-Time Eligibility flow. `duplicate` means customer-configured deduplication found a prior matching request, skipped clearinghouse submission, and returned the previous response. `autosubmit` means the transaction was generated by Coverage Discovery path execution. `historical` means the record originated from historical retrieval rather than a newly created request. example: new processedDate: type: string format: date-time description: Time the 271 response was processed by the system example: '2022-03-04T03:43:00Z' status: type: object description: Normalized eligibility outcome derived from the X12 271. properties: value: type: string enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown example: eligible description: type: string patient: type: object description: Subscriber/patient information from NM1*IL, DMG, N3, N4 properties: firstName: type: string example: JOHNONE lastName: type: string example: DOEONE middleName: type: string example: M memberId: type: string description: Medicare beneficiary identifier example: '0000000000' gender: type: string example: F dateOfBirth: type: string format: date example: '1880-01-02' relationship: type: string description: Normalized patient relationship when present on the transaction response. example: CHILD address: type: object properties: lines: type: array items: type: string example: - 123 address1 city: type: string example: SEATTLE state: type: string example: WA zip: type: string example: '98101' subscriber: type: object description: 'Subscriber details. For Medicare responses, the subscriber is the patient, so this object mirrors `patient` when both are present. ' properties: firstName: type: string example: JOHNONE lastName: type: string example: DOEONE memberId: type: string example: '0000000000' gender: type: string example: F dateOfBirth: type: string format: date example: '1880-01-02' payer: type: object description: Primary and additional payer information from the 271 properties: chcId: type: string description: Normalized CHC payer identifier returned on the real-time transaction response. example: '60054' name: type: string example: CMSMED phone: type: string example: '0000000000' url: type: string example: www.testwebsite.com otherPayer: type: object description: Additional payer from LS/2120 loop properties: name: type: string example: extra healthy insurance address: type: object properties: lines: type: array items: type: string example: - 123 address1 city: type: string example: Nashville state: type: string example: TN zip: type: string example: '37203' plan: type: object description: Medicare plan and pharmacy information properties: insuranceType: type: string enum: - Medicare example: Medicare beginDate: type: string format: date description: Coverage start date (DTP*291) example: '2004-11-01' endDate: type: string format: date description: Coverage end date (DTP*291 RD8) example: '2021-12-31' number: type: string description: Plan identifier from REF*18 example: S5601 description: type: string description: Plan description from REF*N6 example: SilverScript SmartRx benefits: type: array description: Benefits derived from EB, DTP, and MSG segments items: type: object properties: service: type: string description: Service type derived from EB03 example: Health Coverage name: type: string description: Benefit name derived from EB01 example: copay value: type: string example: '1484' type: type: string enum: - string - date - number - percent - monetary example: monetary insuranceType: type: string enum: - Medicare example: Medicare benefitQualifier: type: string description: EB segment qualifiers (EB01 / EB06 / EB09) example: EB01=C x12-271: type: string description: Raw X12 271 eligibility response payload. example: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~ Error: description: The base object model for errors returned from the workflow type: array items: type: string example: Internal - An unknown error occurred Transaction: type: object description: The base object model for the `/transactions` endpoints and the canonical model for Enhanced Eligibility properties: id: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: The unique ID of the transaction sourceId: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: The id of the transaction that spawned this record. If empty, this transaction has no parent. sourceType: type: string enum: - new - historical - duplicate - autosubmit example: new description: How the transaction was created. `new` means the transaction was submitted through the Real-Time Eligibility flow. `duplicate` means customer-configured deduplication found a prior matching request, skipped clearinghouse submission, and returned the previous