openapi: 3.0.3 info: contact: email: healthcare@stedi.com license: name: Proprietary url: https://stedi.com title: Stedi Healthcare Claims Claim acknowledgments Real-time eligibility check API version: '2025-03-07' servers: - description: Production url: https://claims.us.stedi.com/2025-03-07 security: - httpApiKeyAuth: [] tags: - name: Real-time eligibility check paths: /change/medicalnetwork/eligibility/v3: post: description: Submit a real-time 270/271 eligibility check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/send-eligibility-checks operationId: EligibilityCheck parameters: - in: header name: X-Forwarded-For schema: description: '**(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request''s point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS. When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States. Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples.' type: string requestBody: content: application/json: examples: EligibilityCheck_example1: description: '' summary: Eligibility check value: encounter: serviceTypeCodes: - MH externalPatientId: UAA111222333 provider: npi: '1999999984' organizationName: ACME Health Services subscriber: dateOfBirth: '19000101' firstName: Jane lastName: Doe memberId: '123456789' tradingPartnerServiceId: AHS EligibilityCheck_example2: description: '' summary: Invalid provider name value: provider: npi: '1447848577' organizationName: SIMPSON subscriber: dateOfBirth: '20240606' firstName: Abe lastName: Stedi tradingPartnerServiceId: BS001 schema: $ref: '#/components/schemas/EligibilityCheckRequestContent' required: true responses: '200': content: application/json: examples: EligibilityCheck_example1: description: '' summary: Eligibility check value: benefitsInformation: - additionalInformation: - description: Complete Care Management code: '1' name: Active Coverage planCoverage: Open Access Plus serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.1' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.5' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' serviceTypes: - Psychiatric - Inpatient - Day Care (Psychiatric) - Psychiatric - Outpatient - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Anesthesia - Diagnostic X-Ray - Partial Hospitalization (Psychiatric) - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BC - A4 - A6 - '4' - '22' serviceTypes: - Day Care (Psychiatric) - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y code: CB inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Coverage Basis serviceTypeCodes: - '7' - BB serviceTypes: - Anesthesia - Partial Hospitalization (Psychiatric) - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BB serviceTypes: - Partial Hospitalization (Psychiatric) - additionalInformation: - description: ' Provider is out of network based on NPI ID provided in request.' code: '1' name: Active Coverage serviceTypeCodes: - MH serviceTypes: - Mental Health - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '5760' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '2760' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' controlNumber: '214976898' eligibilitySearchId: 01922a35-a177-7171-b868-cd4974dd54df errors: [] id: ec_550e8400-e29b-41d4-a716-446655440000 meta: applicationMode: production outboundTraceId: 01J2VZA127GH93JT74HJU senderId: 030240928 submitterId: '117151744' traceId: 01J2VZA127GH93JT74HJU payer: contactInformation: contacts: - communicationMode: Telephone communicationNumber: '1234567890' - communicationMode: Uniform Resource Locator (URL) communicationNumber: website.company.com entityIdentifier: Payer entityType: Non-Person Entity federalTaxpayersIdNumber: '123412345' name: ABCDE planDateInformation: eligibilityBegin: '20220102' planBegin: '20240101' planEnd: '20241231' planInformation: groupDescription: ABCDE groupNumber: '12341234' priorIdNumber: '1234567890' planStatus: - planDetails: Open Access Plus serviceTypeCodes: - '30' status: Active Coverage statusCode: '1' - serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' status: Active Coverage statusCode: '1' - serviceTypeCodes: - MH status: Active Coverage statusCode: '1' provider: entityIdentifier: Provider entityType: Non-Person Entity npi: '1999999984' providerName: ACME HEALTH SERVICES reassociationKey: '123456789' subscriber: address: address1: 1234 FIRST ST city: NEW YORK postalCode: '123451111' state: WV dateOfBirth: '19000101' entityIdentifier: Insured or Subscriber entityType: Person firstName: JANE gender: F groupNumber: '123456789' lastName: DOE memberId: '123456789' middleName: A tradingPartnerServiceId: '123456789' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~ schema: $ref: '#/components/schemas/EligibilityCheckResponseContent' description: EligibilityCheck 200 response '400': content: application/json: examples: EligibilityCheck_example2: description: '' summary: Invalid provider name value: controlNumber: 000647813 eligibilitySearchId: 0198afa8-1610-7602-a436-911cb4bf2a9f errors: - code: '44' description: Invalid/Missing Provider Name field: AAA followupAction: Please Correct and Resubmit location: Loop 2100B possibleResolutions: Provider's NPI is registered with incorrect name at the payer. Contact the payer directly using the information in the `payer.contactInformation` object (if available) to resolve the issue. id: ec_650e8400-e29b-41d4-a716-446655440001 meta: applicationMode: test outboundTraceId: 01K2QTG5GGN7SSM34JMHS7QBDZ senderId: STEDI submitterId: '117151744' traceId: 01K2QTG5GGN7SSM34JMHS7QBDZ payer: entityIdentifier: Payer entityType: Non-Person Entity name: '100935' payorIdentification: '100935' planDateInformation: plan: '20240726' provider: aaaErrors: - code: '44' description: Invalid/Missing Provider Name field: AAA followupAction: Please Correct and Resubmit location: Loop 2100B possibleResolutions: Provider's NPI is registered with incorrect name at the payer. Contact the payer directly using the information in the `payer.contactInformation` object (if available) to resolve the issue. entityIdentifier: Provider entityType: Person npi: '1447848577' providerName: SIMPSON reassociationKey: 000647813 subscriber: dateOfBirth: '20240606' entityIdentifier: Insured or Subscriber entityType: Person firstName: ABE lastName: STEDI subscriberTraceNumbers: - originatingCompanyIdentifier: '3117151744' referenceIdentification: 01K2QTG5GJ8K030SK9QDWF5HD9 traceType: Current Transaction Trace Numbers traceTypeCode: '1' tradingPartnerServiceId: BS001 warnings: - code: response::271::invalid_subscriber_insured_id description: '[Subscriber/dependent] ID must use one of these formats: a three character alpha-numeric prefix (no zeros or ones) followed by a maximum of 14 alpha-numeric characters, an `R` followed by exactly 8 numbers, or an `H` followed by exactly 8 or 10 numbers.' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *250815*1734*^*00501*000647813*0*T*:~GS*HB*STEDI*117151744*20250815*173448*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01K2QTG5GGN7SSM34JMHS7QBDZ*20250815*1734~HL*1**20*1~NM1*PR*2*100935*****PI*100935~HL*2*1*21*1~NM1*1P*1*SIMPSON*****XX*1447848577~AAA*N**44*C~HL*3*2*22*0~TRN*1*01K2QTG5GJ8K030SK9QDWF5HD9*3117151744~NM1*IL*1*STEDI*ABE~DMG*D8*20240606~DTP*291*D8*20240726~SE*13*1001~GE*1*1~IEA*1*000647813~ schema: $ref: '#/components/schemas/EligibilityCheck400ErrorResponseContent' description: EligibilityCheck400Error 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: - Real-time eligibility check /change/medicalnetwork/eligibility/v3/raw-x12: post: description: Submit a real-time 270/271 eligibility check in raw X12 EDI format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/send-eligibility-checks operationId: EligibilityRawX12Check parameters: - in: header name: X-Forwarded-For schema: description: '**(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request''s point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS. When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States. Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples.' type: string requestBody: content: application/json: examples: EligibilityRawX12Check_example1: description: '' summary: Eligibility check value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~HL*3*2*22*0~TRN*1*11122-12345*1234567890~NM1*IL*1*JANE*DOE****MI*123456789~DMG*D8*19000101~DTP*291*D8*20240108~EQ*MH~SE*13*1234~GE*1*000000001~IEA*1*000000001~ EligibilityRawX12Check_example2: description: '' summary: X12 EDI parse error value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~SE*8*1234~GE*1*000000001~IEA*1*000000001~ schema: $ref: '#/components/schemas/EligibilityRawX12CheckRequestContent' required: true responses: '200': content: application/json: examples: EligibilityRawX12Check_example1: description: '' summary: Eligibility check value: benefitsInformation: - additionalInformation: - description: Complete Care Management code: '1' name: Active Coverage planCoverage: Open Access Plus serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.1' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.5' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' serviceTypes: - Psychiatric - Inpatient - Day Care (Psychiatric) - Psychiatric - Outpatient - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Anesthesia - Diagnostic X-Ray - Partial Hospitalization (Psychiatric) - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BC - A4 - A6 - '4' - '22' serviceTypes: - Day Care (Psychiatric) - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y code: CB inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Coverage Basis serviceTypeCodes: - '7' - BB serviceTypes: - Anesthesia - Partial Hospitalization (Psychiatric) - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BB serviceTypes: - Partial Hospitalization (Psychiatric) - additionalInformation: - description: ' Provider is out of network based on NPI ID provided in request.' code: '1' name: Active Coverage serviceTypeCodes: - MH serviceTypes: - Mental Health - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '5760' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '2760' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' controlNumber: '1001' eligibilitySearchId: 01922a35-a177-7171-b868-cd4974dd54df errors: [] id: ec_650e8400-e29b-41d4-a716-446655440001 meta: applicationMode: production outboundTraceId: 01J2VZA127GH93JT74HJU senderId: STEDI submitterId: '117151744' traceId: 01J2VZA127GH93JT74HJU payer: contactInformation: contacts: - communicationMode: Telephone communicationNumber: '1234567890' - communicationMode: Uniform Resource Locator (URL) communicationNumber: website.company.com entityIdentifier: Payer entityType: Non-Person Entity federalTaxpayersIdNumber: '123412345' name: ABCDE planDateInformation: eligibilityBegin: '20240102' planBegin: '20240101' planEnd: '20241231' planInformation: groupDescription: ABCDE groupNumber: '12341234' priorIdNumber: '1234567890' planStatus: - planDetails: Open Access Plus serviceTypeCodes: - '30' status: Active Coverage statusCode: '1' - serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' status: Active Coverage statusCode: '1' - serviceTypeCodes: - MH status: Active Coverage statusCode: '1' provider: entityIdentifier: Provider entityType: Non-Person Entity npi: '1999999984' providerName: ACME HEALTH SERVICES reassociationKey: '123456789' subscriber: address: address1: 1234 FIRST ST city: NEW YORK postalCode: '123451111' state: WV dateOfBirth: '19000101' entityIdentifier: Insured or Subscriber entityType: Person firstName: JANE gender: F groupNumber: '123456789' lastName: DOE memberId: '123456789' middleName: A tradingPartnerServiceId: '123456789' x12: ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *111111*1234*^*00501*123456782*0*T*>~GS*HB*RECEIVERGS*SENDERGS*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~ schema: $ref: '#/components/schemas/EligibilityRawX12CheckResponseContent' description: EligibilityRawX12Check 200 response '400': content: application/json: examples: EligibilityRawX12Check_example2: description: '' summary: X12 EDI parse error value: eligibilitySearchId: 0198afb0-0e35-7ed3-bc66-6c387c60f4bb errors: - code: '71' description: 'Parse errors: Loop has fewer than the minimum of 1 items' followupAction: Please Correct and Resubmit location: subscriber_level_HL_loop possibleResolutions: The X12 request could not be parsed. Verify the request is a valid 270 transaction. id: ec_650e8400-e29b-41d4-a716-446655440002 status: ERROR schema: $ref: '#/components/schemas/EligibilityRawX12Check400ErrorResponseContent' description: EligibilityRawX12Check400Error 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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Real-time eligibility check components: schemas: EmploymentStatusCode: description: Payers may sometimes return other non-compliant values. enum: - AE - AO - AS - AT - AU - CC - DD - HD - IR - LX - PE - RE - RM - RR - RU type: string UnitForMeasurement: description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' enum: - Days - Months - Visits - Week - Years type: string DiagnosisTypeCode: description: "The type of diagnosis code you are providing. You can set to `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, `BF`- International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or `ABF`- International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis. \n\n Note that ICD-9 codes are **deprecated** and should no longer be used in eligibility checks." enum: - BK - ABK - BF - ABF type: string AdditionalInformation: properties: description: description: A free-form message containing additional information about the benefits in the response. type: string type: object DtpDate: properties: date: description: A single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 EligibilityRawX12Check400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/RawEligibilityResponseValidationErrors' - $ref: '#/components/schemas/ValidationException' 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 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 EligibilityCheckPayerError: 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 `payer` level include issues with payer enrollment and that the payer's system is down or experiencing issues. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckPayerErrorCode' 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/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 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 BenefitsInformation: 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 benefitsRelatedEntity: $ref: '#/components/schemas/BenefitsRelatedEntity' deprecated: true description: Please use `benefitsInformation[].benefitsRelatedEntities` instead. 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' eligibilityAdditionalInformation: $ref: '#/components/schemas/EligibilityAdditionalInformation' deprecated: true description: Please use `benefitsInformation[].eligibilityAdditionalInformationList` instead. 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 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 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 IndividualRelationshipCode: description: The dependent's relationship to the subscriber. You can set this to `01` - Spouse, `19` - Child, `34` - Other Adult. enum: - '01' - '19' - '34' type: string ResponseSubscriberEntityIdentifier: description: The entity identifier for the subscriber. enum: - Insured or Subscriber type: string 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 RequestProviderCode: enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU type: string 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 PlanDateInformation: description: 'Contains the dates associated with the subscriber and dependents'' (if applicable) insurance plan. This information is used to determine their eligibility for benefits. - Most fields contain a single date, but some can contain either a single date or a date range. Each field''s documentation specifies its format. - Fields that can contain either a single date or date range include: `plan`, `eligibility`, `planBegin`, `admission`, and `service`. - The provided dates apply to every benefit within the patient''s health plan unless specifically noted within a `benefitsInformation[].benefitsDateInformation` object. - If the payer sends back date(s) that are different for the subscriber and dependents, Stedi includes only the dates for the dependent in this object and omits the subscriber''s date(s). Dependents can have different coverage dates than the subscriber due to qualifying life events, such as starting a new job or passing the age limit for coverage through their parent''s plan. - Most payers return either `plan` or `planBegin` and `planEnd`, but the exact dates returned depend on the payer''s discretion and the patient''s insurance plan. - 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.' 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 benefit: deprecated: true 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: deprecated: true description: The benefit begin 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 benefitEnd: deprecated: true description: The benefit end 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 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 completion: deprecated: true 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: deprecated: true 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. 