openapi: 3.0.3 info: contact: email: healthcare@stedi.com license: name: Proprietary url: https://stedi.com title: Stedi Healthcare Claims Claim acknowledgments Insurance discovery API version: '2025-03-07' servers: - description: Production url: https://claims.us.stedi.com/2025-03-07 security: - httpApiKeyAuth: [] tags: - name: Insurance discovery paths: /insurance-discovery/check/v1: post: description: Submit an insurance discovery check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/insurance-discovery operationId: InsuranceDiscoveryCheck requestBody: content: application/json: examples: InsuranceDiscoveryCheck_example1: description: '' summary: Insurance discovery check value: encounter: beginningDateOfService: '20240326' endDateOfService: '20240326' provider: npi: '1999999984' subscriber: address: address1: 123 Main St city: Springfield postalCode: '62701' state: IL dateOfBirth: '19800101' firstName: John gender: M lastName: Smith middleName: Robert ssn: '123456789' schema: $ref: '#/components/schemas/InsuranceDiscoveryCheckRequestContent' required: true responses: '200': content: application/json: examples: InsuranceDiscoveryCheck_example1: description: '' summary: Insurance discovery check value: discoveryId: 12345678-abcd-4321-efgh-987654321abc items: - benefitsInformation: - additionalInformation: - description: To determine if a prior authorization is required, please check the health plan's website. benefitsRelatedEntities: - entityFirstname: Jane entityIdentification: XX entityIdentificationValue: '1234567890' entityIdentifier: Primary Care Provider entityName: Dough entityType: Person code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '1' serviceTypes: - Medical Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: per visit benefitAmount: '20' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - additionalInformation: - description: Limited to 26 visits per year (visits in excess of 26 require prior authorization). code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: per prescription benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: PCP code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: PCP benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: PCP code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Specialist - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: Specialist benefitAmount: '30' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Specialist code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - additionalInformation: - description: Prior authorization may be required. Limited to 150 days per year. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: per visit benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '2000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '5000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' confidence: level: REVIEW_NEEDED reason: This record was identified as a low confidence match due to a DOB partial match payer: name: EXAMPLE INSURANCE CO planDateInformation: eligibilityBegin: '20250101' planBegin: '20250101' service: '20250301' planInformation: groupDescription: Individual On-Exchange groupNumber: 123456-78 planNumber: 123456-EXMPL9876 provider: entityType: Non-Person Entity npi: '1999999984' providerName: provider subscriber: address: address1: 123 Main Street city: ANYTOWN postalCode: '12345' state: CA dateOfBirth: '19900115' firstName: John gender: M groupDescription: Individual On-Exchange groupNumber: 123456-78 lastName: Doe memberId: '987654321000' middleName: Smith planNumber: 123456-EXMPL9876 meta: applicationMode: production traceId: 1-abcdef12-123456789abcdef123456789 status: COMPLETE schema: $ref: '#/components/schemas/InsuranceDiscoveryCheckResponseContent' description: InsuranceDiscoveryCheck 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Insurance discovery /insurance-discovery/check/v1/{discoveryId}: get: description: Retrieve insurance discovery check results by `discoveryId` externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/insurance-discovery operationId: GetInsuranceDiscoveryCheck parameters: - description: The unique ID for the insurance discovery check. Stedi returns this value in the response from the [Insurance Discovery Check](https://www.stedi.com/docs/healthcare/api-reference/post-insurance-discovery) endpoint. examples: GetInsuranceDiscoveryCheck_example1: description: '' summary: Poll for results value: 12345678-abcd-4321-efgh-987654321abc in: path name: discoveryId required: true schema: description: The unique ID for the insurance discovery check. Stedi returns this value in the response from the [Insurance Discovery Check](https://www.stedi.com/docs/healthcare/api-reference/post-insurance-discovery) endpoint. type: string responses: '200': content: application/json: examples: GetInsuranceDiscoveryCheck_example1: description: '' summary: Poll for results value: discoveryId: 12345678-abcd-4321-efgh-987654321abc items: - benefitsInformation: - additionalInformation: - description: To determine if a prior authorization is required, please check the health plan's website. benefitsRelatedEntities: - entityFirstname: Jane entityIdentification: XX entityIdentificationValue: '1234567890' entityIdentifier: Primary Care Provider entityName: Dough entityType: Person code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '1' serviceTypes: - Medical Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: per visit benefitAmount: '20' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - additionalInformation: - description: Limited to 26 visits per year (visits in excess of 26 require prior authorization). code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: per prescription benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: PCP code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: PCP benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: PCP code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Specialist - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: Specialist benefitAmount: '30' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Specialist code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - additionalInformation: - description: Prior authorization may be required. Limited to 150 days per year. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: per visit benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '2000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '5000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' confidence: level: REVIEW_NEEDED reason: This record was identified as a low confidence match due to a DOB partial match payer: name: EXAMPLE INSURANCE CO planDateInformation: eligibilityBegin: '20250101' planBegin: '20250101' service: '20250301' planInformation: groupDescription: Individual On-Exchange groupNumber: 123456-78 planNumber: 123456-EXMPL9876 provider: entityType: Non-Person Entity npi: '1999999984' providerName: provider subscriber: address: address1: 123 Main Street city: ANYTOWN postalCode: '12345' state: CA dateOfBirth: '19900115' firstName: John gender: M groupDescription: Individual On-Exchange groupNumber: 123456-78 lastName: Doe memberId: '987654321000' middleName: Smith planNumber: 123456-EXMPL9876 meta: applicationMode: production traceId: 1-abcdef12-123456789abcdef123456789 status: COMPLETE schema: $ref: '#/components/schemas/GetInsuranceDiscoveryCheckResponseContent' description: GetInsuranceDiscoveryCheck 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Insurance discovery components: schemas: EmploymentStatusCode: description: Payers may sometimes return other non-compliant values. enum: - AE - AO - AS - AT - AU - CC - DD - HD - IR - LX - PE - RE - RM - RR - RU type: string UnitForMeasurement: description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' enum: - Days - Months - Visits - Week - Years type: string AdditionalInformation: properties: description: description: A free-form message containing additional information about the benefits in the response. type: string type: object DtpDate: properties: date: description: A single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endDate: description: The end date of a range. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string startDate: description: The beginning date of a range. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object EligibilityCheckProviderAndMemberFollowupAction: description: Payers may sometimes return other non-compliant values. enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly type: string InsuranceDiscoveryCheckResponseContent: properties: coveragesFound: description: The number of potential coverage matches for the patient. This will be `0` if Stedi didn't find any matching coverage. type: integer discoveryId: description: A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint. type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array items: description: An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check `status` is `COMPLETE`. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information. items: $ref: '#/components/schemas/InsuranceDiscoveryResponseFields' type: array meta: $ref: '#/components/schemas/InsuranceDiscoveryMetadata' status: $ref: '#/components/schemas/DiscoveryStatus' description: "The status of the discovery check. This is either `PENDING` or `COMPLETE`.\n - If the status is `COMPLETE`, the `items` array will contain any potential coverage matches Stedi found for the patient.