openapi: 3.0.1 info: title: Enhanced Eligibility 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. ' - name: Eligibility Transactions description: 'Retrieve previously processed real-time eligibility transactions. Use these endpoints to list transactions, filter by status, date range, patient details, or correlation metadata, and fetch a single transaction record by id for audit, troubleshooting, and downstream workflows. ' - name: Coverage Discovery description: 'Create and retrieve asynchronous Coverage Discovery tasks. Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. These endpoints support direct submission using either normalized eligibility data or JSON bodies containing X12 payloads, dry-run validation of enrolled discovery paths, polling for task status, and callback-based delivery of completed discovery results. ' - name: Healthcheck description: 'Verify service availability for the Enhanced Eligibility workflow. Use this endpoint to confirm the API is reachable and the underlying system is healthy before or during integration operations. ' 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`.\n\ Each 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\n\ If 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.\n\ The 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' /rcm/eligibility/v1/transactions: get: tags: - Eligibility Transactions summary: Find all eligibility transactions security: - oAuth: - read_txn description: 'Returns matching eligibility transactions. You can use the query parameters listed below to filter the results. If no query parameters are provided, all eligibility transactions will be returned in paginated form. ' parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/query-status' - $ref: '#/components/parameters/query-correlationid' - $ref: '#/components/parameters/query-patientFirstName' - $ref: '#/components/parameters/query-patientLastName' - $ref: '#/components/parameters/query-patientAccountNumber' - $ref: '#/components/parameters/query-medicalRecordNumber' - $ref: '#/components/parameters/query-memberId' - $ref: '#/components/parameters/query-patientDateOfBirth' - $ref: '#/components/parameters/query-npi' - $ref: '#/components/parameters/query-payerId' - $ref: '#/components/parameters/query-start-date-time' - $ref: '#/components/parameters/query-end-date-time' - $ref: '#/components/parameters/query-sort-txns' - $ref: '#/components/parameters/query-offset' - $ref: '#/components/parameters/query-limit' - $ref: '#/components/parameters/query-return-total-count' responses: '200': description: OK headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' link: $ref: '#/components/headers/link' x-total-count: $ref: '#/components/headers/total-count' content: application/json: schema: type: array items: $ref: '#/components/schemas/Transaction' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/transactions/{id}: get: tags: - Eligibility Transactions summary: Find eligibility transaction by ID security: - oAuth: - read_txn description: Returns an individual transaction with the corresponding ID, if found. parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/path-txn-id' responses: '200': description: OK headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: $ref: '#/components/schemas/Transaction' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' '404': $ref: '#/components/responses/NotFoundError' '422': $ref: '#/components/responses/UnprocessableEntityError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/coverage-discovery: post: operationId: postDiscovery tags: - Coverage Discovery summary: Submit new discovery task(s) security: - oAuth: - create_coveragediscovery description: "\n## Overview\n\n__You must be enrolled in the Coverage Discovery feature in order\ \ to use this system.__\n\nCoverage Discovery paths and add-ons are enabled per customer and are\ \ not included automatically.\n\nCoverage Discovery is an async process that initializes discovery\ \ paths based on the task(s) enabled for the customer and on the details of the provided `canonicalEligibilityRequest`\ \ and, when available, `canonicalEligibilityResponse`. `canonicalEligibilityRequest` is always\ \ required. `canonicalEligibilityResponse` is optional for request-only qualification paths, but\ \ should be supplied when path qualification or request-building depends on response-side facts\ \ such as response status, payer context, HMO plan information, or Medicare QMB/MBI data. This\ \ direct JSON workflow is intended for advanced use cases where the client already has the processed\ \ canonical eligibility models available. If successful, the initial response is either a 202\ \ Accepted receipt for a single record or a 207 Multi-Status response if more than one record\ \ was produced from the request and the customer has more than one enabled task.\n\nCoverage Discovery\ \ is asynchronous because some paths involve chained clearinghouse work and additional connected\ \ workflow dependencies. Most non-Coverage-Insight paths are near real time relative to traditional\ \ discovery workflows. Customers with strict turnaround sensitivity should evaluate Coverage Insight\ \ enrollment carefully.\nCoverage Discovery paths may also participate in customer-configured\ \ deduplication. This can be enabled per path rather than uniformly across every path. RTCOB and\ \ Coverage Insight additionally use a separate non-configurable 72-hour request cache. When that\ \ cache is hit, the path is added to `discoveryPaths.skipped` instead of creating a new downstream\ \ submission.\nTo test if the request meets conditions to generate tasks, see the Dry Run section.\ \ \n\nSupported task types are `serial` and `chained`. In `serial` tasks, multiple qualified paths\ \ may be initialized under the same task. In `chained` tasks, later paths may depend on the outcome\ \ of earlier paths.\n\n## Async Delivery Flow\n\n1. Submit the Coverage Discovery request.\n2.\ \ If `dryRun` is `false`, the API accepts work for asynchronous processing.\n3. For single-task\ \ execution, a `202 Accepted` response includes a `location` header for the created discovery\ \ task resource.\n4. For multi-task execution, a `207 Multi-Status` response returns per-task\ \ results, and accepted items include an `href` for each created task resource.\n5. If you provide\ \ `callbackUrl`, your callback endpoint later receives the completed task payload asynchronously.\n\ 6. If needed, you can poll `/coverage-discovery/{id}` using the task resource returned in `location`\ \ or `href`.