Sign in

v1

latestOpenAPI 3.1.02026-07-1444650.0 KB

Discover

Search for an active plan, return member_id and payer_id if found

post/v1/discover

Request body

member_dobstring date required

Member’s date of birth provided in yyyy-mm-dd format

provider_npistring required

Service Provider’s 10-character NPI

next_appointmentstring date

Patient's next appointment date in yyyy-mm-dd format

patient_type'PROSPECT' | 'NEW_PATIENT' | 'EXISTING_PATIENT'
patient_idstring

Patient's id

member_first_namestring required

Member’s first name; as printed on the insurance card

member_last_namestring required

Member’s last name; as printed on the insurance card

zipstring required

Zip code

office_idstring

An identifier for the office or location being visited.

payer_idstring required

Unique external payer ID associated with the insurer

Example request

{
  "member_first_name": "NAME",
  "member_last_name": "SURNAME",
  "zip": "10001",
  "payer_id": "87726"
}

Response

Successful Response

payer_idstring required

Payer ID used to verify benefits

payer_namestring

Payer name

plan_status'UNKNOWN' | 'INACTIVE' | 'ACTIVE' | 'ACTIVE_AT_RISK'
plan_namestring

The name of the member’s insurance plan

group_namestring

The group name of the member’s insurance plan

group_idstring

The group id of the member's insurance plan

plan_type'UNKNOWN' | 'ORIGINAL_MEDICAID' | 'MANAGED_MEDICAID' | 'MEDICARE_ADVANTAGE' | 'ORIGINAL_MEDICARE' | 'DUAL' | 'MARKETPLACE' | 'GOVERNMENT' | 'COMMERCIAL'
insurance_type'HMO' | 'PPO' | 'EPO' | 'POS'
plan_begin_datestring date

The date the member’s plan was activated

plan_end_datestring date

The date the member’s plan expires

relationship_to_subscriberstring

The member’s relation to the subscriber of the plan (e.g. self, spouse, child, etc.)

bluecard_eligibleboolean

Indicates if the policy belongs to a Bluecard member

Example response

{
  "plan_begin_date": "2021-01-01",
  "plan_end_date": "2022-01-01"
}