v2
latestOpenAPI 3.0.02026-07-2632977728.5 KBBilling
Retrieve an existing past eligibility check
get/api/eligibility_checks/{id}
Path parameters
idstring required
Query parameters
appointmentinteger
appointment_datestring
doctorinteger
query_date_rangestring
appointment_date_rangestring
query_datestring
patientinteger
Response
OK
coverage_subscriberstring
A variable size object containing subscriber information, if returned by the clearinghouse that ran the eligibility check
appointmentstring
eligibilitystring
| Value | Description |
|---|---|
| '1' | Active Coverage |
| '2' | Active - Full Risk Capitation |
| '3' | Active - Services Capitated |
| '4' | Active - Services Capitated to Primary Care Physician |
| '5' | Active - Pending Investigation |
| '6' | Inactive |
| '7' | Inactive - Pending Eligibility Update |
| '8' | Inactive - Pending Investigation |
| 'A' | Co-Insurance |
| 'B' | Co-Payment |
| 'C' | Deductible |
| 'CB' | Coverage Basis |
| 'D' | Benefit Description |
| 'E' | Exclusions |
| 'F' | Limitations |
| 'G' | Out of Pocket (Stop Loss) |
| 'H' | Unlimited |
| 'I' | Non-Covered |
| 'J' | Cost Containment |
| 'K' | Reserve |
| 'L' | Primary Care Provider |
| 'M' | Pre-existing Condition |
| 'MC' | Managed Care Coordinator |
| 'N' | Services Restricted to Following Provider |
| 'O' | Not Deemed a Medical Necessity |
| 'P' | Benefit Disclaimer |
| 'Q' | Second Surgical Opinion Required |
| 'R' | Other or Additional Payor |
| 'S' | Prior Year(s) History |
| 'T' | Card(s) Reported Lost/Stolen |
| 'U' | Contact Following Entity for Eligibility or Benefit Information |
| 'V' | Cannot Process |
| 'W' | Other Source of Data |
| 'X' | Health Care Facility |
| 'Y' | Spend Down |
payer_namestring
The name of the payer as returned by the clearinghouse that ran the eligibility check
coverage_detailsstring
A variable size object containing the details of the eligibility check, if returned by the clearinghouse that ran the eligibility check
updated_atstring
Timestamp of most recent record update
query_datestring
The time at which the request was made
service_type_descriptionstring
patientstring
request_service_type'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'
| Value | Description |
|---|---|
| '1' | Medical Care |
| '2' | Surgical |
| '3' | Consultation |
| '4' | Diagnostic X-Ray |
| '5' | Diagnostic Lab |
| '6' | Radiation Therapy |
| '7' | Anesthesia |
| '8' | Surgical Assistance |
| '9' | Other Medical |
| '10' | Blood Charges |
| '11' | Used Durable Medical Equipment |
| '12' | Durable Medical Equipment Purchase |
| '13' | Ambulatory Service Center Facility |
| '14' | Renal Supplies in the Home |
| '15' | Alternate Method Dialysis |
| '16' | Chronic Renal Disease (CRD) Equipment |
| '17' | Pre-Admission Testing |
| '18' | Durable Medical Equipment Rental |
| '19' | Pneumonia Vaccine |
| '20' | Second Surgical Opinion |
| '21' | Third Surgical Opinion |
| '22' | Social Work |
| '23' | Diagnostic Dental |
| '24' | Periodontics |
| '25' | Restorative |
| '26' | Endodontics |
| '27' | Maxillofacial Prosthetics |
| '28' | Adjunctive Dental Services |
| '30' | Health Benefit Plan Coverage |
| '32' | Plan Waiting Period |
| '33' | Chiropractic |
| '34' | Chiropractic Office Visits |
| '35' | Dental Care |
| '36' | Dental Crowns |
| '37' | Dental Accident |
| '38' | Orthodontics |
| '39' | Prosthodontics |
| '40' | Oral Surgery |
| '41' | Routine (Preventive) Dental |
| '42' | Home Health Care |
| '43' | Home Health Prescriptions |
| '44' | Home Health Visits |
| '45' | Hospice |
| '46' | Respite Care |
| '47' | Hospital |
| '48' | Hospital - Inpatient |
| '49' | Hospital - Room and Board |
| '50' | Hospital - Outpatient |
| '51' | Hospital - Emergency Accident |
| '52' | Hospital - Emergency Medical |
| '53' | Hospital - Ambulatory Surgical |
| '54' | Long Term Care |
| '55' | Major Medical |
| '56' | Medically Related Transportation |
| '57' | Air Transportation |
| '58' | Cabulance |
| '59' | Licensed Ambulance |
| '60' | General Benefits |
| '61' | In-vitro Fertilization |
| '62' | MRI/CAT Scan |
| '63' | Donor Procedures |
| '64' | Acupuncture |
| '65' | Newborn Care |
| '66' | Pathology |
| '67' | Smoking Cessation |