\n\n## Dry Run\nTo validate that your request meets expected conditions for the paths\ \ enabled for your customer, include `dryRun = true` in the request body. In dry-run mode, the\ \ request does not execute discovery, does not create task records, and does not send a callback.\ \ Instead, the endpoint validates the request against the enrolled discovery paths. The response\ \ indicates which paths qualified and which did not.\n\nIf successful, the first response is a\ \ receipt with either a 200 status for a single task or 207 if the request produced more than\ \ one per-task outcome. If no paths qualify, a 422 will be returned for a single task, and a 207\ \ for multi-task responses that include one or more 422 results (see `DryRunMultiStatusMixedResponse`\ \ example).\n\n### Callback API\nDue to the long-running nature of the discovery process, completed\ \ task responses can be communicated asynchronously to `request.callbackUrl` when `callbackUrl`\ \ is supplied. `callbackUrl` is optional on standalone Coverage Discovery request bodies, including\ \ when `dryRun` is `true`. If `callbackUrl` is omitted, use the task resource returned in `location`\ \ or `href` to poll for completion. If this is your first time using callbacks via Swagger, check\ \ out the __\"Callbacks\"__ tab next to __\"Parameters\"__.\n\nWhen supplied, the API specified\ \ in the `callbackUrl` that will receive the asynchronous response once discovery finishes must\ \ meet the customer-specific whitelisting requirements defined by your team. Please reach out\ \ to support if you need to configure whitelisting. This API must meet the callback structure\ \ documented in the \"CustomerCallbacks\" tab.\n\nYour callback implementation should treat deliveries\ \ as asynchronous webhook-style notifications and should be prepared to process the same task\ \ idempotently if a delivery is retried. The callback payload uses the same `CoverageDiscoveryTask`\ \ model returned by `GET /coverage-discovery/{id}`. The most important fields for most clients\ \ are the task `id`, task `status`, any error or failure details, and the embedded real-time eligibility\ \ content when callback consolidation is enabled.\n\nIf you are unsure about the details of your\ \ request and how they might produce eligible discovery paths, you can use `dryRun` to test the\ \ request without executing any transactions. When `dryRun` is enabled, the response is synchronous\ \ and the callback is not invoked.\n" parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/header-subtenant-id' requestBody: $ref: '#/components/requestBodies/DiscoveryRequest' callbacks: response: '{$request.body#/callbackUrl}': post: parameters: - $ref: '#/components/parameters/header-tenant-id' - $ref: '#/components/parameters/header-correlation-id' requestBody: content: application/json: schema: $ref: '#/components/schemas/CoverageDiscoveryTask' examples: Successful Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccess' Successful Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime' Successful Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedSuccess' Failure Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailure' Failure Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime' Failure Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedFailure' responses: '204': description: Return `204 No Content` after successfully accepting and processing the callback payload. responses: '200': $ref: '#/components/responses/DiscoveryDryRunResponse' '202': $ref: '#/components/responses/DiscoveryAcceptedResponse' '207': $ref: '#/components/responses/DiscoveryMultiStatusResponse' '400': $ref: '#/components/responses/BadRequestError' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' '422': $ref: '#/components/responses/UnprocessableEntityDiscoveryError' 5XX: $ref: '#/components/responses/UnexpectedError' get: operationId: getAllDiscoveries tags: - Coverage Discovery summary: Find all discovery tasks security: - oAuth: - read_coveragediscovery description: 'Retrieves discovery tasks based on the supplied query parameters. When no parameters are provided, the endpoint returns the full set of discovery tasks, delivered in paginated form. ' parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/query-correlationid' - $ref: '#/components/parameters/query-task-status' - $ref: '#/components/parameters/query-start-date-time' - $ref: '#/components/parameters/query-end-date-time' - $ref: '#/components/parameters/query-sort-discovery' - $ref: '#/components/parameters/query-offset' - $ref: '#/components/parameters/query-limit' responses: '200': description: OK headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' link: $ref: '#/components/headers/link' content: application/json: schema: type: array items: $ref: '#/components/schemas/CoverageDiscoveryTask' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/coverage-discovery/x12: post: operationId: postDiscoveryX12 tags: - Coverage Discovery summary: Submit new discovery task(s) with EDI security: - oAuth: - create_coveragediscovery description: ' ## Overview __You must be enrolled in the Coverage Discovery feature in order to use this system.__ Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. Coverage Discovery is an async process that initializes discovery paths based on the task(s) enabled for the customer and on the details of the provided `x12-270` and `x12-271`. Both fields are required. This direct X12 workflow is often simpler than the canonical JSON discovery workflow because it allows clients to submit the processed X12 pair without mapping into two canonical models. If successful, the initial response is either a 202 Accepted receipt for a single record or a 207 Multi-Status response if more than one record was produced from the request and the customer has more than one enabled task. Coverage Discovery is asynchronous because some paths involve chained clearinghouse work and additional connected workflow dependencies. Most non-Coverage-Insight paths are near real time relative to traditional discovery workflows. Customers with strict turnaround sensitivity should evaluate Coverage Insight enrollment carefully. Coverage Discovery paths may also participate in customer-configured deduplication. This can be enabled per path rather than uniformly across every path. RTCOB and Coverage Insight additionally use a separate non-configurable 72-hour request cache. When that cache is hit, the path is added to `discoveryPaths.skipped` instead of creating a new downstream submission. To test if the request meets conditions to generate tasks, see the Dry Run section. ## Async Delivery Flow 1. Submit the Coverage Discovery request. 