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 latestVisitOrConsultation: deprecated: true description: The latest visit or consultation 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 periodEnd: deprecated: true 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: deprecated: true 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: 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 primaryCareProvider: deprecated: true 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 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 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 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 MedicalProcedureProductOrServiceIDQualifier: description: Code identifying the type/source of the `procedureCode`. You can set this to `AD` - American Dental Association Codes, `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. enum: - AD - CJ - HC - ID - IV - N4 - ZZ type: string RequestSubscriberAddress: description: "Address information for the subscriber. When providing address information:\n - The `address1` and `city` properties are **required** for standard eligibility checks and MBI lookups with SSN. We also recommend including `state` for member identification.\n - When performing an [MBI lookup without SSN](https://www.stedi.com/docs/healthcare/mbi-lookup) (Payer ID: `MBILUNOSSN`), only `state` is required. You can omit `address1` and `city`." properties: address1: description: The first line of the address. Required for all payers except payer ID `MBILUNOSSN`. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. Required for all payers except payer ID `MBILUNOSSN`. 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/RequestStateOrProvinceCode' description: The state or province code. Required for payer ID `MBILUNOSSN`. 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 AdditionalIdentificationSubscriber: description: 'Use this object when you need to provide an identification number other than or in addition to the subscriber''s member ID. For example, you may provide the patient account number. Don''t include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID.' properties: agencyClaimNumber: description: The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer. maxLength: 50 minLength: 1 type: string contractNumber: description: The contract number for an existing contract between the payer and the provider requesting the eligibility check. maxLength: 50 minLength: 1 type: string healthInsuranceClaimNumber: description: The health insurance claim number. maxLength: 50 minLength: 1 type: string identificationCardSerialNumber: description: The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card. maxLength: 50 minLength: 1 type: string insurancePolicyNumber: description: The insurance policy number. maxLength: 50 minLength: 1 type: string medicalRecordIdentificationNumber: description: The medical record identification number. maxLength: 50 minLength: 1 type: string memberIdentificationNumber: description: This property is never used in practice. Supply the subscriber's member ID in `subscriber.memberId`. maxLength: 50 minLength: 1 type: string patientAccountNumber: description: The patient account number. maxLength: 50 minLength: 1 type: string planNetworkIdentificationNumber: description: The plan network identification number. maxLength: 50 minLength: 1 type: string planNumber: description: The insurance plan number. maxLength: 50 minLength: 1 type: string policyNumber: description: The insurance group or policy number. maxLength: 50 minLength: 1 type: string type: object GenderWithUnknown: enum: - M - F - U type: string EligibilityCheckDependentError: 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 `subscriber` or `dependent` level include missing or incorrect identifying information and that the payer was unable to locate the patient in their system. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckDependentErrorCode' 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 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 EligibilityCheckSubscriberErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '78' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA type: string RequestDependentAddress: description: Address information for the dependent. When providing address information, we recommend including `state` for member identification in addition to the required `address1` and `city` properties. 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: $ref: '#/components/schemas/RequestStateOrProvinceCode' description: The state or province code. required: - address1 - city type: object DependentInsuredIndicator: description: Indicates the status of the insured. For the dependent, this is always `N`. enum: - N type: string HealthCareInformation: properties: diagnosisCode: description: The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed. maxLength: 30 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string diagnosisTypeCode: $ref: '#/components/schemas/DiagnosisTypeCode' required: - diagnosisCode - diagnosisTypeCode type: object EligibilityRawX12CheckRequestContent: properties: eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string externalPatientId: description: A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests. maxLength: 36 type: string x12: type: string required: - x12 type: object Encounter: description: 'Details about the eligibility or benefit information you are requesting for the patient. - If you don''t specify either `serviceTypeCodes` or a `procedureCode` and `productOrServiceIDQualifier`, Stedi defaults to using `30` (Plan coverage and general benefits) as the only `serviceTypeCodes` value. - You can specify either a single `dateOfService` or a `beginningDateOfService` and `endDateOfService`. The payer defaults to using the current date in their timezone if you don''t include one. - When checking eligibility for today, omit the `dateOfService` property to ensure consistent behavior across payers. - We recommend submitting dates up to 12 months in the past or up to the end of the current month. Payers aren''t required to support dates outside these ranges. However, some payers such as the Centers for Medicare and Medicaid Services (CMS) do support requests for dates further in the future - especially the next calendar month. Check the payer''s documentation to determine their specific behavior.' properties: beginningDateOfService: description: The beginning date of service. If you include this value, you must also include the `endDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateOfService: description: The date of service. You can use this value to specify a single occasion, such as a doctor's visit. If you don't specify a service date (either a single day or a range of dates), the payer defaults to using the current date in their timezone. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string diagnosisCodePointer: description: Diagnosis code pointers in order of importance to the service. These pointers are an index to the ICD-10 codes you included in the `subscriber.healthCareCodeInformation` or `dependents.healthCareCodeInformation` object arrays. The pointer values can be from 1 - 8 (integer numbers). If you are including diagnosis codes, you **must** set at least one pointer here for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total). Don't put ICD-10 codes here. items: type: string maxItems: 4 minItems: 1 type: array endDateOfService: description: The end date of service. If you include this value, you must also include the `beginningDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string industryCode: $ref: '#/components/schemas/IndustryCode' medicalProcedures: description: Use only when you need to send multiple procedure codes in a single request. Otherwise, use the `encounter.procedureCode` and `encounter.productOrServiceIDQualifier` properties. items: $ref: '#/components/schemas/MedicalProcedure' maxItems: 98 minItems: 1 type: array priorAuthorizationOrReferralNumber: description: The prior authorization or referral number for a particular benefit or procedure. type: string procedureCode: description: The procedure code. maxLength: 48 minLength: 1 type: string procedureModifiers: description: The procedure modifier that provides additional information related to the performance of the service. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/EncounterProductOrServiceIDQualifier' referenceIdentificationQualifier: $ref: '#/components/schemas/EncounterReferenceIdentificationQualifier' serviceTypeCodes: description: 'One or more codes classifying the type of services for which you want to receive benefits information. If you don''t specify a service type code or a `procedureCode` and `productOrServiceIDQualifier`, Stedi defaults to using `30` - Health Benefit Plan Coverage. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#full-stc-list) for a complete list. Not all payers support all service type codes, and not all payers support multiple service type codes in the same request. We recommend including one service type code per request unless you''re sure the payer supports multiple. Payers aren''t required to respond with exactly the same STC(s) in the response, so you may receive benefits information for STCs you didn''t request. However, receiving different STCs can mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support) to determine their support for specific STCs.' items: $ref: '#/components/schemas/RequestEligibilityServiceTypeCode' maxItems: 99 minItems: 1 type: array type: object 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 SubscriberTraceNumber: properties: originatingCompanyIdentifier: description: The identifier of the organization that assigned the trace number. type: string referenceIdentification: description: The unique trace number assigned to the transaction. type: string secondaryReferenceIdentification: description: Identifies a subdivision within the organization that assigned the trace number. type: string traceType: description: The full name of the `traceTypeCode`. For example `Current Transaction Trace Numbers`. type: string traceTypeCode: description: The code that identifies the type of trace number. Can be `1` - Current Transaction Trace Numbers (refers to trace numbers assigned by the payer) or `2` - Referenced Trace Numbers (refers to numbers sent in the original eligibility check request). type: string type: object RequestProviderAddress: description: "Address information for the provider.\n - Only include when specifically instructed by a payer, such as when the provider has multiple locations and you need to identify the specific location making the request.\n - You must include at least the `address1` and `city` properties." 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/RequestStateOrProvinceCode' description: The state or province code. required: - address1 - city 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 RequestDependent: properties: additionalIdentification: $ref: '#/components/schemas/AdditionalIdentificationDependent' address: $ref: '#/components/schemas/RequestDependentAddress' beginningCardIssueDate: description: The date the insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the `endCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string beginningPlanIssueDate: description: The date the insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the `endPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. maxLength: 9 minLength: 1 pattern: ^[0-9]+$ type: string dateOfBirth: description: The dependent's date of birth (DOB). We **strongly recommend** including the DOB in your request. Many payers need this information to identify the patient in their system and will immediately return an error when it's not provided. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string eligibilityCategory: description: The eligibility category for the dependent. maxLength: 50 minLength: 1 type: string endCardIssueDate: description: The date the insurance card expires. Use when you need to specify a date range. Provide the start of the range in the `beginningCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endPlanIssueDate: description: The date the insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the `beginningPlanIssueDate` property. 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: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: Code indicating the dependent's gender. groupNumber: description: The group number for the dependent's insurance plan. maxLength: 50 minLength: 1 type: string healthCareCodeInformation: description: "Information about the dependent's health care diagnosis. You can include up to eight entries in this array. \n\nThe first array entry must have `diagnosisTypeCode` set to `ABK`. All subsequent entries must have `diagnosisTypeCode` set to `ABF`." items: $ref: '#/components/schemas/HealthCareInformation' maxItems: 8 minItems: 1 type: array idCard: description: The dependent's insurance card number. maxLength: 50 minLength: 1 type: string idCardIssueDate: description: The date the insurance card was issued. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string individualRelationshipCode: $ref: '#/components/schemas/IndividualRelationshipCode' issueNumber: description: The issue number for the dependent's insurance policy. maxLength: 50 minLength: 1 type: string lastName: description: The dependent's last name. **Don't** include the dependent's name suffix, such as Jr. or III. Use the designated `suffix` property instead. maxLength: 60 minLength: 1 type: string memberId: deprecated: true description: 'This shape is deprecated: This property is no longer used.' maxLength: 80 minLength: 2 pattern: ^[A-Za-z0-9- ]+$ type: string middleName: description: The dependent's middle name or middle initial. maxLength: 25 minLength: 1 type: string planIssueDate: description: The date the insurance plan begins. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerCode: $ref: '#/components/schemas/RequestDependentProviderCode' providerIdentifier: description: The provider identifier you specified in the `referenceIdentificationQualifier` property. For example, the provider's National Provider ID or Federal Taxpayer Identification number. If you set the `referenceIdentificationQualifier` to `PXC`, then this property should contain the provider's taxonomy code. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string referenceIdentificationQualifier: $ref: '#/components/schemas/RequestDependentReferenceIdentificationQualifier' ssn: description: The dependent's social security number. Don't use this for Federally-administered programs, such as Medicare. pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) suffix: description: The dependent's name suffix, such as Sr. or III. Only include the dependent's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string type: object 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 IndustryCode: description: The type of facility where the service was provided. You can set this to one of the [place of service codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets). enum: - '01' - '02' - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '71' - '72' - '81' - '99' type: string 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 EncounterProductOrServiceIDQualifier: description: Code identifying the type/source of the `procedureCode`. You can set this to `AD` - American Dental Association Codes, `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. enum: - AD - CJ - HC - ID - IV - N4 - ZZ 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 RawEligibilityResponseValidationErrors: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, co-pays, etc.), out of pocket maximums, and more. \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\nThe payer may send benefits information for service type codes (STCs) you didn't request - this is expected. The STC you send in the request tells the payer the types of benefits information you want, but they aren't required to respond with exactly the same STC(s) in the response. Receiving different STCs than you requested can also mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support) to determine their support for specific STCs.\n\nVisit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits) for more information about benefit types, details about how to interpret the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When the patient is a dependent, this array will contain a single object with the patient's information. When the patient is a subscriber, or considered to be a subscriber because they have a unique member ID, their information is returned in the `subscriber` object, and this array will be empty.