response. `autosubmit` means the transaction was generated by Coverage Discovery path execution. `historical` means the record originated from historical retrieval rather than a newly created request. correlationId: type: string description: An ID provided by the consumer at the time of transaction processing processedDate: type: string example: '2017-07-21T17:32:28Z' description: The time the transaction was processed by the system status: type: object description: The outcome of the transaction properties: value: type: string enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown example: eligible description: type: string example: Eligible with insurance description: A human readable representation of the 'value' field. errors: type: array items: type: string description: A list of errors that occurred during process benefits: type: array items: type: object example: service: Urgent Care networkClass: inNetwork benefitType: family name: copay type: string scope: common benefitQualifier: DY properties: service: type: string example: Urgent Care description: Text description of service type code networkClass: type: string enum: - inNetwork - outNetwork example: inNetwork description: Whether the benefit conditions apply to 'in' or 'out' of network benefitType: type: string enum: - individual - family example: individual description: Benefit type maps to either individual or family name: type: string example: copay description: Benefit field name value: type: string description: Benefit field value type: type: string enum: - string - date - number - percent - monetary - phone description: Benefit field data type scope: type: string enum: - common - service example: common description: Benefit field relates either to a service type or is common (not related to a service type) insuranceType: type: string enum: - AllPayers - Medicaid - Medicare example: AllPayers description: 'Insurance classification: Medicare, Medicaid, or AllPayers' benefitQualifier: type: string example: DY (value of the benefit is in days) description: Benefit field code identifying type or source description: Detailed benefit information for each service returned by the payer patient: type: object properties: dateOfBirth: type: string format: date example: '1880-01-02' dateOfDeath: type: string format: date example: '1880-01-02' eligibilityCategory: type: string description: Expresses the eligibility category of the member to properly administer health benefits and coverage (from Department of Defense) firstName: type: string example: John gender: type: string example: M lastName: type: string example: Doe memberId: type: string example: '4784784' middleName: type: string example: Dave militaryPersonnel: type: boolean example: false mrn: type: string example: '657883' phone: type: string example: '1234567890' relationship: type: string example: child ssn: type: string example: '555443333' suffix: type: string example: Mr. agencyClaimNumber: type: string example: WC1234567 address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' description: The patient details captured on the eligibility response payer: type: object properties: aaaSource: type: string example: Additional Text From Payer certificationNumber: type: string example: '9999999999' description: 10 digits contactExtension: type: string example: '7657' contactName: type: string example: Contact Example description: type: string example: HEALTHFIRST-MANAGED MEDICAID email: type: string example: payer.email@email.com fax: type: string example: '8009999999' name: type: string example: HEALTHFIRST phone: type: string example: '8009252272' thirdPartyAdminstrator: type: object properties: name: type: string example: BCBSM TPA phone: type: string example: '8009252272' url: type: string example: payerwebsite.com address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' chcId: type: string example: 09876z5y-43x2-1w09-v8u7-tr6543s210qp description: Represents data about the payer that is on record for the eligibility request plan: type: object description: Detailed information about the Subscriber’s plan, group, and policy properties: beginDate: type: string format: date example: '2008-01-02' dateOfDecision: type: string format: date example: '2008-01-02' endDate: type: string format: date example: '2008-01-02' benefitFirstBilledDate: type: string format: date example: '2008-01-02' groupOrPolicyNumber: type: string example: '8888888888' insuranceType: type: string example: Health Maintenance Organization (HMO) lastBilledDate: type: string format: date example: '2008-01-02' medicalAssistanceCategory: type: string example: '999' otherAdditionalCoverageQualifier: type: string example: PHARMACY otherCoverage: type: string example: FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY otherProductDescription: type: string example: HealthPlan planBeginDate: type: string format: date example: '2008-01-02' planCoverageDescription: type: string example: HEALTHFIRST-MANAGED MEDICAID description: type: string example: Plan Description name: type: string example: Cigna PPO number: type: string example: S5768 135 ppo: type: string example: Dr. T Test description: Preferred provider organization productDescription: type: string example: HEALTHFIRST-MANAGED MEDICAID dependentMemberID: type: string example: M20220314 familyUnitNumber: type: string example: '01' identificationCardSerialNumber: type: string example: ICSN0001 insurancePolicyNumber: type: string example: ICSN0001 subscriberPremiumPaidEndDate: type: string format: date example: '2008-01-01' aca: type: object properties: hixMessage: type: string example: HIX Grace Period periodStart: type: string format: date example: '2008-01-01' periodEnd: type: string format: date example: '2008-01-01' case: type: object description: Used to clarify plan level details properties: type: type: string description: Reference Information as defined for a Reference Identification Qualifier description: type: string example: Free form text gatewayProvider: type: object properties: name: type: string example: Gateway Provider A address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' group: type: object properties: name: type: string example: FLORIDA MEDICAID number: type: string example: FLMCD000 policyName: type: string example: FLMPOL256 hmo: type: object description: Health maintenance organization details properties: name: type: string example: Cigna HMO planNumber: type: string example: CIG991122 hra: type: object description: Health reimbursement arrangement details properties: balance: type: string example: '90' employerPledge: type: string example: '500' paid: type: string example: '400' priorCarryover: type: string example: '100' hsa: type: object description: Health savings account details properties: balance: type: string example: '500' employerPledge: type: string example: '800' paid: type: string example: '200' priorCarryover: type: string example: '0' ipa: type: object description: Individual practice association details properties: name: type: string example: AETNA CHOICE POS II contactName: type: string example: MERITAIN HEALTH CUSTOMER SERVICE id: type: string example: IPAID phone: type: string example: '8009252272' address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' otherPayer: type: object description: Additional Payer Associated with Patient properties: groupNumber: type: string example: CIG998877 policyNumber: type: string example: CIGNA PPO planNetworkIdentification: type: object properties: description: type: string example: Free form qualifier number: type: string example: PNIN08549 policy: type: object description: Information about the plan policy properties: name: type: string example: Cigna PPO description: Plan description from the payer number: type: string example: S5768 135 description: Group or policy number associated with the plan mapping to the policy reference identifier from the payer preferredProviderOrg: type: object description: Details about the preferred provider organization properties: name: type: string example: Dr. T Test contactName: type: string example: Test Contact Name id: type: string example: '452114586' phone: type: string example: '8009252272' address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' primaryCareProvider: type: object properties: providerName: type: string example: Provider Name physician: type: string example: ALBERTO BRIZUELA-DUCHARNE npi: type: string example: '1234567893' phoneNumber: type: string example: '8009252272' dateRange: type: string example: '2022-01-01' address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' subscriber: type: object properties: agencyNumber: type: string example: WC1234567 anniversaryDate: type: string format: date example: '1880-01-02' dateOfBirth: type: string format: date example: '1880-01-02' employer: type: string example: Optum firstName: type: string example: johnOne gender: type: string example: M idCardNumber: type: string example: 5678 1234-A lastName: type: string example: doeOne memberId: type: string example: '12345921601' middleName: type: string example: mOne militaryPersonnel: type: boolean example: false mrn: type: string example: '657883' priorIdNumber: type: string example: '4784784' description: The prior identification number (memberId) ssn: type: string example: '555443333' suffix: type: string example: Mr. premiumPaidEndDate: type: string format: date example: '2020-01-02' address: type: object properties: lines: type: array items: type: string example: - 1234 Main Street city: type: string example: Dallas county: type: string example: Harris County state: type: string example: TX subdivisionCode: type: string example: TX zip: type: string example: '77001' description: Subscriber data that originated from the Payer x12-271: type: string description: Raw X12 271 eligibility response payload returned for the transaction. example: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~ EligibilityRequestX12: type: object description: Real-time X12 request payload. The JSON field name is `x12`, and its value is the raw X12 270 request payload. The provider NPI in the X12 270 must be valid and follow standard NPI validation rules. The corresponding response is returned as normalized JSON, not as raw X12. required: - x12 properties: x12: type: string description: Raw X12 270 eligibility inquiry payload. The provider NPI in the X12 270 must be valid and follow standard NPI validation rules. example: ISA*00* *01*SomePwd *ZZ*TPG00000 *ZZ*EMDEON *220304*0343*^*00501*123456789*0*T*:~GS*HS*LLX1210001*MTEXE*20131015*2219*123456789*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*1*123456789*9877281234~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~DTP*291*RD8*20210101-20211231~EQ*30~SE*20*0001~GE*1*123456789~IEA*1*123456789~ headers: correlationid: schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: A unique identifier value that is attached to the response that allow reference to the original request. Differs from `x-optum-trace-id` as the correlation-id is stored within the datastore for future queryability. rte-link: schema: type: string example: ; title="coverage discovery - Default Discovery Task"; rel="related", ; title="coverage discovery - Chained Discovery Task"; rel="related" description: (Optional) RFC 8288-style related-resource link header returned by real-time eligibility POST responses when Coverage Discovery task(s) are spawned. The header may include one or more related task paths. Each related path can be used with `GET /coverage-discovery/{id}` to retrieve task status. If you are enrolled in Coverage Discovery and this header is absent, no Coverage Discovery task was initiated for that transaction. traceid: schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: A unique identifier value that is attached to the response that allow reference to the original request. tenantid: schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: The unique ID of the tenant that invoking user belongs to. Used to enforce data tenancy. subtenantid: schema: type: string example: 5e2f9f4f-6f1d-4b37-92b5-6c5a9d1f8a21 description: (Optional) Identifies an Optum-assigned sub-tenant configuration for your organization. Include this header only when Optum has provided a value for a specific enabled customer configuration. Clients must not generate or infer this value. examples: EligibilityRequestMinimal: value: tradingPartnerServiceId: CIGNA provider: organizationName: Example Medical Center npi: '1234567893' subscriber: memberId: '12313423' firstName: johnOne lastName: doeOne dateOfBirth: '18800102' ssn: '144334555' encounter: dateOfService: '20250115' serviceTypeCodes: - '30' RTEEligibilityResponseHMO: value: id: rte-hmo-123 sourceType: new correlationId: corr-8b7c2f3a-1c9e-4d3b-a6f5-112233445566 payer: chcId: CIGNA processedDate: '2024-07-22T17:05:00Z' status: value: eligible plan: hmo: name: Cigna HMO planNumber: CIG991122 subscriber: memberId: HMO123456 dateOfBirth: '1980-01-01' x12-271: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567893~HL*3*2*22*0~TRN*2*2233445566*1234567893~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~ RTEEligibilityRequestHMOCandidate: value: controlNumber: '2233445566' tradingPartnerServiceId: CIGNA provider: organizationName: Example Medical Center npi: '1234567893' subscriber: memberId: HMO123456 firstName: JOHN lastName: DOE dateOfBirth: '19800101' address: address1: 123 Main St city: Hartford state: CT postalCode: '06103' encounter: dateOfService: '20240722' serviceTypeCodes: - '30' RTEEligibilityResponseIneligible: value: id: rte-ineligible-123 sourceType: new correlationId: corr-8b7c2f3a-1c9e-4d3b-a6f5-112233445566 payer: chcId: CIGNA processedDate: '2025-01-15T16:05:10Z' status: value: ineligible subscriber: memberId: SUB123 dateOfBirth: '1950-01-02' x12-271: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *250115*1605*^*00501*000000011*0*T*:~GS*HB*CIGNA*PROVIDERID*20250115*1605*11*X*005010X279A1~ST*271*0011*005010X279A1~BHT*0022*11*1234567891*20250115*1605~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567893~HL*3*2*22*0~TRN*2*1234567891*9876543210~NM1*IL*1*DOE*JOHN****MI*SUB123~DTP*291*D8*20250115~EB*6**30~MSG*Coverage not active for requested date of service.