2. If `dryRun` is `false`, the API accepts work for asynchronous processing. 3. For single-task execution, a `202 Accepted` response includes a `location` header for the created discovery task resource. 4. For multi-task execution, a `207 Multi-Status` response returns per-task results, and accepted items include an `href` for each created task resource. 5. If you provide `callbackUrl`, your callback endpoint later receives the completed task payload asynchronously. 6. If needed, you can poll `/coverage-discovery/{id}` using the task resource returned in `location` or `href`. ## Dry Run To validate that your request meets expected conditions for the paths enabled for your customer, include `dryRun = true` in the request body. In dry-run mode, the request does not execute discovery, does not create task records, and does not send a callback. Instead, the endpoint validates the request against the enrolled discovery paths. The response indicates which paths qualified and which did not. If successful, the first response is a receipt with either a 200 status for a single task or 207 if the request produced more than one per-task outcome. If no paths qualify, a 422 will be returned for a single task, and a 207 for multi-task responses that include one or more 422 results (see `DryRunMultiStatusMixedResponse` example). ### Callback API Due to the long-running nature of the discovery process, completed task responses can be communicated asynchronously to `request.callbackUrl` when `callbackUrl` is supplied. `callbackUrl` is optional on standalone Coverage Discovery request bodies, including when `dryRun` is `true`. If `callbackUrl` is omitted, use the task resource returned in `location` or `href` to poll for completion. When supplied, the API specified in the `callbackUrl` that will receive the asynchronous response once discovery finishes must meet the customer-specific whitelisting requirements defined by your team. Please reach out to support if you need to configure whitelisting. This API must meet the callback structure documented in the "CustomerCallbacks" tab. Your callback implementation should treat deliveries as asynchronous webhook-style notifications and should be prepared to process the same task idempotently if a delivery is retried. The callback payload uses the same `CoverageDiscoveryTask` model returned by `GET /coverage-discovery/{id}`. The most important fields for most clients are the task `id`, task `status`, any error or failure details, and the embedded real-time eligibility content when callback consolidation is enabled. If you are unsure about the details of your request and how they might produce eligible discovery paths, you can use `dryRun` to test the request without executing any transactions. When `dryRun` is enabled, the response is synchronous and the callback is not invoked. ' parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/header-subtenant-id' requestBody: $ref: '#/components/requestBodies/DiscoveryRequestX12' callbacks: response: '{$request.body#/callbackUrl}': post: parameters: - $ref: '#/components/parameters/header-tenant-id' - $ref: '#/components/parameters/header-correlation-id' requestBody: content: application/json: schema: $ref: '#/components/schemas/CoverageDiscoveryTask' examples: Successful Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccess' Successful Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime' Successful Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedSuccess' Failure Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailure' Failure Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime' Failure Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedFailure' responses: '204': description: Return `204 No Content` after successfully accepting and processing the callback payload. responses: '200': $ref: '#/components/responses/DiscoveryDryRunResponse' '202': $ref: '#/components/responses/DiscoveryAcceptedResponse' '207': $ref: '#/components/responses/DiscoveryMultiStatusResponse' '400': $ref: '#/components/responses/BadRequestError' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' '422': $ref: '#/components/responses/UnprocessableEntityDiscoveryError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/coverage-discovery/{id}: get: operationId: getDiscoveryById tags: - Coverage Discovery summary: Find discovery task by ID security: - oAuth: - read_coveragediscovery description: Returns an individual discovery response with the corresponding ID, if found. parameters: - $ref: '#/components/parameters/header-correlation-id' - $ref: '#/components/parameters/path-discovery-task-id' responses: '200': $ref: '#/components/responses/DiscoveryResponse' '401': $ref: '#/components/responses/PermissionDeniedError' '403': $ref: '#/components/responses/ForbiddenError' '404': $ref: '#/components/responses/NotFoundError' '422': $ref: '#/components/responses/UnprocessableEntityError' 5XX: $ref: '#/components/responses/UnexpectedError' /rcm/eligibility/v1/healthcheck: get: tags: - Healthcheck summary: Validate the status of the system description: A healthcheck of the Enhanced Eligibility workflow security: - oAuth: - read_healthcheck operationId: healthcheck responses: '200': $ref: '#/components/responses/HealthcheckHealthyResponse' '401': $ref: '#/components/responses/PermissionDeniedError' '500': $ref: '#/components/responses/HealthcheckUnhealthyResponse' components: 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 parameters: header-tenant-id: in: header name: x-optum-tenant-id schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 required: true description: The unique ID of the tenant that invoking user belongs to. Used to enforce data tenancy. 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. 