\n\n When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' 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 id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataRawX12' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. You can also optionally [supply your own trace number](https://www.stedi.com/docs/healthcare/send-eligibility-checks#trn) in a `TRN` segment. Stedi returns its internal trace number in this array as well as the trace numbers from you and the payer (if provided).' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object RequestSubscriber: description: 'The primary policyholder for the insurance plan _or_ a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave `dependents` empty. - At a minimum, our API requires that you supply at least one of these fields in the request: `memberId`, `dateOfBirth`, or `lastName`. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. - When you provide all four of `memberId`, `dateOfBirth`, `firstName`, and `lastName`, payers are required to return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. - We recommend always including the patient''s member ID when possible. - Enter the patient''s name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures.' properties: additionalIdentification: $ref: '#/components/schemas/AdditionalIdentificationSubscriber' address: $ref: '#/components/schemas/RequestSubscriberAddress' beginningCardIssueDate: description: The date the subscriber's insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the `endCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string beginningPlanIssueDate: description: The date the subscriber's insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the `endPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. maxLength: 9 minLength: 1 pattern: ^[0-9]$ type: string caseNumber: description: The case number associated with the subscriber. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string coverageLevelCode: description: This property is no longer used. type: string dateOfBirth: description: The subscriber's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endCardIssueDate: description: The date the subscriber's insurance card expires. Use when you need to specify a date range. Provide the start of the range in the `beginningCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endPlanIssueDate: description: The date the subscriber's insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the `beginningPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The patient's first name. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: Code indicating the subscriber's gender. groupNumber: description: The group number associated with the subscriber's insurance policy. maxLength: 50 minLength: 1 type: string healthCareCodeInformation: description: "Information about the subscriber's health care diagnosis. You can include up to eight entries in this array. \n\nThe first array entry must have `diagnosisTypeCode` set to `ABK`. All subsequent entries must have `diagnosisTypeCode` set to `ABF`." items: $ref: '#/components/schemas/HealthCareInformation' maxItems: 8 minItems: 1 type: array idCard: description: The subscriber's identification card number. Include this property when this number is different than the subscriber's member ID. This is common in Medicaid. maxLength: 50 minLength: 1 type: string idCardIssueDate: description: The date the subscriber's insurance card was issued. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string lastName: description: The subscriber's last name. **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead. maxLength: 60 minLength: 1 type: string medicaidRecipientIdentificationNumber: description: The Medicaid Recipient Identification Number. You can provide this number to identify the subscriber when it is the primary number the payer knows a member by (such as for Medicare or Medicaid). Do not supply this value unless it is different from the `memberId`. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string memberId: description: The member ID for the subscriber's insurance policy. maxLength: 80 minLength: 2 pattern: ^[A-Za-z0-9- ]+$ type: string middleName: description: The patient's middle name or middle initial. maxLength: 25 minLength: 1 type: string planIssueDate: description: The date the subscriber's insurance plan begins. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerCode: $ref: '#/components/schemas/RequestSubscriberProviderCode' providerIdentifier: description: "The provider identifier you specified in the `referenceIdentificationQualifier` property. It is **required** if you set the `referenceIdentificationQualifier`. For example, this property could contain the provider's National Provider ID or Federal Taxpayer Identification number.\n\n If you set the `referenceIdentificationQualifier` to `PXC`, then this property should contain the provider's taxonomy code." maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string referenceIdentificationQualifier: $ref: '#/components/schemas/RequestSubscriberReferenceIdentificationQualifier' spendDownAmount: description: Identify the dollar amount the subscriber will apply toward their spend down amount, if required. For some Medicaid programs, individuals must pay a certain amount towards their healthcare cost (spend down) before coverage starts. maxLength: 15 minLength: 1 type: string spendDownTotalBilledAmount: description: The subscriber's spend down total billed amount. maxLength: 15 minLength: 1 type: string ssn: description: The subscriber's Social Security Number (SSN). Many commercial and government payers ignore this property due to concerns about member privacy. However, some Medicaid programs support alternative searches using the patient's Social Security Number, instead of the member ID. pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) suffix: description: The name suffix, such as Jr., Sr., or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string type: object 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 EligibilityCheckSubscriberError: 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 `subscriber` or `dependent` level include missing or incorrect identifying information and that the payer was unable to locate the patient in their system. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckSubscriberErrorCode' 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 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 AdditionalIdentificationDependent: description: Use this object when you need to provide an additional identification number for the dependent. This is rarely required for standard eligibility checks. properties: agencyClaimNumber: description: The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer. maxLength: 50 minLength: 1 type: string contractNumber: description: The contract number for an existing contract between the payer and the provider requesting the eligibility check. maxLength: 50 minLength: 1 type: string healthInsuranceClaimNumber: description: This property is never used in practice. maxLength: 50 minLength: 1 type: string identificationCardSerialNumber: description: The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card. maxLength: 50 minLength: 1 type: string insurancePolicyNumber: description: The insurance policy number. maxLength: 50 minLength: 1 type: string medicalRecordIdentificationNumber: description: The medical record identification number. maxLength: 50 minLength: 1 type: string memberIdentificationNumber: description: 'Not intended for most use cases. Only set this when the property and casualty patient identifier is a member ID that would be used in an 837 claim submission. If the patient has their own member ID for the health plan, you should identify them in the `subscriber` object. If the patient doesn''t have their own member ID, don''t set this property.' maxLength: 50 minLength: 1 type: string patientAccountNumber: description: The patient account number. maxLength: 50 minLength: 1 type: string planNetworkIdentificationNumber: description: The plan network identification number. maxLength: 50 minLength: 1 type: string planNumber: description: The insurance plan number. maxLength: 50 minLength: 1 type: string policyNumber: description: The insurance group or policy number. maxLength: 50 minLength: 1 type: string type: object RequestDependentProviderCode: description: "Use this for providers that are not requesting the eligibility check - the requestor is specified in the `provider` object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role. \n\n You can use one of the following: `AD` - Admitting, `AT` - Attending, `BI` - Billing, `CO` - Consulting, `CV` - Covering, `H` - Hospital, `HH` - Home