\n - If the status is `PENDING`, the check is still in progress. You can immediately begin polling the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint to retrieve the results asynchronously." warnings: description: Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests. items: $ref: '#/components/schemas/Warning' type: array type: object ValidationExceptionResponseContent: description: 'A standard error for input validation failures. Thrown when a member of the input structure falls outside of the modeled or documented constraints.' properties: code: description: A code describing the type of validation failure. type: string message: description: A message describing the causes of the validation failure. There may be more than one. type: string required: - message type: object BenefitsInformationName: description: 'The full name of the benefits information code. Payers may sometimes return other non-compliant values.' enum: - Active Coverage - Active - Full Risk Capitation - Active - Services Capitated - Active - Services Capitated to Primary Care Physician - Active - Pending Investigation - Inactive - Inactive - Pending Eligibility Update - Inactive - Pending Investigation - Co-Insurance - Co-Payment - Deductible - Coverage Basis - Benefit Description - Exclusions - Limitations - Out of Pocket (Stop Loss) - Unlimited - Non-Covered - Cost Containment - Reserve - Primary Care Provider - Pre-existing Condition - Managed Care Coordinator - Services Restricted to Following Provider - Not Deemed a Medical Necessity - Benefit Disclaimer - Second Surgical Opinion Required - Other or Additional Payor - Prior Year(s) History - Card(s) Reported Lost/Stolen - Contact Following Entity for Eligibility or Benefit Information - Cannot Process - Other Source of Data - Health Care Facility - Spend Down type: string Contacts: description: Contacts properties: communicationMode: $ref: '#/components/schemas/CommunicationMode' description: 'The type of communication number provided. Payers may sometimes return other non-compliant values.' communicationNumber: description: "The communication number referenced in `communicationMode`. It includes the country or area code when applicable. \n \n Note that phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`." type: string type: object TimePeriodQualifier: description: 'The name of the `timePeriodQualifierCode`. For example, `Calendar Year`. Payers may sometimes return other non-compliant values.' enum: - Hour - Day - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week type: string ResponseDependentEntityIdentifier: description: The entity identifier for the dependent. enum: - Dependent type: string TimeQualifierCode: description: 'Code indicating the time period for the benefit information. Payers may sometimes return other non-compliant values.' enum: - '6' - '7' - '13' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' - '36' type: string MaintenanceReasonCode: description: 'Code identifying the reason for the changes to subscriber identifying information, such as name, date of birth, or address. This is always `25` Payers may sometimes return other non-compliant values.' enum: - '25' type: string GovernmentServiceAffiliationCode: description: Payers may sometimes return other non-compliant values. enum: - A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - Q - R - S - U - W type: string DiscoveryPlanDateInformation: properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string admission: description: The admission date or dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string certification: description: The certification date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string cobraBegin: description: The date when COBRA coverage begins. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string cobraEnd: description: The date when COBRA coverage ends. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string dateOfDeath: description: The date of death. Payers may return this information in the case of a deceased subscriber or dependent. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string dateOfLastUpdate: description: The date when the plan information was last updated. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string discharge: description: The discharge date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string effectiveDateOfChange: description: The effective date of change. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibility: description: Plan eligibility dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibilityBegin: description: The date when the patient is first eligible for benefits under the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibilityEnd: description: The date when the patient is no longer eligible for benefits under the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string enrollment: description: The date when the patient is enrolled in the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string issue: description: The issue date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string plan: description: Plan effective dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string planBegin: description: The date coverage from the plan begins. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string planEnd: description: The date coverage from the plan ends. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string policyEffective: description: The date when the policy becomes effective. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string policyExpiration: description: The date when the policy expires. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string premiumPaidToDateBegin: description: The start of the period when the plan premium was paid in full. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string premiumPaidToDateEnd: description: The end of period when the plan premium payments are up-to-date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string service: description: The service date or dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string status: description: The status date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string type: object DeliveryPatternTimeQualifier: description: 'The name of the `deliveryPatternTimeCode`. Payers may sometimes return other non-compliant values.' enum: - 1st Shift (Normal Working Hours) - 2nd Shift - 3rd Shift - A.M. - P.M. - As Directed - Any Shift - None (Also Used to Cancel or Override a Previous Pattern) type: string DiscoveryResponseDependent: description: Common fields shared between subscriber and dependent structures in the eligibility response. properties: address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseDependentEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/DependentInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: deprecated: true description: This property will never be populated. Please use `subscriber.memberId` instead. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/DependentRelationship' relationToSubscriberCode: $ref: '#/components/schemas/DependentRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object EligibilityCheckFollowupAction: description: Payers may sometimes return other non-compliant values. enum: - Please Correct and Resubmit - Resubmission Not Allowed - Please Resubmit Original Transaction - Resubmission Allowed - Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly type: string InPlanNetworkIndicatorName: description: 'The name of the in-plan network indicator code. Payers may sometimes return other non-compliant values.' enum: - 'Yes' - 'No' - Unknown - Not Applicable type: string RelatedEntityIdentifierName: description: "Code identifying an organizational entity, a physical location, property or an individual. \n - `PPO` is used to identify a PPO by name or identification number, and also may also be used if identifying the Network that benefits are restricted to for In-Network benefits.\n\nPayers may sometimes return other non-compliant values." enum: - Contracted Service Provider - Preferred Provider Organization (PPO) - Provider - Third-Party Administrator - Employer - Other Physician - Facility - Gateway Provider - Group - Independent Physicians Association (IPA) - Insured or Subscriber - Legal Representative - Origin Carrier - Primary Care Provider - Prior Insurance Carrier - Plan Sponsor - Payer - Primary Payer - Secondary Payer - Tertiary Payer - Party Performing Verification - Vendor - Organization Completing Configuration Change - Utilization Management Organization - Managed Care Organization type: string CodeListQualifierCode: description: Payers may sometimes return other non-compliant values. enum: - GR - NI - ZZ type: string MilitaryServiceRankCode: description: Payers may sometimes return other non-compliant values. enum: - A1 - A2 - A3 - B1 - B2 - C1 - C2 - C3 - C4 - C5 - C6 - C7 - C8 - C9 - E1 - F1 - F2 - F3 - F4 - G1 - G4 - L1 - L2 - L3 - L4 - L5 - L6 - M1 - M2 - M3 - M4 - M5 - M6 - P1 - P2 - P3 - P4 - P5 - R1 - R2 - S1 - S2 - S3 - S4 - S5 - S6 - S7 - S8 - S9 - SA - SB - SC - T1 - V1 - W1 type: string ResponseSubscriberEntityIdentifier: description: The entity identifier for the subscriber. enum: - Insured or Subscriber type: string InsuranceDiscoveryDependent: description: 'Demographic information for the patient when they are a dependent on a health plan. - We **strongly recommend** providing as much information as possible to improve the probability of finding matching coverage. We especially recommend providing the dependent''s Social Security Number and their address - particularly their ZIP Code. - You should provide information for both the subscriber and the dependent in the request when possible. - If you only have the dependent''s information, you should identify them in the `subscriber` object instead and leave this object empty. Note that some payers require information about both the dependent and the subscriber, so providing only the dependent''s information limits Stedi''s ability to return coverage matches for those payers.' properties: address: $ref: '#/components/schemas/Address' description: 'The dependent''s address. We strongly recommend providing this information if possible to improve the probability of finding matching coverage. We especially recommend providing the patient’s ZIP Code, as this helps narrow down the list of probable payers. ZIP Code search isn’t an exact match, so even the first 3-4 digits of the patient’s current ZIP Code can help improve the results. If the patient’s current address isn’t available, you can try a full or partial ZIP Code from one of the patient’s previous addresses or even one in close proximity.' dateOfBirth: description: The dependent's date of birth (DOB), formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The dependent's first name. maxLength: 25 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: The dependent's gender. This can be set to either `M` - Male or `F` - Female. lastName: description: The dependent's last name. maxLength: 25 minLength: 1 type: string middleName: description: The dependent's middle name or initial. maxLength: 25 minLength: 1 type: string ssn: description: The dependent's Social Security Number (SSN). We strongly recommend providing this information if possible to improve the probability of finding matching coverage. pattern: ^(?:\d{9}|\d{3}-\d{2}-\d{4}|\d{4})$ type: string x-meta: title: Social Security Number (SSN) required: - firstName - lastName type: object ContactInformation: properties: contacts: description: The contact information. items: $ref: '#/components/schemas/Contacts' type: array name: description: The name of the contact person. type: string type: object BenefitsInformationCode: description: 'The code indicating the type of benefits information. Visit [Eligibility and benefit codes](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#benefit-type-codes) for more information. Payers may sometimes return other non-compliant