---
title: "POST /api/eligibility/v3"
method: POST
path: "/api/eligibility/v3"
---

# POST /api/eligibility/v3

`POST /api/eligibility/v3`

Provides real-time access to patient eligibility benefits information, including procedure-specific benefits and optional coordination of benefits (COB) check.

## Request body

- object
  - `patientFirstName` string, required — Patient first name
  - `patientLastName` string, required — Patient last name
  - `patientDOB` string, required — Patient Date of Birth, formatted as MM-DD-YYYY
  - `patientMemberId` string, required — Member ID of patient's insurance policy
  - `dateOfCoverage` string, required — Date to request coverage information. Formatted as MM-DD-YYYY
  - `payerId` string, required — Payer ID. Can be found under the enrollments page in the platform, or the [Fetch Enrollments](../fetch-enrollments) API
  - `providerId` string, required — Provider ID. Can be found by copying the enrollment ID in the enrollments page in the platform, or the [Fetch Enrollments](../fetch-enrollments) API
  - `mockRequest` boolean — Optional flag to only return mock data
  - `serviceTypeCodes` string[] — Service type codes to request coverage information for
  - `procedureCodes` string[] — CPT or CDT codes to check coverage for
  - `procedureCodesType` 'CPT' | 'CDT' — Type of procedure codes being provided. Must be either 'CPT' or 'CDT'
  - `runCobCheck` boolean — Whether to run a coordination of benefits check

## Response `200`

Eligibility check successful

- object
  - `payerName` string — Name of the insurance payer
  - `status` 'Active Coverage' | 'Inactive' — Coverage status
  - `memberId` string — Member ID of the subscriber
  - `groupName` string — Group name from the plan
  - `groupNumber` string — Group number from the plan
  - `insuranceType` string — Type of insurance (e.g. PPO, HMO)
  - `planName` string — Name of the plan
  - `effectiveDateRange` object, nullable — Effective date range of the plan
    - `start` string — Start date (YYYY-MM-DD)
    - `end` string — End date (YYYY-MM-DD)
  - `eligibilityBeginDate` string — Eligibility begin date (YYYY-MM-DD)
  - `dependents` EligibilityDependent[] — Dependent details when the policy is mapped from a family member
    - `firstName` string — Dependent first name
    - `lastName` string — Dependent last name
    - `middleName` string — Dependent middle name
    - `dateOfBirth` string — Dependent date of birth
    - `relationToSubscriber` string — Relationship to subscriber (e.g. Spouse, Child)
    - `relationToSubscriberCode` string — X12 code for relationship to subscriber
    - `groupNumber` string — Group number for the dependent
    - `address` object
      - `address1` string
      - `city` string
      - `state` string
      - `postalCode` string
    - `gender` string — Dependent gender
    - `insuredIndicator` string — Whether the dependent is the insured
    - `maintenanceTypeCode` string — Maintenance type code
    - `maintenanceReasonCode` string — Maintenance reason code
  - `response` object — Map of service type codes to benefit information
  - `message` string — Overall message about the eligibility check
  - `cob` object — Coordination of benefits information, only present if runCobCheck was true
    - `cobCode` string — Code indicating the type of coordination of benefits
    - `requestedPlanBenefits` object[] — Information about the requested plan benefits
      - `payerName` string — Name of the payer
      - `serviceTypeCodes` object[] — Service type codes and their descriptions
        - `code` string — Service type code
        - `name` string — Description of the service type
      - `benefitDate` object
        - `planStartDate` string — Start date of the plan
    - `additionalPlanBenefitInfo` object[] — Additional information about plan benefits
      - `payerName` string — Name of the payer
      - `payerPrimacy` string — Indicates if this is the primary or secondary payer
      - `serviceTypeCodes` object[] — Service type codes and their descriptions
        - `code` string — Service type code
        - `name` string — Description of the service type
      - `benefitDate` object
        - `overlapBeginDate` string — Start date of benefit overlap
        - `overlapEndDate` string — End date of benefit overlap
        - `planStartDate` string — Start date of the plan
        - `planEndDate` string — End date of the plan
        - `coordinationOfBenefits` string — Coordination of benefits date
      - `subscriber` object
        - `firstName` string — Subscriber's first name
        - `lastName` string — Subscriber's last name
        - `dateOfBirth` string — Subscriber's date of birth
        - `memberId` string — Subscriber's member ID

## Other responses

- `400` — Invalid request body or validation error
- `401` — Unauthorized access or invalid organization ID
- `500` — Server error or provider/payer enrollment issue

---

[API](https://skmtc.net/cairhealth/apis/cair-health-apis.md) · [All operations](https://skmtc.net/cairhealth/apis/cair-health-apis/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/cairhealth/cair-health-apis/revisions/dfc60069747b/schema)