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-trace-id: in: header name: x-optum-trace-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 query-task-status: in: query name: status required: false explode: false schema: type: string enum: - success - failure - pending example: pending description: (Optional) When provided, only discovery tasks with the specified status will be returned. Valid values are 'success', 'failure', and 'pending'. query-status: in: query name: status required: false explode: false schema: type: array items: enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown description: (Optional) The status of the eligibility transaction. Valid values match `Transaction.status.value`. query-start-date-time: in: query name: startDateTime required: false schema: type: string example: '2017-07-21T17:32:28Z' description: (Optional) The start date for the report. Start date must be before the end date query-end-date-time: in: query name: endDateTime required: false schema: type: string example: '2017-09-21T17:32:28Z' description: (Optional) The end date for the report. Must occur after the provided start date query-sort-txns: in: query name: sort required: false explode: false schema: type: array items: enum: - processedDate - -processedDate example: - -processedDate description: (Optional) The property to order the results of the report by. Defaults to '-processedDate', negative sign is 'desc' query-sort-discovery: in: query name: sort required: false explode: false schema: type: array items: enum: - startDateTime - -startDateTime example: - -startDateTime description: (Optional) The property to order the results of the report by. Defaults to '-startDateTime', negative sign is 'desc' query-offset: in: query name: offset required: false schema: type: integer description: (Optional) Pagination. The offset number to retrieve, which is determined by the limit. For example,if limit is 30 and offset is 0, then the response data will include records 1~30; If offset is 30 and limit is 30 then the response data will include records 30~59. query-limit: in: query name: limit schema: type: integer nullable: true minimum: 1 maximum: 100 example: 30 description: (Optional) Number of transactions to return per page. Must be greater than 0 and less than or equal to 100. Defaults to 30. query-return-total-count: in: query name: returnTotalCount schema: type: boolean nullable: true example: true description: (Optional) Whether or not to return the total number of records matching the supplied query parameters under the x-total-number HTTP response header. Defaults to false query-correlationid: in: query name: correlationId schema: type: string example: 9fb77454-8c58-4345-aa50-43f133e06d20 description: (Optional) The correlationId associated with the original request. query-patientFirstName: in: query name: patientFirstName schema: type: string example: Jane description: (Optional) Patient's first name. query-patientLastName: in: query name: patientLastName schema: type: string example: Doe description: (Optional) Patient's last name. query-patientAccountNumber: in: query name: patientAccountNumber schema: type: string example: '38300904' description: (Optional) Patient's account number. query-medicalRecordNumber: in: query name: medicalRecordNumber schema: type: string example: '194570' description: (Optional) Medical Record Number. query-memberId: in: query name: memberId schema: type: string example: XKY933M53442 description: (Optional) Member Id. query-patientDateOfBirth: in: query name: patientDateOfBirth schema: type: string example: '1995-01-15' description: (Optional) Patient's date of birth. query-npi: in: query name: npi schema: type: string example: '1234567893' description: (Optional) NPI of the primary care provider. query-payerId: in: query name: payerId schema: type: string example: '12345' description: (Optional) Payer ID (CHC ID). path-txn-id: in: path name: id description: The unique ID of the target transaction required: true schema: type: string example: 36743735-3303-4d9d-9f21-20dd5f6d7ab2 path-discovery-task-id: in: path name: id description: The unique ID of the target discovery task required: true schema: type: string example: 36743735-3303-4d9d-9f21-20dd5f6d7ab2 headers: 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. 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. 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. location: schema: type: string example: /coverage-discovery/09876z5y-43x2-1w09-v8u7-tr6543s210qp description: Relative path of the created Coverage Discovery task resource. Clients can `GET` this path to poll task status when they are not relying solely on callback delivery. link: schema: type: string example: ; rel="next" description: RFC 8288-style pagination link header used by list endpoints such as `GET /transactions` and `GET /coverage-discovery`. This header is separate from the related-task `link` header used by real-time eligibility responses. 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. total-count: schema: type: string example: '1440' description: The total number of records associated with the query. For example, with the query `?correlationId=123456579`, `x-total-count` returns the total amount of records associated with the given correlationId. requestBodies: 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 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 DiscoveryRequest: description: New Coverage Discovery request using normalized eligibility request and response payloads. content: application/json: schema: type: object description: '`canonicalEligibilityRequest` is required. `callbackUrl` is optional for standalone Coverage Discovery requests. `canonicalEligibilityResponse` is optional for request-only qualification paths, but should be supplied when path qualification or request-building depends on response-side facts such as response status, payer context, HMO plan information, or Medicare QMB/MBI data. Set `dryRun` to `true` to validate paths without creating discovery records.' required: - canonicalEligibilityRequest properties: canonicalEligibilityRequest: $ref: '#/components/schemas/EligibilityRequest' canonicalEligibilityResponse: allOf: - $ref: '#/components/schemas/Transaction' - type: object properties: metadata: type: object properties: canonicalizerVersion: type: string example: 1.0.0 description: version of the clearinghouse to canonical mapper clearinghouse: type: string enum: - CLR - CI - IMN example: IMN description: clearinghouse that processed the request clearinghouseRequest: type: string description: A stringified version of the JSON request sent to the clearinghouse example: '{"type":"clearinghouseRequest","foo":"bar"}' clearinghouseResponse: type: string description: A stringified version of the JSON response received from the clearinghouse example: '{"type":"clearinghouseResponse","foo":"bar"}' customerRequest: type: string description: A stringified version of the JSON request sent by the customer example: '{"type":"customerRequest","foo":"bar"}' x12-270: type: string description: The received 270 message for the transaction description: Data captured during the processing of an Eligibility Transaction. - description: Optional canonical transaction response that was previously processed by the RCMC Eligibility engine. Supply this when the configured paths rely on response-side facts. HMO is a response-required path. callbackUrl: type: string example: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses description: 