values.' enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - A - B - C - CB - D - E - F - G - H - I - J - K - L - M - MC - N - O - P - Q - R - S - T - U - V - W - X - Y type: string Confidence: properties: level: $ref: '#/components/schemas/ConfidenceLevel' description: The confidence level for the match. reason: description: A reason for the confidence level. For example, `This record was identified as a low confidence match due to a DOB partial match`. type: string type: object SubscriberRelationshipCode: description: For the subscriber, this is always `18` for Self. enum: - '18' type: string InsuranceTypeName: description: 'The full name of the insurance type code. Payers may sometimes return other non-compliant values.' enum: - Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan - Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan - Medicare Secondary, No-fault Insurance including Auto is Primary - Medicare Secondary Worker's Compensation - Medicare Secondary Public Health Service (PHS)or Other Federal Agency - Medicare Secondary Black Lung - Medicare Secondary Veteran's Administration - Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP) - Medicare Secondary, Other Liability Insurance is Primary - Auto Insurance Policy - Commercial - Consolidated Omnibus Budget Reconciliation Act (COBRA) - Medicare Conditionally Primary - Disability - Disability Benefits - Exclusive Provider Organization - Family or Friends - Group Policy - Health Maintenance Organization (HMO) - Health Maintenance Organization (HMO) - Medicare Risk - Special Low Income Medicare Beneficiary - Indemnity - Individual Policy - Long Term Care - Long Term Policy - Life Insurance - Litigation - Medicare Part A - Medicare Part B - Medicaid - Medigap Part A - Medigap Part B - Medicare Primary - Other - Property Insurance - Personal - Personal - Personal Payment (Cash - No Insurance) - Preferred Provider Organization (PPO) - Point of Service (POS) - Qualified Medicare Beneficiary - Property Insurance - Real - Supplemental Policy - Tax Equity Fiscal Responsibility Act (TEFRA) - Workers Compensation - Wrap Up Policy type: string DiscoveryBenefitsInformation: properties: additionalInformation: description: A free-form message containing additional information about the benefits in the response. items: $ref: '#/components/schemas/AdditionalInformation' type: array authOrCertIndicator: $ref: '#/components/schemas/AuthOrCertIndicator' description: "Code indicating whether the benefit is subject to prior authorization or certification. Can be `Y` - Yes, `N` - No, or `U` - Unknown.\n - When this property is set to `U`, it means the payer can't determine in real time whether prior authorization is required for the service. They may require additional details, like diagnosis or place of service to make a determination. Check the `additionalInformation[].description` property for any additional clarification. You can also contact the payer directly or use their provider portal to get more information.\n - Some payers may send additional notes about prior authorization rules in the `additionalInformation[].description` property. Payers may also send prior authorization notes in a separate `benefitsInformation` object with a code of `1` (Active coverage), `CB` (Coverage Benefit), or `D` (Benefit Description).\n\nVisit our [patient benefits docs](https://www.stedi.com/docs/healthcare/eligibility-network-status-authorization-referrals#is-prior-authorization-required) to learn more about prior authorization.\n\nPayers may sometimes return other non-compliant values." benefitAmount: description: "The monetary benefit amount, such as a patient's co-pay or deductible. This value is expressed as a decimal, such as 100.00. \n \n The payer will always send a value in this property when the `benefitsInformation[].code` = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or `Y` - Spend Down. For those codes, this value represents the patient's portion of responsibility. \n \n The payer will **never** send this value when `benefitsInformation[].code` = `A` - Co-Insurance. This property can contain zero when the patient has no responsibility. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitPercent: description: "The percentage of the benefit, such as co-insurance. This property can contain zero when the patient has no responsibility. \n \n The payer will always send a value in this property when `benefitsInformation[].code` = `A` - Co-Insurance. For this code, this value represents the patient's portion of the responsibility. The percentage is expressed as a decimal, such as `0.80` represents 80%. \n \n The payer will **never** send a value in this property when `benefitsInformation[].code` = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or `Y` - Spend Down. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitQuantity: description: The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For example, `10` when the `quantityQualifier` is `Visits`. type: string benefitsAdditionalInformation: $ref: '#/components/schemas/BenefitsAdditionalInformation' benefitsDateInformation: $ref: '#/components/schemas/BenefitsDateInformation' benefitsRelatedEntities: description: 'Other entities associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. When present, this array typically contains information about the patient''s primary care provider (PCP), another organization that handles a specific benefit type (such as telehealth mental health services), or another health plan for the patient (coordination of benefits scenarios). - This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable to the patient and the payer supports it. - For Blue Cross Blue Shield (BCBS) payers, Stedi returns an entry containing information about the patient''s home plan - the plan that actually verified the coverage. In this object, the `entityIdentifier` property is set to `Party Performing Verification`. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#bcbs-home-plan)' items: $ref: '#/components/schemas/BenefitsRelatedEntity' type: array benefitsServiceDelivery: items: $ref: '#/components/schemas/BenefitsServiceDelivery' type: array code: $ref: '#/components/schemas/BenefitsInformationCode' compositeMedicalProcedureIdentifier: $ref: '#/components/schemas/CompositeMedicalProcedureIdentifier' coverageLevel: $ref: '#/components/schemas/BenefitsInformationCoverageLevelName' coverageLevelCode: $ref: '#/components/schemas/BenefitsInformationCoverageLevelCode' eligibilityAdditionalInformationList: description: Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response. items: $ref: '#/components/schemas/EligibilityAdditionalInformation' type: array headerLoopIdentifierCode: description: The loop header identifier number in the `LS` segment of the original X12 EDI transaction. type: string inPlanNetworkIndicator: $ref: '#/components/schemas/InPlanNetworkIndicatorName' inPlanNetworkIndicatorCode: $ref: '#/components/schemas/InPlanNetworkIndicatorCode' insuranceType: $ref: '#/components/schemas/InsuranceTypeName' insuranceTypeCode: $ref: '#/components/schemas/InsuranceTypeCode' description: 'Code identifying the type of insurance policy. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#insurance-type-codes) for a complete list. Payers may sometimes return other non-compliant values.' name: $ref: '#/components/schemas/BenefitsInformationName' planCoverage: description: 'The specific product name or special program name for an insurance plan. For example `Gold 1-2-3`. Payers are normally required to send the plan name when `benefitsInformation[].code` is set to values `1` - `8` and the `benefitsInformation[].serviceTypeCodes` contains `30` (Health Benefit Plan Coverage). However, behavior may vary by payer, so don''t rely on this information being present in the response. Note that the plan name returned in this property may not exactly match the name the payer uses in official plan documents or marketing literature. Visit [What''s the plan name?](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#what’s-the-plan-name%3F) in the benefits response documentation for more details.' type: string quantityQualifier: $ref: '#/components/schemas/QuantityQualifierName' description: 'The name of the `quantityQualifierCode`. Payers may sometimes return other non-compliant values.' quantityQualifierCode: $ref: '#/components/schemas/QuantityQualifierCode' description: 'Code indicating the type of quantity for the benefit. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#quantity-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' serviceTypeCodes: description: 'Service Type Codes (STCs) related to the benefit type. For example, `7` - Anesthesia. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceTypeCode' type: array serviceTypes: description: 'The names of the Service Type Codes listed in the `serviceTypeCodes` array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list of codes and their names. The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceType' type: array timeQualifier: $ref: '#/components/schemas/TimeQualifierName' description: 'The name of the `timeQualifierCode`. Payers may sometimes return other non-compliant values.' timeQualifierCode: $ref: '#/components/schemas/TimeQualifierCode' description: 'Code indicating the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' trailerLoopIdentifierCode: description: The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction. type: string type: object TimePeriodQualifierCode: description: 'Code specifying the time period for the benefit information. Payers may sometimes return other non-compliant values.' enum: - '6' - '7' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' type: string Gender: enum: - M - F type: string InsuranceDiscoverySubscriber: description: 'Demographic information for the patient when they are the health plan subscriber. We strongly recommend providing as much information as possible to improve the probability of finding matching coverage. We especially recommend providing the subscriber''s Social Security Number and their address - particularly their ZIP Code.' properties: address: $ref: '#/components/schemas/Address' description: 'The subscriber''s current or previous address. We strongly recommend providing this information if possible to improve the probability of finding matching coverage. We especially recommend providing the patient’s ZIP Code, as this helps narrow down the list of probable payers. ZIP Code search isn’t an exact match, so even the first 3-4 digits of the patient’s current ZIP Code can help improve the results. If the patient’s current address isn’t available, you can try a full or partial ZIP Code from one of the patient’s previous addresses or even one in close proximity.' dateOfBirth: description: The subscriber's date of birth (DOB), formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. maxLength: 25 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: The subscriber's gender. This can be set to either `M` - Male or `F` - Female. lastName: description: The subscriber's last name. maxLength: 25 minLength: 1 type: string middleName: description: The subscriber's middle name or initial. maxLength: 25 minLength: 1 type: string ssn: description: The subscriber's Social Security Number (SSN). We strongly recommend providing this information if possible to improve the probability of finding matching coverage. The patient's full SSN is preferred, but even the last 4 digits of the SSN can help narrow down matching coverage. pattern: ^(?:\d{9}|\d{3}-\d{2}-\d{4}|\d{4})$ type: string x-meta: title: Social Security Number (SSN) required: - firstName - lastName type: object SubscriberInsuredIndicator: description: Indicates the status of the insured. For the subscriber, this is always `Y`. enum: - Y type: string BenefitsServiceDeliveryQuantityQualifierCode: description: 'Code specifying the type of quantity. Payers may sometimes return other non-compliant values.' enum: - DY - FL - HS - MN - VS type: string EligibilityCheckProviderError: description: When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `provider` level include missing or incorrect information and issues with the provider's NPI registration with the payer. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckProviderErrorCode' description: 'The error code. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckProviderAndMemberFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object ServiceUnavailableExceptionResponseContent: description: The server is temporarily unavailable. properties: code: description: Classification of the exception type. type: string message: description: Human readable exception message. type: string required: - message type: object DateTimePeriodFormatQualifier: description: Payers may sometimes return other non-compliant values. enum: - D8 - RD8 type: string HealthCareDiagnosisCode: description: Information about the patient's healthcare diagnosis. properties: diagnosisCode: description: The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed. type: string diagnosisTypeCode: description: The type of diagnosis code provided. It can be `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. type: string type: object ResourceNotFoundExceptionResponseContent: description: The server response when the specified resource cannot be found after an API request passes authentication and authorization. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object TimeQualifierName: description: "The name of the time period qualifier code. \n \n Note that for the patient's deductible, `Calendar Year` indicates the patient's total deductible amount for the year, while `Remaining` indicates the amount left to meet the deductible. Visit [Payer benefit response](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits#deductible) to learn more about deductibles.\n\nPayers may sometimes return other non-compliant values." enum: - Hour - Day - 24 Hours - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week - Admission type: string EligibilityCheckErrorCode: description: 'This is a superset of all the possible codes in the sub-loops, as all errors are bubbled up to the top level of the response Payers may sometimes return other non-compliant values.' enum: - '04' - '15' - '33' - '35' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '97' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA - T4 type: string PlanInformation: description: Additional identification for the subscriber's healthcare plan. properties: agencyClaimNumber: description: The agency claim number, only used when the information source is a Property and Casualty payer. type: string alternativeListId: description: The alternative list ID - identifies a list of alternative drugs with the associated formulary status for the patient. type: string caseNumber: description: The case number type: string centersForMedicareAndMedicaidServicesNPI: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned by the Centers for Medicare and Medicaid Services pattern: ^\d{10}$ type: string classOfContractCode: description: The class of contract code - used to identify the applicable class of contract for claims processing. type: string contractNumber: description: The contract number of a contract between the payer and the provider that requested the eligibility check. type: string coverageListId: description: The coverage list ID - identifies a list of drugs that have coverage limitations for the patient. type: string drugFormularyNumber: description: The drug formulary number type: string electronicDevicePin: description: The electronic device pin number type: string eligibilityCategory: description: The eligibility category type: string facilityIdNumber: description: The facility ID number type: string facilityNetworkIdentificationNumber: description: The facility network identification number type: string familyUnitNumber: description: The family unit number type: string federalTaxpayersIdentificationNumber: description: The federal taxpayer's identification number type: string groupDescription: description: The group description type: string groupNumber: description: The group number type: string hicNumber: description: The health insurance claim number (HICN). Note that CMS previously used the HICN to uniquely identify Medicare beneficiaries. However, they have since transitioned to a new, randomized Medicare Beneficiary Identifier (MBI) format. The HICN is no longer used for Medicare transactions but this property is now used by some payers to return MBI. If you receive a value in this property that matches the format specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis), the number is likely an MBI and we recommend sending a follow-up eligibility check to CMS for additional benefits data. This most commonly occurs with patients who are covered by both Medicare and Medicaid. type: string idCardNumber: description: The identity card number, used when the Identity Card Number is different than the Member Identification Number. type: string idCardSerialNumber: description: The identification card serial number. The Identification Card Serial Number uniquely identifies the identification card when multiple cards have been or will be issued to a member, such as a replacement card. type: string insurancePolicyNumber: description: The insurance policy number type: string issueNumber: description: The issue number type: string medicaidProviderNumber: description: The Medicaid provider number type: string medicaidRecipientIdNumber: description: The Medicaid recipient identification number type: string medicalAssistanceCategory: description: The medical assistance category type: string medicalRecordIdentificationNumber: description: The medical record identification number type: string medicareProviderNumber: description: The Medicare provider number type: string memberId: description: The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer. type: string patientAccountNumber: description: The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response. type: string personalIdentificationNumber: description: The personal identification number (PIN) type: string planDescription: description: The plan description type: string planNetworkIdDescription: description: The plan, group, or plan network name type: string planNetworkIdNumber: description: The plan network identification number type: string planNumber: description: The plan number type: string policyNumber: description: The group or policy number type: string priorAuthorizationNumber: description: The prior authorization number type: string priorIdNumber: description: The prior identifier number type: string referralNumber: description: The referral number type: string socialSecurityNumber: description: The social security number type: string x-meta: title: Social Security Number (SSN) stateLicenseNumber: description: The state license number type: string submitterIdentificationNumber: description: The submitter identification number type: string userIdentification: description: The user identification type: string type: object GenderWithUnknown: enum: - M - F - U type: string DeliveryOrCalendarPatternQualifier: description: 'The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`. Payers may sometimes return other non-compliant values.' enum: - 1st Week of the Month - 2nd Week of the Month - 3rd Week of the Month - 4th Week of the Month - 5th Week of the Month - 1st & 3rd Week of the Month - 2nd & 4th Week of the Month - 1st Working Day of Period - Last Working Day of Period - Monday through Friday - Monday through Saturday - Monday through Sunday - Monday - Tuesday - Wednesday - Thursday - Friday - Saturday - Sunday - Monday through Thursday - Immediately - As Directed - Daily Mon. Through Fri. - 1/2 Mon. & 1/2 Tues. - 1/2 Tues. & 1/2 Thurs. - 1/2 Wed. & 1/2 Fri. - Once Anytime Mon. through Fri. - Tuesday through Friday - Monday, Tuesday and Thursday - Monday, Tuesday and Friday - Wednesday and Thursday - Monday, Wednesday and Thursday - Tuesday, Thursday and Friday - 1/2 Tues. & 1/2 Fri. - 1/2 Mon. & 1/2 Wed. - 1/3 Mon., 1/3 Wed., 1/3 Fri. - Whenever Necessary - 1/2 By Wed. Bal. By Fri. - None (Also Used to Cancel or Override a Previous Pattern) type: string InsuranceDiscoveryProvider: description: Information about the provider requesting the insurance discovery check. properties: npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). maxLength: 15 minLength: 10 pattern: ^[12].*$ type: string x-meta: title: National Provider Identifier (NPI) required: - npi type: object DependentInsuredIndicator: description: Indicates the status of the insured. For the dependent, this is always `N`. enum: - N type: string DependentRelationshipCode: description: For the dependent, this can be `01` - Spouse, `19` - Child, `20` Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 - Unknown type: string ProviderInformation: properties: providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' referenceIdentification: description: The provider's taxonomy code. type: string type: object Warning: properties: code: description: The warning code. type: string description: description: The warning description. type: string type: object DeliveryOrCalendarPatternQualifierCode: description: 'Code that specifies the routine shipments, deliveries, or calendar pattern. For example `9` - Last Working Day of Period. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-frequency-codes) for a complete list. Payers may sometimes return other non-compliant values.' enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - A - B - C - D - E - F - G - H - J - K - L - M - N - O - P - Q - R - S - SG - SL - SP - SX - SY - SZ - T - U - V - W - X - Y type: string ResponseStateOrProvinceCode: description: 'The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. Payers may sometimes return other non-compliant values.' enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AA - AE - AP - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY type: string InsuranceDiscoveryCheckRequestContent: properties: dependent: $ref: '#/components/schemas/InsuranceDiscoveryDependent' encounter: $ref: '#/components/schemas/InsuranceDiscoveryEncounter' provider: $ref: '#/components/schemas/InsuranceDiscoveryProvider' subscriber: $ref: '#/components/schemas/InsuranceDiscoverySubscriber' required: - provider - subscriber type: object DeliveryPatternTimeQualifierCode: description: 'A code specifying the time for routine shipments or deliveries. Payers may sometimes return other non-compliant values.' enum: - A - B - C - D - E - F - G - Y type: string QuantityQualifierName: description: 'The name of the quantity qualifier code. Payers may sometimes return other non-compliant values.' enum: - Minimum - Quantity Used - Covered - Actual - Covered - Estimated - Number of Co-insurance Days - Deductible Blood Units - Days - Hours - Life-time Reserve - Actual - Life-time Reserve - Estimated - Maximum - Month - Number of Services or Procedures - Quantity Approved - Age, High Value - Age, Low Value - Visits - Years type: string DependentRelationship: description: The name of the `relationToSubscriberCode`. For example, `Child` when the code is `19`. enum: - Spouse - Child - Employee - Unknown - Organ Donor - Cadaver Donor - Life Partner - Other Relationship type: string ResponseProviderCode: description: 'A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU type: string BenefitsAdditionalInformation: description: Identifying information specific to this type of benefit. properties: alternativeListId: description: The alternative list ID. This identifier allows the payer to specify a list of drugs and its alternative drugs with the associated formulary status for the patient. type: string coverageListId: description: The coverage list ID. This identifier allows the payer to specify the identifier of a list of drugs that have coverage limitations for the associated patient. type: string drugFormularyNumber: description: The drug formulary number. type: string familyUnitNumber: description: The family unit number. This is returned when the payer is a pharmacy benefits manager (PBM) and the patient has a suffix to their member ID number that is used in the NCPDP Telecom Standard Insurance Segment, in field `303-C3` (Person Code). For all other uses, the family unit number (suffix) is considered part of the patient's member ID number. type: string groupDescription: description: Group name type: string groupNumber: description: The group number for the patient's health insurance plan. type: string hicNumber: description: The health insurance claim number (HICN). Note that CMS previously used the HICN to uniquely identify Medicare beneficiaries. However, they have since transitioned to a new, randomized Medicare Beneficiary Identifier (MBI) format. The HICN is no longer used for Medicare transactions but this property is now used by some payers to return MBI. If you receive a value in this property that matches the format specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis), the number is likely an MBI and we recommend sending a follow-up eligibility check to CMS for additional benefits data. This most commonly occurs with patients who are covered by both Medicare and Medicaid. type: string insurancePolicyNumber: description: The insurance policy number. type: string medicaidRecepientIdNumber: description: The Medicaid Recipient Identification number. type: string medicalAssistanceCategory: description: The medical assistance category. type: string memberId: description: The patient's member ID. type: string planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The plan network identification number. type: string planNumber: description: The insurance plan number. type: string policyNumber: description: The patient's policy number. type: string priorAuthorizationNumber: description: The prior authorization number. type: string referralNumber: description: The referral number. type: string type: object Address: properties: address1: description: The first line of the address. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. maxLength: 30 minLength: 2 type: string countryCode: description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). maxLength: 2 minLength: 2 type: string countrySubDivisionCode: description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). maxLength: 3 minLength: 1 type: string postalCode: description: The United States or Canadian postal code, excluding punctuation and blanks. maxLength: 9 minLength: 5 type: string state: $ref: '#/components/schemas/ResponseStateOrProvinceCode' type: object BenefitsInformationCoverageLevelCode: description: "Code indicating the level of coverage for the patient. \n\nThis will either be `CHD` - Children Only, `DEP` - Dependents Only, `ECH` - Employee and Children, `EMP` - Employee Only, `ESP` - Employee and Spouse, `FAM` - Family, `IND` - Individual, `SPC` - Spouse and Children, `SPO` - Spouse Only, or `Unknown`.\n\nPayers may sometimes return other non-compliant values." enum: - CHD - DEP - ECH - EMP - ESP - FAM - IND - SPC - SPO type: string ResponseEligibilityServiceType: description: 'The name of a Service Type Code listed in the `serviceTypeCodes` array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list of codes and their names. The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals. Payers may sometimes return other non-compliant values.' enum: - Medical Care - Surgical - Consultation - Diagnostic X-Ray - Diagnostic Lab - Radiation Therapy - Anesthesia - Surgical Assistance - Other Medical - Blood Charges - Used Durable Medical Equipment - Durable Medical Equipment Purchase - Ambulatory Service Center Facility - Renal Supplies in the Home - Alternate Method Dialysis - Chronic Renal Disease (CRD) Equipment - Pre-Admission Testing - Durable Medical Equipment Rental - Pneumonia Vaccine - Second Surgical Opinion - Third Surgical Opinion - Social Work - Diagnostic Dental - Periodontics - Restorative - Endodontics - Maxillofacial Prosthetics - Adjunctive Dental Services - Health Benefit Plan Coverage - Plan Waiting Period - Chiropractic - Chiropractic Office Visits - Dental Care - Dental Crowns - Dental Accident - Orthodontics - Prosthodontics - Oral Surgery - Routine (Preventive) Dental - Home Health Care - Home Health Prescriptions - Home Health Visits - Hospice - Respite Care - Hospital - Hospital - Inpatient - Hospital - Room and Board - Hospital - Outpatient - Hospital - Emergency Accident - Hospital - Emergency Medical - Hospital - Ambulatory Surgical - Long Term Care - Major Medical - Medically Related Transportation - Air Transportation - Cabulance - Licensed Ambulance - General Benefits - In-vitro Fertilization - MRI/CAT Scan - Donor Procedures - Acupuncture - Newborn Care - Pathology - Smoking Cessation - Well Baby Care - Maternity - Transplants - Audiology Exam - Inhalation Therapy - Diagnostic Medical - Private Duty Nursing - Prosthetic Device - Dialysis - Otological Exam - Chemotherapy - Allergy Testing - Immunizations - Routine Physical - Family Planning - Infertility - Abortion - AIDS - Emergency Services - Cancer - Pharmacy - Free Standing Prescription Drug - Mail Order Prescription Drug - Brand Name Prescription Drug - Generic Prescription Drug - Podiatry - Podiatry - Office Visits - Podiatry - Nursing Home Visits - Professional (Physician) - Anesthesiologist - Professional (Physician) Visit - Office - Professional (Physician) Visit - Inpatient - Professional (Physician) Visit - Outpatient - Professional (Physician) Visit - Nursing Home - Professional (Physician) Visit - Skilled Nursing Facility - Professional (Physician) Visit - Home - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Psychiatric - Inpatient - Psychiatric - Outpatient - Rehabilitation - Rehabilitation - Room and Board - Rehabilitation - Inpatient - Rehabilitation - Outpatient - Occupational Therapy - Physical Medicine - Speech Therapy - Skilled Nursing Care - Skilled Nursing Care - Room and Board - Substance Abuse - Alcoholism - Drug Addiction - Vision (Optometry) - Frames - Routine Exam - Lenses - Nonmedically Necessary Physical - Experimental Drug Therapy - Burn Care - Brand Name Prescription Drug - Formulary - Brand Name Prescription Drug - Non-Formulary - Independent Medical Evaluation - Partial Hospitalization (Psychiatric) - Day Care (Psychiatric) - Cognitive Therapy - Massage Therapy - Pulmonary Rehabilitation - Cardiac Rehabilitation - Pediatric - Nursery - Skin - Orthopedic - Cardiac - Lymphatic - Gastrointestinal - Endocrine - Neurology - Eye - Invasive Procedures - Gynecological - Obstetrical - Obstetrical/Gynecological - 'Mail Order Prescription Drug: Brand Name' - 'Mail Order Prescription Drug: Generic' - 'Physician Visit - Office: Sick' - 'Physician Visit - Office: Well' - Coronary Care - Private Duty Nursing - Inpatient - Private Duty Nursing - Home - Surgical Benefits - Professional (Physician) - Surgical Benefits - Facility - Mental Health Provider - Inpatient - Mental Health Provider - Outpatient - Mental Health Facility - Inpatient - Mental Health Facility - Outpatient - Substance Abuse Facility - Inpatient - Substance Abuse Facility - Outpatient - Screening X-ray - Screening laboratory - Mammogram, High Risk Patient - Mammogram, Low Risk Patient - Flu Vaccination - Eyewear and Eyewear Accessories - Case Management - Dermatology - Durable Medical Equipment - Diabetic Supplies - Generic Prescription Drug - Formulary - Generic Prescription Drug - Non-Formulary - Allergy - Intensive Care - Mental Health - Neonatal Intensive Care - Oncology - Physical Therapy - Pulmonary - Renal - Residential Psychiatric Treatment - Transitional Care - Transitional Nursery Care - Urgent Care - Diagnostic Imaging - Fixed Prosthodontics - Removable Prosthodontics - Intraoral Images - Complete Series - Oral Evaluation - Dental Prophylaxis - Panoramic Images - Sealants - Fluoride Treatments - Dental Implants - Temporomandibular Joint Dysfunction - Prescription Fluoride Toothpaste - Antimicrobial Rinse - Major Oral Surgery - Orthognathics - Amalgam Restorations - Posterior Composite Restorations - Simple Extraction - Bridges - Bitewing X-Rays - Occlusal & Extraoral X-Rays - Periapical X-Ray - Full Mouth X-Rays - Space Maintenance - Occlusal Adjustments - Restorative - Major - Restorative - Routine - Additional Diagnostic and Preventive - Surgical Periodontics - Non-Surgical Periodontics - Repair Crown - Recement Crown - Basic - Denture Adjust, Rebase, Reline, Repair - Restorative - Other - Root Planing & Scaling - Simple Restorations - Stainless Crowns - Crowns - Harmful Habits Appliance - Buildups / Post and Core - Inlay / Onlay - Amalgam / Composite Restorations - Dentures - Dentures - Repair - Dentures - Reline - Dentures - Rebase - Full Mouth / Panoramic X-Rays - Composites - Stainless Steel, Resin, Acrylic Crowns - Root Canal / Retreatment - Dentures - Adjustments - Dentures - Reline / Rebase - Tissue Conditioning - Cosmetic - Emergency Care type: string EligibilityCheckError: description: When a payer rejects your eligibility check, the response contains one or more AAA errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckErrorCode' description: 'The error code. Visit [Eligibility troubleshooting](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) for a complete list of all possible error codes and descriptions. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object BenefitRelatedEntityIdentification: description: 'Code identifying the type of value provided in `entityIdentificationValue`. For example, `FI` - Federal Taxpayer''s Identification Number. Payers may sometimes return other non-compliant values.' enum: - '24' - '34' - '46' - FA - FI - II - MI - NI - PI - PP - SV - XV - XX type: string UnitForMeasurementCode: description: 'Code specifying the unit of measurement for the quantity. Payers may sometimes return other non-compliant values.' enum: - DA - MO - VS - WK - YR type: string MaintenanceTypeCode: description: 'The maintenance type code. Used to acknowledge a change in the identifying elements for the subscriber from those submitted in the original eligibility check request. It can also be included when the payer used the birth sequence number from the original request to locate the subscriber in their system. This is always `001` Payers may sometimes return other non-compliant values.' enum: - '001' type: string DiscoveryStatus: enum: - PENDING - COMPLETE - ERROR type: string ResponseProvider: description: Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. This object will always include at least one identifier, such as the provider's [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier), tax ID, or EIN. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckProviderError' type: array address: $ref: '#/components/schemas/Address' description: The provider's contact information. employersId: deprecated: true description: 'Deprecated; The provider''s identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used.' type: string entityIdentifier: $ref: '#/components/schemas/ResponseProviderEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' federalTaxpayersIdNumber: description: The Federal Taxpayer Identification Number (also known as an EIN). pattern: ^\d{9}$ type: string middleName: description: The provider's middle name. This applies to providers that are an individual. type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string payorIdentification: description: The Payor Identification. type: string pharmacyProcessorNumber: description: The pharmacy processor number. type: string providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' providerFirstName: description: The provider's first name. This applies to providers that are an individual. type: string providerName: description: The provider's last name. This applies to providers that are an individual. type: string providerOrgName: description: The provider's organization name. type: string referenceIdentification: description: The Health Care Provider Taxonomy Code. type: string serviceProviderNumber: description: The service provider number. This is an identification number assigned by the payer. type: string servicesPlanID: description: The Centers for Medicare and Medicaid Services (CMS) Plan ID. type: string ssn: description: The Social Security Number (SSN). pattern: ^\d{9}$ type: string suffix: description: The provider's name suffix, such as Jr., Sr., or III. type: string type: object InformationStatusCode: description: Payers may sometimes return other non-compliant values. enum: - A - C - L - O - P - S - T type: string BenefitsRelatedEntityRelationshipCode: description: 'Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values.' enum: - '01' - '02' - '27' - '41' - '48' - '65' - '72' type: string InPlanNetworkIndicatorCode: description: "Code indicating whether the benefit is in-network or out-of-network. Can be `Y` - Yes, `N` - No, `U` - Unknown, or `W` - Not Applicable\n\n Code `U` indicates that it is unknown whether the benefits are in or out-of-network. Code `W` indicates that the benefit applies to both in and out-of-network providers. \n \n Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly.\n\nPayers may sometimes return other non-compliant values." enum: - Y - N - U - W type: string ThrottlingExceptionResponseContent: description: The server response when usage plan or account-level throttling limits exceeded. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object SubscriberRelationship: description: The name of the `relationToSubscriberCode`. For the subscriber, this is always `Self`. enum: - Self type: string InsuranceDiscoveryResponseFields: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, copays, etc.), out of pocket maximums, and more. This is the same information you would get from a standard eligibility check.\n \n Payers typically return at least the following properties: `code`, `coverageLevelCode`, `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`. However, the exact properties returned in this object are up to the payer's discretion.\n \n Visit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits) in our eligibility check documentation for more information about benefit types, details about how to interpret the response, and additional examples." items: $ref: '#/components/schemas/DiscoveryBenefitsInformation' type: array confidence: $ref: '#/components/schemas/Confidence' description: "Information indicating how likely it is that this coverage is a match for the patient submitted in the insurance discovery request. \n\n Even if the confidence level is high, you **must** always check the subscriber information to confirm that the coverage is a match for the patient." dependent: $ref: '#/components/schemas/DiscoveryResponseDependent' description: Information about the dependent for this coverage. You should **always** review this information to ensure that the coverage Stedi found is a match for the patient. payer: $ref: '#/components/schemas/DiscoveryPayer' description: Information about the payer for this coverage. Note that payer names and IDs aren't normalized, so you'll need to handle matching these results to Stedi's Payer Network or your own internal payer list. planDateInformation: $ref: '#/components/schemas/DiscoveryPlanDateInformation' description: "Contains the dates associated with coverage for this health plan. This information can help you determine the patient's eligibility for benefits.\n - All dates are formatted as YYYYMMDD (for single dates) or as YYYYMMDD-YYYYMMDD (for date ranges).\n - Properties contain a single date unless otherwise noted.\n - Most payers return either `plan` or `planBegin` and `planEnd`, but the exact dates returned depend on the payer's discretion and the specific health plan.\n - If the date of service is after the earliest ending `plan`, `eligibility`, `planEnd`, `eligibilityEnd`, `policyEffective`, or `policyExpiration` value, the patient likely doesn't have active coverage." planInformation: $ref: '#/components/schemas/PlanInformation' description: Additional identification for the patient's health plan. provider: $ref: '#/components/schemas/DiscoveryResponseProvider' description: Information about the provider who requested the insurance discovery check. subscriber: $ref: '#/components/schemas/DiscoveryResponseSubscriber' description: Information about the subscriber for this coverage. You should **always** review this information to ensure that the coverage Stedi found is a match for the patient. type: object QuantityQualifierCode: description: 'Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values.' enum: - 8H - '99' - CA - CE - D3 - DB - DY - HS - LA - LE - M2 - MN - P6 - QA - S7 - S8 - VS - YY type: string DiscoveryResponseSubscriber: description: Common fields shared between subscriber and dependent structures in the eligibility response. properties: address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseSubscriberEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/SubscriberInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: description: The member ID for the insurance policy. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/SubscriberRelationship' relationToSubscriberCode: $ref: '#/components/schemas/SubscriberRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object BenefitsDateInformation: description: "Dates associated with the benefits.\n - This is where you can find benefit-specific eligibility dates, if provided. These dates override dates provided in `planDateInformation` for this benefit type.\n - This is where the payer may specify the last time the service was rendered (`latestVisitOrConsultation`), which you can use to determine whether the patient has already reached the allowed frequency, if applicable. For example, this object could contain the date when the patient received their last dental cleaning.\n - These dates only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided." properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string admission: description: The admission date or dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string admissions: description: The date(s) for admission. items: $ref: '#/components/schemas/DtpDate' type: array benefit: description: The benefit date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string benefitBegin: description: The date when the benefit begins. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string benefitEnd: description: The date when the benefit ends. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string certification: deprecated: true description: The certification date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string cobraBegin: deprecated: true description: The date when COBRA coverage begins. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string cobraEnd: deprecated: true description: The date when COBRA coverage ends. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string completion: description: The completion date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string coordinationOfBenefits: description: The coordination of benefits date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string dateOfDeath: description: The date of death. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string dateOfLastUpdate: description: The date when the plan information was last updated. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string discharge: description: The discharge date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string discharges: description: The date(s) when the patient was discharged. items: $ref: '#/components/schemas/DtpDate' type: array effectiveDateOfChange: deprecated: true description: The effective date of change. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibility: description: Plan eligibility dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibilityBegin: description: The date when the patient is first eligible for benefits under the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibilityEnd: description: The date when the patient is no longer eligible for benefits under the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string enrollment: deprecated: true description: The date when the patient is enrolled in the plan. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string issue: deprecated: true description: The issue date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string latestVisitOrConsultation: description: The latest visit or consultation date. This date may be used to determine whether the patient has already reached the allowed frequency for a specific benefit. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string periodEnd: description: The end of a period. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string periodStart: description: The start of a period. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string plan: description: Only included when multiple plans apply to the patient or multiple plan periods apply. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string planBegin: description: Only included when multiple plans apply to the patient or multiple plan periods apply. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string planEnd: deprecated: true description: The date coverage from the plan ends. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string policyEffective: deprecated: true description: The date when the policy becomes effective. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string policyExpiration: deprecated: true description: The date when the policy expires. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string premiumPaidToDateEnd: deprecated: true description: The end of period when the plan premium payments are up-to-date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string premiumPaidtoDateBegin: deprecated: true description: The start of the period when the plan premium was paid in full. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string primaryCareProvider: description: The primary care provider date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string service: description: The service date or dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string status: description: The status date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string type: object EligibilityAdditionalInformation: properties: codeCategory: $ref: '#/components/schemas/InjuryCodeCategory' description: 'The code category. Always set to `44` - Nature of Injury. Payers may sometimes return other non-compliant values.' codeListQualifier: description: The name of the `codeListQualifierCode`. For example `Mutually Defined` when the code is set to `ZZ`. type: string codeListQualifierCode: $ref: '#/components/schemas/CodeListQualifierCode' description: "Identifies a specific industry code list. Can be `GR` - National Council on Compensation Insurance (NCCI) Nature of Injury Code, `NI` - Nature of Injury Code, or `ZZ` - Mutually Defined.\n\n When this is set to `ZZ`, the `industryCode` property will be set to a place of service code.\n\nPayers may sometimes return other non-compliant values." industry: description: The name of the `industryCode`. For example `Pharmacy` when the code is `01`. type: string industryCode: description: The specific industry code. When `codeListQualifierCode` is set to `ZZ` - Mutually Defined, this property will be set to a place of service code. Visit the [Place of Service Code Set](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list of these codes and their descriptions. type: string injuredBodyPartName: description: Description of injured body parts. type: string type: object CompositeMedicalProcedureIdentifier: description: Identifies relevant medical procedures by their standard codes and modifiers (if applicable). properties: diagnosisCodePointer: description: The diagnosis code pointer. items: type: string type: array procedureCode: description: The procedure code. Many payers do not support eligibility checks for specific procedure codes. If the payer does not support procedure codes, they return a generic benefits response for the service type code `30`. type: string procedureModifiers: description: Procedure modifiers that provides additional information related to the performance of the service. items: type: string type: array productOrServiceID: description: The product or service ID. This value represents the end of the range of applicable procedure codes. The beginning of the range is listed in `procedureCode`. type: string productOrServiceIDQualifier: description: The name of the `productOrServiceIDQualifierCode`. For example, `American Dental Association`. type: string productOrServiceIDQualifierCode: description: Identifies the external code list used to provide the specified procedure or service codes. Can be `AD` - American Dental Association, `CJ` - Current Procedural Terminology (CPT) codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually Defined type: string type: object BenefitsRelatedEntity: description: 'Identify another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. This array is commonly used to designate the patient''s primary care provider (PCP), another organization that handles a specific carveout benefit type, or another health plan for the patient (coordination of benefits scenarios). This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable to the patient and the payer supports it.' properties: address: $ref: '#/components/schemas/Address' description: The address of the entity, such as a provider or organization. contactInformation: $ref: '#/components/schemas/ContactInformation' description: The contact information for the entity, such as a phone number or email address. entityFirstname: description: The first name of the entity, if the entity is a person. type: string entityIdentification: $ref: '#/components/schemas/BenefitRelatedEntityIdentification' description: 'Code identifying the type of identifier in the `entityIdentificationValue` property. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#identification-code-qualifiers) for a complete list. Payers may sometimes return other non-compliant values.' entityIdentificationValue: description: The identification number for the entity, qualified by the code in `entityIdentification`. type: string entityIdentifier: $ref: '#/components/schemas/RelatedEntityIdentifierName' description: 'Code identifying an organizational entity, a physical location, property, or individual. When set to `Party Performing Verification` for a BCBS payer, this is the patient''s home plan. Payers may sometimes return other non-compliant values.' entityMiddlename: description: The middle name or initial of the entity, if the entity is a person. type: string entityName: description: The last name (if the entity is a person) or the business name (if the entity is an organization). type: string entityRelationship: $ref: '#/components/schemas/BenefitsRelatedEntityRelationshipCode' description: 'Code specifying the relationship between the entity and the patient. Can be `01` - Parent, `02` - Child, `27` - Domestic Partner, `41` - Spouse, `48` - Employee, `65` - Other, or `72` - Unknown. Payers may sometimes return other non-compliant values.' entitySuffix: description: The name suffix, such as Sr. Jr. or III. type: string entityType: $ref: '#/components/schemas/EntityTypeQualifier' providerInformation: $ref: '#/components/schemas/ProviderInformation' type: object InjuryCodeCategory: description: Payers may sometimes return other non-compliant values. enum: - '44' type: string BenefitsInformationCoverageLevelName: description: 'The full name of the coverage level code. Payers may sometimes return other non-compliant values.' enum: - Children Only - Dependents Only - Employee and Children - Employee Only - Employee and Spouse - Family - Individual - Spouse and Children - Spouse Only type: string ApplicationModes: description: 'The type of data in the request. This is either `production` when you send a request with a standard API key or `test` when you send a request in test mode with a [test API key](https://www.stedi.com/docs/api-reference/index#api-key-types). The `information` value is not currently used. Payers may sometimes return other non-compliant values.' enum: - production - test - information type: string InternalFailureExceptionResponseContent: description: The server response when an unexpected error occurred while processing request. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object AccessDeniedExceptionResponseContent: description: The server response for authorization failure. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object BenefitsServiceDeliveryQuantityQualifier: description: 'The name of the `quantityQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' enum: - Days - Units - Hours - Month - Visits type: string InsuranceDiscoveryEncounter: description: "The date range for the service being requested. If you don't specify a service date (either a single day or a range of dates), Stedi defaults to the current date.\n\n You can specify either a single `dateOfService` or a `beginningDateOfService` and `endDateOfService`." properties: beginningDateOfService: description: The beginning date, formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateOfService: description: The date of service, formatted as YYYYMMDD. You can use this value to specify a single occasion. If you don't specify a service date (either a single day or a range of dates), Stedi defaults to the current date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endDateOfService: description: The end date, formatted as YYYYMMDD. If you don't specify an end date, Stedi defaults to the same date as `beginningDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object ResponseEligibilityServiceTypeCode: description: 'A code identifying a type of service. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' 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 - EA - EB - EC - ED - EE - EF - EG - EH - EI - EJ - EK - FA - FB - V3 - V4 - V5 - V6 - V7 - V8 - V9 - V10 - V11 - V12 - V13 - V14 - V15 - V16 - V17 - V18 - V19 - V20 - V21 - V22 - V23 - V24 - V25 - V26 - V27 - V28 - V29 - V30 - V31 - V32 - V33 - V34 - V35 - V36 - V37 - V38 - V39 - V40 - V41 - V42 - V43 - V44 - V45 type: string ConfidenceLevel: enum: - REVIEW_NEEDED - HIGH type: string DiscoveryResponseProvider: properties: address: $ref: '#/components/schemas/Address' description: The provider's contact information. entityIdentifier: $ref: '#/components/schemas/ResponseProviderEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' federalTaxpayersIdNumber: description: The Federal Taxpayer Identification Number (also known as an EIN). pattern: ^\d{9}$ type: string middleName: description: The provider's middle name. This applies to providers that are an individual. type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string payorIdentification: description: The Payor Identification. type: string pharmacyProcessorNumber: description: The pharmacy processor number. type: string providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' providerFirstName: description: The provider's first name. This applies to providers that are an individual. type: string providerName: description: The provider's last name. This applies to providers that are an individual. type: string providerOrgName: description: The provider's organization name. type: string referenceIdentification: description: The Health Care Provider Taxonomy Code. type: string serviceProviderNumber: description: The service provider number. This is an identification number assigned by the payer. type: string servicesPlanID: description: The Centers for Medicare and Medicaid Services (CMS) Plan ID. type: string ssn: description: The Social Security Number (SSN). pattern: ^\d{9}$ type: string suffix: description: The provider's name suffix, such as Jr., Sr., or III. type: string type: object GatewayTimeoutExceptionResponseContent: description: The server response for a gateway timeout error. properties: code: description: Classification of the exception type. type: string message: description: Human readable exception message. type: string required: - message type: object DiscoveryPayer: properties: centersForMedicareAndMedicaidPlanId: description: The payer's Centers for Medicare and Medicaid Services PlanID. type: string contactInformation: $ref: '#/components/schemas/ContactInformation' description: 'The payer''s contact information. Note that when `contacts[].communicationMode` is set to `UR`, the `communicationNumber` property may not contain a valid URL. Most payers provide a partial web address for their provider portal, or something similar, such as `www.example.com/portal`. You must add the appropriate scheme and separators, such as `https://` or `http://`, to make it a valid URL.' entityIdentifier: $ref: '#/components/schemas/PayerEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type qualifier for the payer. Can be set to `Person` (not commonly used) or `Non-Person Entity` (most common). Payers may sometimes return other non-compliant values.' etin: description: The payer's Electronic Transmitter Identification Number (ETIN). type: string federalTaxpayersIdNumber: description: The payer's federal taxpayer's identification number. pattern: ^\d{9}$ type: string firstName: description: The payer's first name, when the payer is an individual (not commonly used). type: string lastName: description: The payer's last name. Used when the payer is an individual (not commonly used). type: string middleName: description: The payer's middle name or initial, when the payer is an individual (not commonly used). type: string naic: description: The payer's National Association of Insurance Commissioners (NAIC) identification number. type: string name: description: The payer's business name, when the payer is not a person. type: string npi: description: The payer's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) payorIdentification: description: The payor identification. type: string suffix: description: The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used). type: string type: object BenefitsServiceDelivery: description: The delivery or usage pattern for the benefits. properties: deliveryOrCalendarPatternCode: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier' deliveryOrCalendarPatternQualifier: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier' deliveryOrCalendarPatternQualifierCode: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifierCode' deliveryPatternTimeCode: $ref: '#/components/schemas/DeliveryPatternTimeQualifier' deliveryPatternTimeQualifier: $ref: '#/components/schemas/DeliveryPatternTimeQualifier' deliveryPatternTimeQualifierCode: $ref: '#/components/schemas/DeliveryPatternTimeQualifierCode' description: 'Code specifying the time for routine shipments or deliveries. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-pattern-time-codes) for a complete list. Payers may sometimes return other non-compliant values.' numOfPeriods: description: The number of periods in the time period. For example, `12` when the `timePeriodQualifier` is `Hour`. type: string quantity: description: The quantity of the benefit. For example, `10` when the `quantityQualifier` is `Visits`. type: string quantityQualifier: $ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifier' description: 'The name of the `quantityQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' quantityQualifierCode: $ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifierCode' description: 'Code specifying the type of quantity for the benefit. Can be `DY` - Days, `FL` - Units, `HS` - Hours, `MN` - Month, and `VS` - Visits. Payers may sometimes return other non-compliant values.' sampleSelectionModulus: description: Specifies the sampling frequency, based on the unit of measure. For example `every 2 months` or `once per calendar year`. type: string timePeriodQualifier: $ref: '#/components/schemas/TimePeriodQualifier' description: 'The name of the `timePeriodQualifierCode`. For example, `Calendar Year`. Payers may sometimes return other non-compliant values.' timePeriodQualifierCode: $ref: '#/components/schemas/TimePeriodQualifierCode' description: 'Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' unitForMeasurementCode: $ref: '#/components/schemas/UnitForMeasurement' deprecated: true unitForMeasurementQualifier: $ref: '#/components/schemas/UnitForMeasurement' description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' unitForMeasurementQualifierCode: $ref: '#/components/schemas/UnitForMeasurementCode' description: 'Code specifying the unit of measurement. For example, `DA` - Days, `MO` - Months, `VS` - Visits, `WK` - Week, and `YR` - Years. Payers may sometimes return other non-compliant values.' type: object EligibilityCheckProviderErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '41' - '43' - '44' - '45' - '46' - '47' - '48' - '50' - '51' - '79' - '97' - T4 type: string ResponseProviderEntityIdentifier: description: 'A code identifying the type of provider. Payers may sometimes return other non-compliant values.' enum: - Provider - Third-Party Administrator - Employer - Hospital - Facility - Gateway Provider - Plan Sponsor - Payer type: string PayerEntityIdentifier: description: 'The entity identifier code for the payer. Payers may sometimes return other non-compliant values.' enum: - Third-Party Administrator - Employer - Gateway Provider - Plan Sponsor - Payer type: string EntityTypeQualifier: description: 'The type of entity. Payers may sometimes return other non-compliant values.' enum: - Person - Non-Person Entity type: string CommunicationMode: description: Payers may sometimes return other non-compliant values. enum: - Electronic Data Interchange Access Number - Electronic Mail - Facsimile - Telephone - Uniform Resource Locator (URL) - Telephone Extension - Work Phone Number type: string AuthOrCertIndicator: description: 'Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values.' enum: - N - U - Y type: string GetInsuranceDiscoveryCheckResponseContent: properties: coveragesFound: description: The number of potential coverage matches for the patient. This will be `0` if Stedi didn't find any matching coverage. type: integer discoveryId: description: A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint. type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array items: description: An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check `status` is `COMPLETE`. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information. items: $ref: '#/components/schemas/InsuranceDiscoveryResponseFields' type: array meta: $ref: '#/components/schemas/InsuranceDiscoveryMetadata' status: $ref: '#/components/schemas/DiscoveryStatus' description: "The status of the discovery check. This is either `PENDING` or `COMPLETE`.\n - If the status is `COMPLETE`, the `items` array will contain any potential coverage matches Stedi found for the patient.\n - If the status is `PENDING`, the check is still in progress. You can immediately begin polling the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint to retrieve the results asynchronously." warnings: description: Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests. items: $ref: '#/components/schemas/Warning' type: array type: object InsuranceTypeCode: description: 'Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values.' enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' - AP - C1 - CO - CP - D - DB - EP - FF - GP - HM - HN - HS - IN - IP - LC - LD - LI - LT - MA - MB - MC - MH - MI - MP - OT - PE - PL - PP - PR - PS - QM - RP - SP - TF - WC - WU type: string InsuranceDiscoveryMetadata: description: Metadata about the response. Stedi uses this data for tracking and troubleshooting. properties: applicationMode: $ref: '#/components/schemas/ApplicationModes' description: 'The type of data in the request. This is always `production`. Payers may sometimes return other non-compliant values.' traceId: description: The unique ID Stedi assigns to this request. type: string type: object securitySchemes: httpApiKeyAuth: description: A [Stedi API Key](https://www.stedi.com/app/settings/api-keys) for authentication. in: header name: Authorization type: apiKey x-stedi: lifecycle: general_availability product: claims public: true