| '68' | Well Baby Care |
| '69' | Maternity |
| '70' | Transplants |
| '71' | Audiology Exam |
| '72' | Inhalation Therapy |
| '73' | Diagnostic Medical |
| '74' | Private Duty Nursing |
| '75' | Prosthetic Device |
| '76' | Dialysis |
| '77' | Otological Exam |
| '78' | Chemotherapy |
| '79' | Allergy Testing |
| '80' | Immunizations |
| '81' | Routine Physical |
| '82' | Family Planning |
| '83' | Infertility |
| '84' | Abortion |
| '85' | AIDS |
| '86' | Emergency Services |
| '87' | Cancer |
| '88' | Pharmacy |
| '89' | Free Standing Prescription Drug |
| '90' | Mail Order Prescription Drug |
| '91' | Brand Name Prescription Drug |
| '92' | Generic Prescription Drug |
| '93' | Podiatry |
| '94' | Podiatry - Office Visits |
| '95' | Podiatry - Nursing Home Visits |
| '96' | Professional (Physician) |
| '97' | Anesthesiologist |
| '98' | Professional (Physician) Visit - Office |
| '99' | Professional (Physician) Visit - Inpatient |
| 'A0' | Professional (Physician) Visit - Outpatient |
| 'A1' | Professional (Physician) Visit - Nursing Home |
| 'A2' | Professional (Physician) Visit - Skilled Nursing Facility |
| 'A3' | Professional (Physician) Visit - Home |
| 'A4' | Psychiatric |
| 'A5' | Psychiatric - Room and Board |
| 'A6' | Psychotherapy |
| 'A7' | Psychiatric - Inpatient |
| 'A8' | Psychiatric - Outpatient |
| 'A9' | Rehabilitation |
| 'AA' | Rehabilitation - Room and Board |
| 'AB' | Rehabilitation - Inpatient |
| 'AC' | Rehabilitation - Outpatient |
| 'AD' | Occupational Therapy |
| 'AE' | Physical Medicine |
| 'AF' | Speech Therapy |
| 'AG' | Skilled Nursing Care |
| 'AH' | Skilled Nursing Care - Room and Board |
| 'AI' | Substance Abuse |
| 'AJ' | Alcoholism |
| 'AK' | Drug Addiction |
| 'AL' | Vision (Optometry) |
| 'AM' | Frames |
| 'AN' | Routine Exam |
| 'AO' | Lenses |
| 'AQ' | Nonmedically Necessary Physical |
| 'AR' | Experimental Drug Therapy |
| 'B1' | Burn Care |
| 'B2' | Brand Name Prescription Drug - Formulary |
| 'B3' | Brand Name Prescription Drug - Non-Formulary |
| 'BA' | Independent Medical Evaluation |
| 'BB' | Partial Hospitalization (Psychiatric) |
| 'BC' | Day Care (Psychiatric) |
| 'BD' | Cognitive Therapy |
| 'BE' | Massage Therapy |
| 'BF' | Pulmonary Rehabilitation |
| 'BG' | Cardiac Rehabilitation |
| 'BH' | Pediatric |
| 'BI' | Nursery |
| 'BJ' | Skin |
| 'BK' | Orthopedic |
| 'BL' | Cardiac |
| 'BM' | Lymphatic |
| 'BN' | Gastrointestinal |
| 'BP' | Endocrine |
| 'BQ' | Neurology |
| 'BR' | Eye |
| 'BS' | Invasive Procedures |
| 'BT' | Gynecological |
| 'BU' | Obstetrical |
| 'BV' | Obstetrical/Gynecological |
| 'BW' | Mail Order Prescription Drug: Brand Name |
| 'BX' | Mail Order Prescription Drug: Generic |
| 'BY' | Physician Visit - Office: Sick |
| 'BZ' | Physician Visit - Office: Well |
| 'C1' | Coronary Care |
| 'CA' | Private Duty Nursing - Inpatient |
| 'CB' | Private Duty Nursing - Home |
| 'CC' | Surgical Benefits - Professional (Physician) |
| 'CD' | Surgical Benefits - Facility |
| 'CE' | Mental Health Provider - Inpatient |
| 'CF' | Mental Health Provider - Outpatient |
| 'CG' | Mental Health Facility - Inpatient |
| 'CH' | Mental Health Facility - Outpatient |
| 'CI' | Substance Abuse Facility - Inpatient |
| 'CJ' | Substance Abuse Facility - Outpatient |
| 'CK' | Screening X-ray |
| 'CL' | Screening laboratory |
| 'CM' | Mammogram, High Risk Patient |
| 'CN' | Mammogram, Low Risk Patient |
| 'CO' | Flu Vaccination |
| 'CP' | Eyewear and Eyewear Accessories |
| 'CQ' | Case Management |
| 'DG' | Dermatology |
| 'DM' | Durable Medical Equipment |
| 'DS' | Diabetic Supplies |
| 'GF' | Generic Prescription Drug - Formulary |
| 'GN' | Generic Prescription Drug - Non-Formulary |
| 'GY' | Allergy |
| 'IC' | Intensive Care |
| 'MH' | Mental Health |
| 'NI' | Neonatal Intensive Care |
| 'ON' | Oncology |
| 'PT' | Physical Therapy |
| 'PU' | Pulmonary |
| 'RN' | Renal |
| 'RT' | Residential Psychiatric Treatment |
| 'TC' | Transitional Care |
| 'TN' | Transitional Nursery Care |
| 'UC' | Urgent Care |
idinteger
System identifier
cob_levelstring
The level of insurance the eligibility check was run on. Can be one of the following: Primary Insurance or Secondary Insurance