Health Care, `LA` - Laboratory, `OT` - Other Physician, `P1` - Pharmacist, `P2` - Pharmacy, `PC` - Primary Care Physician, `PE`- Performing, `R`- Rural Health Clinic, `RF` - Referring, `SB` - Submitting, `SK` - Skilled Nursing Facility, `SU` - Supervising" enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU type: string PlanStatus: deprecated: true properties: planDetails: deprecated: true type: string serviceTypeCodes: deprecated: true 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 status: deprecated: true type: string statusCode: deprecated: true type: string type: object 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 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 RequestEligibilityServiceTypeCode: 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 type: string Payer: description: Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer's tax ID. Most payers also include contact information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckPayerError' type: array 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.' employersId: deprecated: true description: 'Deprecated; The payer''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/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 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 EligibilityCheckOutputValidationErrors: properties: controlNumber: deprecated: true description: An identifier for the payer's response. type: string eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' 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 id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataJSON' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. Stedi returns both its internal trace number and the payer''s trace number (if present) in this array. You can''t set your own trace number when submitting eligibility checks through this endpoint.' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object 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 MedicalProcedure: properties: diagnosisCodePointer: description: The diagnosis code pointer. items: type: string maxItems: 4 minItems: 1 type: array procedureCode: description: The procedure code. maxLength: 48 minLength: 1 type: string procedureModifiers: description: Procedure modifiers that provide additional information related to the service. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/MedicalProcedureProductOrServiceIDQualifier' required: - procedureCode - productOrServiceIDQualifier type: object SubscriberRelationship: description: The name of the `relationToSubscriberCode`. For the subscriber, this is always `Self`. enum: - Self type: string EncounterReferenceIdentificationQualifier: description: The type of information you provided in the `priorAuthorizationOrReferralNumber` property. You can set this to `9F` - Referral Number or `G1` - Prior Authorization Number. enum: - 9F - G1 type: string QuantityQualifierCode: description: 'Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values.' enum: - 8H - '99' - CA - CE - D3 - DB - DY - HS - LA - LE - M2 - MN - P6 - QA - S7 - S8 - VS - YY type: string BenefitsDateInformation: description: "Dates associated with the benefits.\n - This is where you can find benefit-specific eligibility dates, if provided. These dates override dates provided in `planDateInformation` for this benefit type.\n - This is where the payer may specify the last time the service was rendered (`latestVisitOrConsultation`), which you can use to determine whether the patient has already reached the allowed frequency, if applicable. For example, this object could contain the date when the patient received their last dental cleaning.\n - These dates only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided." properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ 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 EligibilityMetaDataRawX12: 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 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.' billerId: description: The biller ID Stedi assigns to this request. type: string outboundTraceId: description: The transaction identifier in the request's `BHT03` element. This identifier isn't guaranteed to be globally unique. We recommend using the `id` property to identify and track eligibility checks instead. type: string senderId: description: The sender ID Stedi assigns to this request. type: string submitterId: description: The submitter ID Stedi assigns to this request. type: string traceId: description: The transaction identifier in the response's `BHT03` element. This should be the same as the `outboundTraceId`. type: string type: object RequestStateOrProvinceCode: description: The US state or Canadian province code. For example, `TN` for Tennessee or `NB` for New Brunswick. 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 ProviderType: description: Identify the type of provider. enum: - payer - third-party administrator - employer - hospital - facility - gateway provider - plan sponsor - provider type: string 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 ResponseDependent: description: Information about the dependent listed in the original eligibility check request. Note that a dependent submitted in the request may be returned in the subscriber object. When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckDependentError' type: array 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 ValidationException: description: 'A standard error for input validation failures. This should be thrown by services when a member of the input structure falls outside of the modeled or documented constraints.' properties: fieldList: description: 'A list of specific failures encountered while validating the input. A member can appear in this list more than once if it failed to satisfy multiple constraints.' items: $ref: '#/components/schemas/ValidationExceptionField' type: array message: description: A summary of the validation failure. type: string required: - message title: ValidationException type: object 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 ResponseSubscriber: description: Information about the primary policyholder for the insurance plan listed in the original eligibility check request. The response will always include either the subscriber's name or member ID for identification, but most payers will also return the subscriber's date of birth and other identifying information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckSubscriberError' type: array 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 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 EligibilityCheckPayerErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '04' - '41' - '42' - '79' - '80' - T4 type: string 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 EligibilityCheckResponseContent: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, co-pays, etc.), out of pocket maximums, and more. \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\nThe payer may send benefits information for service type codes (STCs) you didn't request - this is expected. The STC you send in the request tells the payer the types of benefits information you want, but they aren't required to respond with exactly the same STC(s) in the response. Receiving different STCs than you requested can also mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support) to determine their support for specific STCs.\n\nVisit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits) for more information about benefit types, details about how to interpret the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When the patient is a dependent, this array will contain a single object with the patient's information. When the patient is a subscriber, or considered to be a subscriber because they have a unique member ID, their information is returned in the `subscriber` object, and this array will be empty.\n\n When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' 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 id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataJSON' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. Stedi returns both its internal trace number and the payer''s trace number (if present) in this array. You can''t set your own trace number when submitting eligibility checks through this endpoint.' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object RequestSubscriberProviderCode: description: "Use this for providers that are not requesting the eligibility check - the requestor is specified in the `provider` object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role. \n\n This property is **required** when the `providerIdentifier` and `referenceIdentificationQualifier` properties are populated. \n\n You can use one of the following: `AD` - Admitting, `AT` - Attending, `BI` - Billing, `CO` - Consulting, `CV` - Covering, `H` - Hospital, `HH` - Home Health Care, `LA` - Laboratory, `OT` - Other Physician, `P1` - Pharmacist, `P2` - Pharmacy, `PC` - Primary Care Physician, `PE` - Performing, `R` - Rural Health Clinic, `RF` - Referring, `SB` - Submitting, `SK` - Skilled Nursing Facility, `SU` - Supervising" enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU type: string 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 ValidationExceptionField: description: Describes one specific validation failure for an input member. properties: message: description: A detailed description of the validation failure. type: string path: description: A JSONPointer expression to the structure member whose value failed to satisfy the modeled constraints. type: string required: - message - path 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 EligibilityMetaDataJSON: 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 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.' billerId: description: The biller ID Stedi assigns to this request. type: string outboundTraceId: description: 'A unique identifier Stedi assigns to this check. Instead of this property, we recommend using `id` to identify and track eligibility checks. An eligibility check''s `id` is guaranteed to be globally unique, and you can use it to deep link to the eligibility check''s results within the Stedi portal.' type: string senderId: description: The sender ID Stedi assigns to this request. type: string submitterId: description: The submitter ID Stedi assigns to this request. type: string traceId: description: The transaction identifier the payer sends in the response. This should be the same as the `outboundTraceId`. type: string type: object 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 EligibilityCheckRequestContent: properties: controlNumber: deprecated: true description: Stedi generates a control number for each eligibility check, so you don’t need to include this property in your request. maxLength: 9 minLength: 9 type: string dependents: description: 'A dependent for which you want to retrieve benefits information. - You can only submit one dependent per eligibility check. - Only include the patient''s information here when they are listed as a dependent on the subscriber''s insurance plan AND the payer cannot uniquely identify them through information outside the subscriber''s policy. For example, if the dependent has their own member ID number, you should identify them in the `subscriber` object instead. This includes member IDs that differ only by a suffix, such as `01`, because the patient can still be uniquely identified. - Most Medicaid plans don''t support dependents, with a [few exceptions](https://www.stedi.com/docs/healthcare/send-eligibility-checks#medicaid-dependents). Sending this array to payers that don''t support dependents will either cause an error, or the payer may ignore the information and return results for the subscriber instead. - Each payer has different requirements, so you should supply the fields necessary for each payer to identify the dependent in their system. However, we **strongly recommend** including the dependent''s date of birth in the request when available because many payers return errors without it. - Enter the patient''s name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures.' items: $ref: '#/components/schemas/RequestDependent' maxItems: 1 minItems: 1 type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string encounter: $ref: '#/components/schemas/Encounter' externalPatientId: description: A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests. maxLength: 36 type: string informationReceiverName: $ref: '#/components/schemas/InformationReceiverName' deprecated: true description: Use the corresponding properties in the `provider` object instead. portalPassword: description: The password that the provider uses to log in to the payer's portal. For payers Medicaid California, AltaMed, and Kern Family Health Care, this property is **required** and should be the [provider's PIN](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#portal-credentials). Otherwise, this is not commonly used. maxLength: 50 minLength: 1 type: string portalUsername: description: The username that the provider uses to log in to the payer's portal. This is not commonly used. maxLength: 50 minLength: 1 type: string provider: $ref: '#/components/schemas/Provider' description: "Information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider.\n - You must provide the `organizationName` (if the entity is an organization), or `firstName` and `lastName` (if the provider is an individual).\n - You must also provide an identifier - this is typically the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier) (`npi`). If the provider doesn't have an NPI, you can supply an alternative, such as their `taxId` or `ssn`.\n - Don't include additional properties, such as `taxId` or `address`, unless they are specifically required or suggested by the payer." submitterTransactionIdentifier: description: This property is only relevant for asynchronous batch eligibility checks. type: string subscriber: $ref: '#/components/schemas/RequestSubscriber' tradingPartnerName: description: The payer's name, such as Cigna or Aetna. maxLength: 60 minLength: 1 type: string tradingPartnerServiceId: description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list.\n - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.\n - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`." maxLength: 80 minLength: 1 type: string required: - provider - subscriber - tradingPartnerServiceId type: object EligibilityCheckDependentErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '77' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA type: string RequestDependentReferenceIdentificationQualifier: description: "The type of `providerIdentifier` you are using. Use for providers that are not requesting the eligibility check, such as the referring provider.\n- Set to `HPI` when the National Provider ID is mandated for use.\n- Set to `PXC` if you're identifying a type of specialty associated with services provided to the dependent. \n \n Otherwise, you can set to the following: `9K` - Servicer, `D3` - National Council for Prescription Drug Programs Pharmacy Number, `EI` - Employer's Identification Number, `HPI` - Centers for Medicare and Medicaid Services National Provider Identifier, `PXC` - Health Care Provider Taxonomy Code, `SY` - Social Security Number, `TJ` - Federal Taxpayer's Identification Number" enum: - 9K - D3 - EI - HPI - PXC - SY - TJ 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 InformationReceiverName: deprecated: true properties: address: $ref: '#/components/schemas/RequestProviderAddress' deprecated: true contactNumber: deprecated: true maxLength: 50 minLength: 1 type: string contractNumber: deprecated: true maxLength: 50 minLength: 1 type: string devicePinNumber: deprecated: true maxLength: 50 minLength: 1 type: string facilityIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string facilityNetworkIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string federalTaxpayerIdentificationNumber: deprecated: true maxLength: 50 minLength: 1 type: string informationReceiverAdditionalIdentifierState: deprecated: true maxLength: 80 minLength: 1 type: string medicaidProviderNumber: deprecated: true description: The provider's Medicaid provider number. maxLength: 50 minLength: 1 type: string medicareProviderNumber: deprecated: true maxLength: 50 minLength: 1 type: string nationalProviderIdentifier: deprecated: true maxLength: 50 minLength: 1 type: string x-meta: title: National Provider Identifier (NPI) priorIdentifierNumber: deprecated: true maxLength: 50 minLength: 1 type: string providerPlanNetworkIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string socialSecurityNumber: deprecated: true maxLength: 50 minLength: 1 type: string x-meta: title: Social Security Number (SSN) stateLicenceNumber: deprecated: true maxLength: 50 minLength: 1 type: string submitterIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string type: object RequestSubscriberReferenceIdentificationQualifier: description: "Use this for providers that are not requesting the eligibility check. This is the type of `providerIdentifier` you are providing.