'Optional URL of the consumer-owned API that will receive an asynchronous callback once discovery finishes. If omitted, use the task resource returned in `location` or `href` to poll for completion. When `dryRun` is `true`, the callback is not invoked. If supplied, the URL must meet the customer-specific whitelisting requirements defined by your team and the callback structure documented in the "CustomerCallbacks" tab. Your callback handler should be prepared to process retries idempotently. ' dryRun: type: boolean example: false description: When set to true, no discovery paths will be initialized, but instead will evaluate the request and respond with the discovery paths that are configured and meet validation requirements. Use this as a tool to test the request input. examples: Coverage Discovery Request: $ref: '#/components/examples/CoverageDiscoveryRequest' Coverage Discovery Request Request Only: $ref: '#/components/examples/CoverageDiscoveryRequestRequestOnly' Coverage Discovery Request HMO Response Driven: $ref: '#/components/examples/CoverageDiscoveryRequestHMO' Coverage Discovery Request Medicare Response Driven: $ref: '#/components/examples/CoverageDiscoveryRequestMedicareQMB' Dry Run Request: $ref: '#/components/examples/CoverageDiscoveryRequestDryRun' DiscoveryRequestX12: description: New Coverage Discovery request using raw X12 request and response payloads. content: application/json: schema: type: object description: '`x12-270` and `x12-271` are required. `callbackUrl` is optional for standalone Coverage Discovery requests. These fields represent the original eligibility inquiry and response in raw X12 form. Set `dryRun` to `true` to validate paths without creating discovery records.' required: - x12-270 - x12-271 properties: x12-270: 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. x12-271: type: string description: Raw X12 271 eligibility response payload. callbackUrl: type: string example: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses description: 'Optional URL of the consumer-owned API that will receive an asynchronous callback once discovery finishes. If omitted, use the task resource returned in `location` or `href` to poll for completion. When `dryRun` is `true`, the callback is not invoked. If supplied, the URL must meet the customer-specific whitelisting requirements defined by your team and the callback structure documented in the "CustomerCallbacks" tab. Your callback handler should be prepared to process retries idempotently. ' dryRun: type: boolean example: false description: When set to true, no discovery paths will be initialized, but instead will evaluate the request and respond with the discovery paths that are configured and meet validation requirements. Use this as a tool to test the request input. examples: Coverage Discovery Request: $ref: '#/components/examples/CoverageDiscoveryRequestX12' Dry Run Request: $ref: '#/components/examples/CoverageDiscoveryRequestX12DryRun' responses: 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 NotFoundError: description: Not found. 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: - Not Found - record not found 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' 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 UnprocessableEntityError: description: Unprocessable Entity. 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: - Unprocessable Entity - Unable to deserialize record UnprocessableEntityDiscoveryError: description: Unprocessable Entity. 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: - 'Unprocessable Resource - Task chained discover task: No discovery paths qualified for execution. Please use the dryRun field to validate your input produces the expected paths prior to submitting the next request.' ConflictError: description: Conflict. 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' 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' DiscoveryAcceptedResponse: description: Accepted. The request was accepted for asynchronous Coverage Discovery processing. Use the `location` header to poll the created task resource if needed. 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' location: $ref: '#/components/headers/location' content: application/json: schema: type: object properties: id: type: string example: d0747d80-ed4e-4af9-b127-1277fb472c44 description: Unique identifier of the newly created task record. name: type: string example: serial discover task description: Customer-appointed name that ascribes meaning and/or business need for task. Defined during enrollment. If no name is provided by customer, the Product team will provide a default value. DiscoveryMultiStatusResponse: description: Multi-Status. The request produced multiple per-task outcomes. Each item contains the task-specific status and, for accepted items, an `href` to the created discovery task resource. 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: type: array description: List of per-task results returned when a request produces multiple task outcomes. items: $ref: '#/components/schemas/DiscoveryMultiStatusItem' examples: MultiStatus Response: $ref: '#/components/examples/MultiStatusResponseSuccess' DryRun MultiStatus Response: $ref: '#/components/examples/DryRunMultiStatusSuccessful' DryRun MultiStatus Mixed Response: $ref: '#/components/examples/DryRunMultiStatusMixedResponse' DiscoveryDryRunResponse: description: OK. Synchronous dry-run validation result. No Coverage Discovery task record was created and no callback will be delivered. 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/CoverageDiscoveryDryRunResult' examples: DryRun Serial Response Two Tasks Pending: $ref: '#/components/examples/DryRunSerialTwoPending' DryRun Serial Response All Pending: $ref: '#/components/examples/DryRunSerialAllPending' DiscoveryResponse: description: OK headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: $ref: '#/components/schemas/CoverageDiscoveryTask' examples: Successful Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccess' Successful Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime' Successful Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedSuccess' Failure Serial Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailure' Failure Serial Task With Real Time Response: $ref: '#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime' Failure Chained Task: $ref: '#/components/examples/GetCoverageDiscoveryTaskChainedFailure' HealthcheckHealthyResponse: description: OK headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: type: object properties: status: type: string example: ok HealthcheckUnhealthyResponse: description: Internal Server Error headers: x-optum-tenant-id: $ref: '#/components/headers/tenantid' x-optum-correlation-id: $ref: '#/components/headers/correlationid' x-optum-trace-id: $ref: '#/components/headers/traceid' content: application/json: schema: type: object properties: status: type: string example: unhealthy schemas: Error: description: The base object model for errors returned from the workflow type: array items: type: string example: Internal - An unknown error occurred CoverageDiscoveryDryRunPath: type: object properties: name: type: string description: The configured discovery path name. description: type: string description: A brief description of the discovery path. reason: type: string description: Why the path failed validation or is included in the returned set. CoverageDiscoveryDryRunResult: type: object description: Synchronous validation result returned when `dryRun` is `true`. No task record is created. properties: successful: type: array description: Discovery paths whose rules validated successfully during the dry run. items: $ref: '#/components/schemas/CoverageDiscoveryDryRunPath' unsuccessful: type: array description: Discovery paths that failed validation during the dry run. items: $ref: '#/components/schemas/CoverageDiscoveryDryRunPath' pending: type: array description: Discovery paths that would be attempted if the request were executed. items: $ref: '#/components/schemas/CoverageDiscoveryDryRunPath' DiscoveryAcceptedReceipt: type: object description: Accepted task creation receipt. properties: id: type: string description: Unique identifier of the newly created task record. name: type: string description: Customer-appointed name that ascribes meaning and/or business need for the task. DiscoveryMultiStatusItem: type: object description: Per-task result returned within a 207 response. properties: status: type: integer description: HTTP status code associated with the individual task result. body: oneOf: - $ref: '#/components/schemas/DiscoveryAcceptedReceipt' - $ref: '#/components/schemas/CoverageDiscoveryDryRunResult' - type: string description: Error message for the individual task result. href: type: string description: Relative resource path for a created task. Present for accepted task-creation results. 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' 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~ 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~ CoverageDiscoveryTask: type: object description: The base object model for the `/coverage-discovery` endpoints properties: id: type: string example: 36743735-3303-4d9d-9f21-20dd5f6d7ab2 description: The unique ID of the task status: type: string enum: - success - failure - pending example: success description: The current state of the discovery task. `pending` means at least one path has not completed. `success` means at least one path produced eligible coverage and no paths remain pending. `failure` means no path produced eligible coverage and no paths remain pending. tenantName: type: string example: Customer Name traceId: type: string example: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: type: string example: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: type: string example: serial discover task description: Customer-configured task name assigned during enrollment to identify the overall discovery workflow. This root name identifies the configured task, not an individual path. Examples include `Medicaid + HMO` for a chained task or `Commercial + HMO + RTCOB` for a serial task. type: type: string example: serial enum: - serial - chained startDateTime: type: string format: date-time example: '2017-07-21T17:32:28Z' description: The time that the discovery task was initiated endDateTime: type: string format: date-time example: '2017-07-21T17:32:28Z' description: The time the discovery task finished. Omitted while the task status is `pending`. realTime: type: object description: The abbreviated parent Real-Time transaction response that triggered or accompanied the Coverage Discovery workflow. This object is populated only when a customer is enrolled in Integrated Coverage Discovery and selects the `Include RealTime Response` capability. Use this object for parent RTE context. Use `discoveryPaths.*[].transaction` for the child transactions produced by discovery path execution. properties: id: type: string example: ccf9a2c8-2e36-4c93-b0ec-743859e569cc name: type: string example: Real Time timestamp: type: string format: date-time description: The date-time the parent transaction was executed transaction: type: object properties: id: type: string description: The unique ID of the parent transaction response from the Real Time Flow. status: type: string enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown description: The normalized outcome of the parent transaction. chcPayerId: type: string description: The CHC PayerID used in the submission of the transaction x12-271: type: string description: The raw x12-271 response from the parent Real-Time transaction. description: Abbreviated parent real-time transaction details. discoveryPaths: type: object description: A list of routes that are automatically generated based on customer configuration and supplied input data to attempt to find positive patient coverage. properties: successful: type: array items: type: object properties: id: type: string example: ee7612c4-d400-4b48-83e3-c05875ee8b1f name: type: string description: The name of the discovery path that ran for this record. Typical values include `Medicare`, `Commercial`, `RTCOB`, `CoverageInsight`, `Medicaid`, and `HMO`. description: type: string description: A brief description of the path timestamp: type: string format: date-time description: The date-time the path was executed transaction: type: object properties: id: type: string description: The unique ID of the transaction status: type: string enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown description: The normalized outcome of the discovery-path transaction. chcPayerId: type: string description: The CHC PayerID used in the submission of the transaction x12-271: type: string description: The x12-271 response from the submitted transaction description: 'A list of successful discovery paths. A path is deemed "successful" when the nested child `transaction.status` is `eligible`. ' unsuccessful: type: array items: type: object properties: id: type: string example: ee7612c4-d400-4b48-83e3-c05875ee8b1f name: type: string description: The name of the discovery path that ran for this record. Typical values include `Medicare`, `Commercial`, `RTCOB`, `CoverageInsight`, `Medicaid`, and `HMO`. description: type: string description: A brief description of the path timestamp: type: string format: date-time description: The date-time the path was executed transaction: type: object properties: id: type: string description: The unique ID of the transaction status: type: string enum: - eligible - ineligible - payer_unavailable - payer_not_in_system - processing_error - patient_unknown description: The normalized outcome of the discovery-path transaction. chcPayerId: type: string description: The CHC PayerID used in the submission of the transaction x12-271: type: string description: The raw x12-271 response from the child discovery-produced transaction. description: 'A list of unsuccessful discovery paths. A path is deemed "unsuccessful" when the nested child `transaction.status` is anything other than `eligible`, including `ineligible`, `patient_unknown`, `payer_unavailable`, `payer_not_in_system`, and `processing_error`. These child transaction statuses are often the main operational signal for retry or resubmission decisions. ' pending: type: array items: type: object properties: id: type: string example: ee7612c4-d400-4b48-83e3-c05875ee8b1f name: type: string description: The name of the discovery path description: type: string description: A brief description of the path timestamp: type: string format: date-time description: The date-time the path entered the pending state. transaction: type: object example: {} description: Empty while the discovery path has not executed. description: A list of discovery paths that have yet to be executed. skipped: type: array items: type: object properties: id: type: string example: ee7612c4-d400-4b48-83e3-c05875ee8b1f name: type: string description: The name of the discovery path description: type: string description: A brief description of the path timestamp: type: string format: date-time description: The date-time the path was evaluated and marked as skipped. reason: type: string description: The reason why the path was skipped description: 'A list of skipped discovery paths. A path is considered "skipped" if there was an error building the path''s requests, if another path resulted in found coverage before the skipped path executed, or if an RTCOB or Coverage Insight request matched the fixed 72-hour request cache and therefore did not create a new downstream submission. Cached requests are represented as skipped because the downstream response is not replayed from that cache layer. ' 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~ 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' 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' CoverageDiscoveryRequest: value: canonicalEligibilityRequest: 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' canonicalEligibilityResponse: id: 9fb77454-8c58-4345-aa50-43f133e06d20 payer: chcPayerId: CMSHSP plan: hmo: name: Cigna HMO planNumber: CIG991122 processedDate: '2017-07-21T17:32:28Z' status: value: ineligible subscriber: dateOfBirth: '1880-01-02' callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses 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' 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' 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~ 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~ 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~ 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~ 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~ CoverageDiscoveryRequestRequestOnly: value: canonicalEligibilityRequest: submitterTransactionIdentifier: txn-commercial-request-only 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' callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses CoverageDiscoveryRequestHMO: value: canonicalEligibilityRequest: submitterTransactionIdentifier: txn-hmo-response-driven controlNumber: '123456789' tradingPartnerServiceId: CIGNA provider: organizationName: Example Medical Center npi: '1234567893' subscriber: memberId: HMO123 firstName: JOHN lastName: DOE dateOfBirth: '19800101' encounter: dateOfService: '20240722' serviceTypeCodes: - '30' canonicalEligibilityResponse: id: resp-hmo-123 status: value: ineligible plan: hmo: name: HMO-TEXAS payer: chcPayerId: CIGNA callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses CoverageDiscoveryRequestMedicareQMB: value: canonicalEligibilityRequest: submitterTransactionIdentifier: txn-medicare-qmb controlNumber: '123456789' tradingPartnerServiceId: AETNA provider: organizationName: Example Medical Center npi: '1234567893' subscriber: firstName: JOHN lastName: DOE dateOfBirth: '19500102' ssn: '111223333' encounter: dateOfService: '20250115' serviceTypeCodes: - '30' canonicalEligibilityResponse: id: resp-medicare-123 status: value: patient_unknown payer: chcPayerId: CMSHSP benefits: - name: QMBIndicator value: Y - name: mbi value: 1EG4TE5MK73 callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses CoverageDiscoveryRequestX12: value: x12-270: 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~ x12-271: 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~ callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses CoverageDiscoveryRequestDryRun: value: canonicalEligibilityRequest: 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' canonicalEligibilityResponse: id: 9fb77454-8c58-4345-aa50-43f133e06d20 payer: chcPayerId: CMSHSP plan: hmo: name: Cigna HMO planNumber: CIG991122 processedDate: '2017-07-21T17:32:28Z' status: value: ineligible subscriber: dateOfBirth: '1880-01-02' callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses dryRun: true CoverageDiscoveryRequestX12DryRun: value: x12-270: 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~ x12-271: 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~ callbackUrl: http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses dryRun: true DryRunSerialAllPending: value: successful: null unsuccessful: null pending: - name: Medicare - name: HMO - name: Commercial - name: Medicaid DryRunSerialTwoPending: value: successful: null unsuccessful: null pending: - name: Medicare - name: HMO DryRunMultiStatusSuccessful: value: - status: 200 body: successful: null unsuccessful: null pending: - name: HMO - status: 200 body: successful: null unsuccessful: null pending: - name: Medicare - name: HMO DryRunMultiStatusMixedResponse: value: - status: 200 body: successful: null unsuccessful: null pending: - name: HMO - status: 422 body: 'Unprocessable Resource - Task chained discover task: No discovery paths qualified for execution. Please use the dryRun field to validate your input produces the expected paths prior to submitting the next