~SE*13*0011~GE*1*11~IEA*1*000000011~ RTEEligibilityResponsePatientUnknown: value: id: rte-patient-unknown-123 sourceType: new correlationId: corr-8b7c2f3a-1c9e-4d3b-a6f5-112233445566 payer: chcId: AETNA processedDate: '2025-01-15T16:02:28Z' status: value: patient_unknown subscriber: memberId: SUB123 dateOfBirth: '1950-01-02' x12-271: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *250115*1602*^*00501*000000010*0*T*:~GS*HB*AETNA*PROVIDERID*20250115*1602*10*X*005010X279A1~ST*271*0010*005010X279A1~BHT*0022*11*1234567890*20250115*1602~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567893~HL*3*2*22*0~TRN*2*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*SUB123~DTP*291*D8*20250115~EB*I**30~MSG*Patient not found.~SE*13*0010~GE*1*10~IEA*1*000000010~ RTEEligibilityRequestX12CoverageDiscoveryCandidate: value: x12: ISA*00* *01*SomePwd *ZZ*TPG00000 *ZZ*EMDEON *240722*1617*^*00501*000000001*0*T*:~GS*HS*AETNA*PROVIDERID*20240722*1617*1*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1234567890*20240722*1617~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567893~HL*3*2*22*0~TRN*1*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*123456789~N3*123 MAIN ST~N4*DALLAS*TX*75001~DMG*D8*19500102*M~DTP*291*D8*20240722~EQ*30~SE*13*0001~GE*1*1~IEA*1*000000001~ RTEEligibilityRequestCoverageDiscoveryCandidate: value: controlNumber: '123456789' tradingPartnerServiceId: AETNA provider: organizationName: Example Medical Center npi: '1234567893' informationReceiverName: address: state: TX subscriber: memberId: SUB123 firstName: JOHN lastName: DOE dateOfBirth: '19500102' ssn: '111223333' additionalIdentification: patientAccountNumber: PAN-1001 address: address1: 123 Main St city: Dallas state: TX postalCode: '75001' encounter: dateOfService: '20250115' serviceTypeCodes: - '30' EligibilityRequestExpanded: value: submitterTransactionIdentifier: 1-622233a9-6fca5eb41ae6862b269452c9 controlNumber: '123456789' tradingPartnerServiceId: CIGNA tradingPartnerName: CIGNA provider: organizationName: Example Medical Center npi: '1234567893' serviceProviderNumber: '54321' providerCode: AD referenceIdentification: 54321g providerType: provider portalUsername: portal-user portalPassword: portal-password informationReceiverName: submitterIdNumber: SUBMITTER01 nationalProviderIdentifier: '1234567893' informationReceiverAdditionalIdentifierState: WA address: address1: 123 address1 city: SEATTLE state: WA postalCode: '981010000' subscriber: birthSequenceNumber: '1' caseNumber: CASE12345 medicaidRecipientIdentificationNumber: MCD1234567 spendDownAmount: '25.00' spendDownTotalBilledAmount: '100.00' memberId: '0000000000' firstName: johnOne middleName: M lastName: doeOne suffix: Jr gender: M dateOfBirth: '18800102' ssn: '555443333' groupNumber: '1111111111' idCard: card123 providerCode: AD referenceIdentificationQualifier: PXC providerIdentifier: '54321' idCardIssueDate: '20210101' planIssueDate: '20210101' healthCareCodeInformation: - diagnosisTypeCode: BK diagnosisCode: A123 address: address1: 123 address1 address2: APT 4 city: SEATTLE state: WA postalCode: '981010000' additionalIdentification: planNumber: PLAN001 policyNumber: POL123456 memberIdentificationNumber: MID998877 patientAccountNumber: PAT445566 insurancePolicyNumber: INS123456 planNetworkIdentificationNumber: NET9001 dependents: - individualRelationshipCode: '19' memberId: DEP0000001 firstName: janeOne middleName: Q lastName: doeOne gender: F dateOfBirth: '18160421' groupNumber: '1111111111' healthCareCodeInformation: - diagnosisTypeCode: BF diagnosisCode: B456 address: address1: 123 address1 city: SEATTLE state: WA postalCode: '981010000' additionalIdentification: planNumber: PLAN001 policyNumber: POL123456 encounter: beginningDateOfService: '20100101' endDateOfService: '20100102' dateOfService: '20100101' serviceTypeCodes: - '30' - '35' priorAuthorizationOrReferralNumber: AUTH123 referenceIdentificationQualifier: 9F industryCode: '01' productOrServiceIDQualifier: HC procedureCode: '99213' procedureModifiers: - '25' diagnosisCodePointer: - '1' medicalProcedures: - productOrServiceIDQualifier: HC procedureCode: '99214' procedureModifiers: - '59' diagnosisCodePointer: - '1' RTEEligibilityRequestX12HMOCandidate: value: x12: ISA*00* *01*SomePwd *ZZ*TPG00000 *ZZ*EMDEON *240722*1705*^*00501*000000002*0*T*:~GS*HS*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*270*0002*005010X279A1~BHT*0022*13*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567893~HL*3*2*22*0~TRN*1*2233445566*1234567893~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~DTP*291*D8*20240722~EQ*30~SE*13*0002~GE*1*2~IEA*1*000000002~ responses: ForbiddenError: description: Forbidden. headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: $ref: '#/components/schemas/Error' example: - invalid tenant id UnexpectedError: description: Unexpected error. headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: $ref: '#/components/schemas/Error' EligibilityResponse: description: OK. Returns the normalized real-time eligibility response. If Coverage Discovery was automatically started, the response `link` header contains related discovery task resource path(s). headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' link: $ref: '#/components/headers/rte-link' content: application/json: schema: $ref: '#/components/schemas/Transaction' examples: RTE Response Patient Unknown: $ref: '#/components/examples/RTEEligibilityResponsePatientUnknown' RTE Response Ineligible: $ref: '#/components/examples/RTEEligibilityResponseIneligible' RTE Response HMO: $ref: '#/components/examples/RTEEligibilityResponseHMO' BadRequestError: description: Bad request. headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: $ref: '#/components/schemas/Error' example: - Failed Precondition - Field 'example' is required PermissionDeniedError: description: Unauthorized. headers: x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' content: application/json: schema: type: object properties: error: type: string example: invalid_product error_description: type: string example: Permission Denied. traceId: type: string example: 942537e6-d544-ed7c-469b-a27efc4a6cff EligibilityResponseX12: description: OK. Returns a normalized JSON representation of the X12 271 response, not a raw X12 payload. headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-subtenant-id: $ref: '#/components/headers/subtenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' link: $ref: '#/components/headers/rte-link' content: application/json: schema: $ref: '#/components/schemas/TransactionMedicare' examples: RTE Response Patient Unknown: $ref: '#/components/examples/RTEEligibilityResponsePatientUnknown' RTE Response Ineligible: $ref: '#/components/examples/RTEEligibilityResponseIneligible' RTE Response HMO: $ref: '#/components/examples/RTEEligibilityResponseHMO' parameters: header-subtenant-id: in: header name: x-optum-subtenant-id schema: type: string example: 5e2f9f4f-6f1d-4b37-92b5-6c5a9d1f8a21 required: false description: (Optional) Identifies an Optum-assigned sub-tenant configuration for your organization. Include this header only when Optum has provided a value for a specific enabled customer configuration. Clients must not generate or infer this value. header-correlation-id: in: header name: x-optum-correlation-id schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 required: false description: (Optional) A unique identifier value that is attached to the response that allow reference to the original request. Differs from `x-optum-trace-id` as the correlation-id is stored within the datastore for future queryability. requestBodies: EligibilityRequestX12: description: New real-time eligibility transaction request using a JSON body whose `x12` field contains an X12 270 payload. The provider NPI in the X12 270 must be valid and follow standard NPI validation rules. content: application/json: schema: $ref: '#/components/schemas/EligibilityRequestX12' examples: RTE X12 Request Feeding Coverage Discovery: $ref: '#/components/examples/RTEEligibilityRequestX12CoverageDiscoveryCandidate' RTE X12 Request Feeding HMO Discovery: $ref: '#/components/examples/RTEEligibilityRequestX12HMOCandidate' required: true EligibilityRequest: description: New real-time eligibility transaction request. `controlNumber` is optional; when omitted, Enhanced Eligibility generates one. `encounter.dateOfService` is required. The submitted provider NPI must be valid and follow standard NPI validation rules. content: application/json: schema: $ref: '#/components/schemas/EligibilityRequest' examples: Eligibility Request Minimal: $ref: '#/components/examples/EligibilityRequestMinimal' Eligibility Request Expanded: $ref: '#/components/examples/EligibilityRequestExpanded' RTE JSON Request Feeding Coverage Discovery: $ref: '#/components/examples/RTEEligibilityRequestCoverageDiscoveryCandidate' RTE JSON Request Feeding HMO Discovery: $ref: '#/components/examples/RTEEligibilityRequestHMOCandidate' required: true securitySchemes: oAuth: type: oauth2 description: This API uses OAuth 2 with the client_credentials grant flow. [More info](https://api.example.com/docs/auth) flows: clientCredentials: tokenUrl: /apip/auth/v2/token scopes: read_txn: read transactions create_txn: submit a new transaction request read_coveragediscovery: read coverage discovery tasks create_coveragediscovery: submit a new coverage discovery task read_healthcheck: check the status of the system