\n- Set to `HPI` when the National Provider ID is mandated for use.\n- Set to `PXC` if you're identifying a type of specialty associated with services provided to the subscriber. \n \n Otherwise, you can set to the following: `9K` - Servicer, `D3` - National Council for Prescription Drug Programs Pharmacy Number, `EI` - Employer's Identification Number, `HPI` - Centers for Medicare and Medicaid Services National Provider Identifier, `PXC` - Health Care Provider Taxonomy Code, `SY - Social Security Number, `TJ` - Federal Taxpayer's Identification Number" enum: - 9K - D3 - EI - HPI - PXC - SY - TJ 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 Provider: description: "Information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider.\n - You must provide the `organizationName` (if the entity is an organization), or `firstName` and `lastName` (if the provider is an individual).\n - You must also provide an identifier - this is typically the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier) (`npi`). If the provider doesn't have an NPI, you can supply an alternative, such as their `taxId` or `ssn`.\n - Don't include additional properties, such as `taxId` or `address`, unless they are specifically required or suggested by the payer." properties: address: $ref: '#/components/schemas/RequestProviderAddress' contactNumber: deprecated: true description: 'The provider''s contract number. Only include when required by a payer. This shape is deprecated: Use `contractNumber` instead.' maxLength: 50 minLength: 1 type: string contractNumber: description: The provider's contract number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string devicePinNumber: description: The provider's electronic device pin number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string employersId: deprecated: true description: 'Deprecated; The submitter''s Employer''s Identification Number (EIN). Only use when an employer is checking the eligibility and benefits of their employees. This shape is deprecated: This property is no longer used.' maxLength: 80 minLength: 2 type: string facilityIdNumber: description: The ID number for the provider's facility. Only include when required by a payer. maxLength: 50 minLength: 1 type: string facilityNetworkIdNumber: description: The provider's facility network identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string firstName: description: The provider's first name. This property is required if the provider is an individual. maxLength: 35 minLength: 1 type: string informationReceiverAdditionalIdentifierState: description: The two-character state ID of the state that assigned the `stateLicenseNumber`. Only include when required by a payer. maxLength: 80 minLength: 1 type: string lastName: description: The provider's last name. This property is required if the provider is an individual. maxLength: 60 minLength: 1 type: string medicaidProviderNumber: description: The provider's Medicaid provider number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string medicareProviderNumber: description: The provider's Medicare provider number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). This identifier is required for all healthcare providers who are eligible to receive an NPI. Some non-traditional providers such as transportation services, durable medical equipment (DME) suppliers, or alternative medicine practitioners are not eligible to receive an NPI. If the provider doesn't have an NPI, requests with alternate IDs are virtually never supported. In the rare circumstance that a payer has instructed you to use an alternate ID, the payer will typically require you to supply either their `taxId` or `ssn` instead. pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) organizationName: description: The provider's business name. This property is required if the provider is not an individual. maxLength: 60 minLength: 1 type: string payorId: description: Only used for payer-to-payer transactions, which are not currently supported. Do not use. maxLength: 80 minLength: 2 type: string pharmacyProcessorNumber: description: The provider's pharmacy processor number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. maxLength: 80 minLength: 2 type: string priorIdentifierNumber: description: The provider's prior identifier number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string providerCode: $ref: '#/components/schemas/RequestProviderCode' description: Communicate the provider's role in the type of benefits specified in the request. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Only include when required by a payer. providerPlanNetworkIdNumber: description: The provider's plan network identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string providerType: $ref: '#/components/schemas/ProviderType' referenceIdentification: description: The provider's [Taxonomy Code](https://x12.org/codes/provider-taxonomy-codes). Only used when the provider's taxonomy code is relevant to the eligibility/benefit inquiry. For example, an institutional provider such as a hospital may need to use a taxonomy code to specify a specific unit or department. type: string serviceProviderNumber: description: The provider's service provider number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. maxLength: 80 minLength: 2 type: string servicesPlanID: deprecated: true maxLength: 80 minLength: 2 type: string ssn: description: "The provider's Social Security Number (SSN).\n - Only include when specifically instructed by a payer - for example, if the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.\n - If the payer has instructed you to send an EIN but the provider operates using their SSN, use provider.taxId instead of this field.\n - Don't use this for Federally-administered programs, such as Medicare." pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) stateLicenceNumber: description: The provider's state license number. If you include this information, you must also include the `informationReceiverAdditionalIdentifierState`. Only include when required by a payer. maxLength: 50 minLength: 1 type: string submitterIdNumber: description: The provider's submitter identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string taxId: description: The provider's Federal Taxpayer Identification Number. This is typically the provider's EIN (Employer Identification Number), but the provider's SSN may be used if the provider does not have an EIN. Only include if required by the payer. pattern: ^\d{9}$ type: string type: object 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 EligibilityCheck400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/EligibilityCheckOutputValidationErrors' - $ref: '#/components/schemas/ValidationException' 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 EligibilityRawX12CheckResponseContent: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, co-pays, etc.), out of pocket maximums, and more. \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\nThe payer may send benefits information for service type codes (STCs) you didn't request - this is expected. The STC you send in the request tells the payer the types of benefits information you want, but they aren't required to respond with exactly the same STC(s) in the response. Receiving different STCs than you requested can also mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support) to determine their support for specific STCs.\n\nVisit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits) for more information about benefit types, details about how to interpret the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When the patient is a dependent, this array will contain a single object with the patient's information. When the patient is a subscriber, or considered to be a subscriber because they have a unique member ID, their information is returned in the `subscriber` object, and this array will be empty.\n\n When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' 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 id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataRawX12' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. You can also optionally [supply your own trace number](https://www.stedi.com/docs/healthcare/send-eligibility-checks#trn) in a `TRN` segment. Stedi returns its internal trace number in this array as well as the trace numbers from you and the payer (if provided).' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' 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