request.' MultiStatusResponseSuccess: value: - status: 202 body: id: e97357ea-f44a-4e90-9a3b-dd077166fa51 name: chained discover task href: /coverage-discovery/e97357ea-f44a-4e90-9a3b-dd077166fa51 - status: 202 body: id: 84fa1bc0-aae9-45ec-b5bb-4982d630ef3a name: serial discover task href: /coverage-discovery/84fa1bc0-aae9-45ec-b5bb-4982d630ef3a GetCoverageDiscoveryTaskSerialSuccess: value: id: cd1505db-3cdf-4361-b515-52f86cd52a4c status: success tenantName: Customer Name traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: serial discover task type: serial startDateTime: '2024-07-22T16:17:08Z' endDateTime: '2024-07-22T16:17:09Z' realTime: {} discoveryPaths: pending: [] skipped: [] successful: - id: 239da46d-4c63-4365-a440-9f316bb0a069 name: Commercial timestamp: '2024-07-22T16:17:08Z' transaction: id: 611c1f2c-4b0a-49df-918b-5d40c8d41fc9 chcPayerId: AETNA status: eligible x12-271: 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~ unsuccessful: [] GetCoverageDiscoveryTaskSerialSuccessRealTime: value: id: cd1505db-3cdf-4361-b515-52f86cd52a4c status: success tenantName: '' traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: serial discover task type: serial startDateTime: '2024-07-22T16:17:08Z' endDateTime: '2024-07-22T16:17:09Z' realTime: id: ccf9a2c8-2e36-4c93-b0ec-743859e569cc name: Real Time timestamp: '2024-07-22T16:17:08Z' transaction: id: 611c1f2c-4b0a-49df-918b-5d40c8d41fc9 chcPayerId: AETNA status: patient_unknown x12-271: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *230101*1253*^*00501*000000001*0*T*:~GS*HB*EMDEON*TPG00000*20230101*1253*1*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*13*10001234*20230101*1253*TH~HL*1**20*1~NM1*PR*2*SOURCE NAME*****PI*SOURCEID~HL*2*1*21*1~NM1*1P*2*RECEIVER NAME*****PI*RECEIVERID~HL*3*2*22*0~NM1*IL*1*SUBSCRIBER NAME****MI*SUBSCRIBERID~DTP*291*RD8*20230101-20230101~EB*I**30~SE*10*0001~GE*1*1~IEA*1*000000001~ discoveryPaths: pending: [] skipped: - id: '' name: Commercial reason: request does not meet path conditions timestamp: '2024-07-22T17:05:59Z' - id: '' name: Medicaid reason: parent path (Commercial) conditions not met timestamp: '2024-07-22T17:05:59Z' successful: - id: 18f36e9e-458b-417d-8222-6c57fdecf935 name: Medicare timestamp: '2024-07-22T17:05:58Z' transaction: id: 5d26c880-aa58-4e8d-9f5a-d20e1369145d chcPayerId: CMSHSP status: eligible x12-271: '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~ ' - id: 7f0af208-4e93-4bb3-9ef5-1b34760d7a01 name: HMO timestamp: '2024-07-22T17:05:59Z' transaction: id: 9327e9c3-0f92-4575-9d48-8c26b38d0f0f chcPayerId: CIGNA status: eligible 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~ ' GetCoverageDiscoveryTaskSerialFailureRealTime: value: id: cd1505db-3cdf-4361-b515-52f86cd52a4c status: failure tenantName: '' traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: serial discover task type: serial startDateTime: '2024-07-22T16:17:08Z' endDateTime: '2024-07-22T16:17:09Z' realTime: id: ccf9a2c8-2e36-4c93-b0ec-743859e569cc name: Real Time timestamp: '2024-07-22T16:17:08Z' transaction: id: 611c1f2c-4b0a-49df-918b-5d40c8d41fc9 chcPayerId: AETNA status: eligible x12-271: ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *240722*1617*^*00501*000000001*0*T*:~GS*HB*AETNA*PROVIDERID*20240722*1617*1*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*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*2*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*123456789~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*GOLD PLAN~MSG*Eligibility confirmed for AETNA Gold Plan.~SE*25*0001~GE*1*1~IEA*1*000000001~ discoveryPaths: pending: [] skipped: - id: '' name: HMO reason: request does not meet path conditions timestamp: '2024-07-22T17:07:12Z' successful: [] unsuccessful: [] GetCoverageDiscoveryTaskChainedSuccess: value: id: fe3339a2-fbe4-47e9-8739-8d80d8e30f74 status: success tenantName: '' traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: chained discover task type: chained startDateTime: '2024-07-22T17:05:58Z' endDateTime: '2024-07-22T17:05:59Z' discoveryPaths: pending: [] skipped: - id: '' name: Commercial reason: request does not meet path conditions timestamp: '2024-07-22T17:05:59Z' - id: '' name: Medicaid reason: parent path (Commercial) conditions not met timestamp: '2024-07-22T17:05:59Z' successful: - id: 18f36e9e-458b-417d-8222-6c57fdecf935 name: Medicare timestamp: '2024-07-22T17:05:58Z' transaction: id: 5d26c880-aa58-4e8d-9f5a-d20e1369145d chcPayerId: CMSHSP status: eligible x12-271: '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~ ' - id: 7f0af208-4e93-4bb3-9ef5-1b34760d7a01 name: HMO timestamp: '2024-07-22T17:05:59Z' transaction: id: 9327e9c3-0f92-4575-9d48-8c26b38d0f0f chcPayerId: CIGNA status: eligible 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~ ' GetCoverageDiscoveryTaskSerialFailure: value: id: cb27966f-f2fc-4c53-936f-b5f6d6278069 status: failure tenantName: '' traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: serial discover task type: serial startDateTime: '2024-07-22T17:05:40Z' endDateTime: '2024-07-22T17:05:41Z' discoveryPaths: pending: [] skipped: [] successful: [] unsuccessful: - id: aa3711a8-a5c5-4ab9-8f3a-07a58706e1aa name: Medicare timestamp: '2024-07-22T17:05:40Z' transaction: id: 23ab8447-0779-40ce-8171-2771015d9e46 chcPayerId: CMSHSP status: processing_error - id: b4f7cf8e-63fb-4f78-8a26-8d56946d08fc name: HMO timestamp: '2024-07-22T17:05:40Z' transaction: id: 6a37eade-844a-49b2-b314-74a2119a61ef payeridCHANGESARAH: CIGNA status: processing_error - id: 55353a66-2c9c-4030-8609-7d43d41f0d6c name: Commercial timestamp: '2024-07-22T17:05:40Z' transaction: id: f0622b1a-e241-47e7-bf39-43e58fe76a33 chcPayerId: AETNA status: processing_error - id: e141bb4c-d754-495d-be76-9b9f6d73ff3e name: Medicaid timestamp: '2024-07-22T17:05:40Z' transaction: id: 0823f041-21f7-47d1-ad6e-16911e4da4a2 chcPayerId: ANTHEM status: patient_unknown x12-271: '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~ ' GetCoverageDiscoveryTaskChainedFailure: value: id: 3d63a3ba-1a82-4866-887d-aaf8eeb0894d status: failure tenantName: '' traceId: 4c22f47b-1cca-7f48-373c-af7d887443b0, correlationId: 91d76432-ac2b-4ae2-b031-f8a6615a2df4, name: chained discover task type: chained startDateTime: '2024-07-22T17:07:12Z' endDateTime: '2024-07-22T17:07:12Z' discoveryPaths: pending: [] skipped: - id: '' name: HMO reason: request does not meet path conditions timestamp: '2024-07-22T17:07:12Z' successful: [] unsuccessful: - id: 294d4439-57fe-4b1f-834d-4e5c3b6211fc name: Medicare timestamp: '2024-07-22T17:07:12Z' transaction: id: 0e4c24ac-cd79-44ae-be4a-1792cda0b505 payerIdCHANGE: CMSHSP status: processing_error