--- title: "GET /insurance-discovery/check/v1/{discoveryId}" method: GET path: "/insurance-discovery/check/v1/{discoveryId}" tags: ["Insurance discovery"] --- # GET /insurance-discovery/check/v1/{discoveryId} `GET /insurance-discovery/check/v1/{discoveryId}` Retrieve insurance discovery check results by `discoveryId` ## Path parameters - `discoveryId` string, required — The unique ID for the insurance discovery check. Stedi returns this value in the response from the [Insurance Discovery Check](https://www.stedi.com/docs/healthcare/api-reference/post-insurance-discovery) endpoint. ## Response `200` GetInsuranceDiscoveryCheck 200 response - GetInsuranceDiscoveryCheckResponseContent - `coveragesFound` integer — The number of potential coverage matches for the patient. This will be `0` if Stedi didn't find any matching coverage. - `discoveryId` string — A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint. - `errors` EligibilityCheckError[] — 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. - `code` '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' — 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. - `description` string — The error description. - `field` string — The error type, `AAA`. - `followupAction` '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' — Payers may sometimes return other non-compliant values. - `location` string — The location of the error within the original X12 EDI response. - `possibleResolutions` string — 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.** - `items` InsuranceDiscoveryResponseFields[] — An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check `status` is `COMPLETE`. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information. - `benefitsInformation` DiscoveryBenefitsInformation[] — Information about the patient's healthcare benefits, such as coverage level (individual vs. family), coverage type (deductibles, copays, etc.), out of pocket maximums, and more. This is the same information you would get from a standard eligibility check. 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. Visit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits) in our eligibility check documentation for more information about benefit types, details about how to interpret the response, and additional examples. - `additionalInformation` AdditionalInformation[] — A free-form message containing additional information about the benefits in the response. - `description` string — A free-form message containing additional information about the benefits in the response. - `authOrCertIndicator` 'N' | 'U' | 'Y' — Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `benefitAmount` string — The monetary benefit amount, such as a patient's co-pay or deductible. This value is expressed as a decimal, such as 100.00. 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. The payer will **never** send this value when `benefitsInformation[].code` = `A` - Co-Insurance. This property can contain zero when the patient has no responsibility. Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits). - `benefitPercent` string — The percentage of the benefit, such as co-insurance. This property can contain zero when the patient has no responsibility. 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%. 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. Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits). - `benefitQuantity` string — The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For example, `10` when the `quantityQualifier` is `Visits`. - `benefitsAdditionalInformation` BenefitsAdditionalInformation — Identifying information specific to this type of benefit. - `alternativeListId` string — 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. - `coverageListId` string — 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. - `drugFormularyNumber` string — The drug formulary number. - `familyUnitNumber` string — 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. - `groupDescription` string — Group name - `groupNumber` string — The group number for the patient's health insurance plan. - `hicNumber` string — 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. - `insurancePolicyNumber` string — The insurance policy number. - `medicaidRecepientIdNumber` string — Deprecated (misspelled): use medicaidRecipientIdNumber. The Medicaid Recipient Identification number. This shape is deprecated: Misspelled. Use medicaidRecipientIdNumber instead. Still populated for backward compatibility. - `medicaidRecipientIdNumber` string — The Medicaid Recipient Identification number. - `medicalAssistanceCategory` string — The medical assistance category. - `memberId` string — The patient's member ID. - `planDescription` string — Plan name - `planNetworkDescription` string — Plan network name - `planNetworkIdNumber` string — The plan network identification number. - `planNumber` string — The insurance plan number. - `policyNumber` string — The patient's policy number. - `priorAuthorizationNumber` string — The prior authorization number. - `referralNumber` string — The referral number. - `benefitsDateInformation` BenefitsDateInformation — Dates associated with the benefits. - This is where you can find benefit-specific eligibility dates, if provided. These dates override dates provided in `planDateInformation` for this benefit type. - 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. - These dates only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided. - `added` string — Added date. Payers may return this information in the case of retroactive eligibility. - `admission` string — The admission date or dates. - `admissions` DtpDate[] — The date(s) for admission. - `date` string — A single date. - `endDate` string — The end date of a range. - `startDate` string — The beginning date of a range. - `benefit` string — The benefit date. - `benefitBegin` string — The date when the benefit begins. - `benefitEnd` string — The date when the benefit ends. - `certification` string — The certification date. - `cobraBegin` string — The date when COBRA coverage begins. - `cobraEnd` string — The date when COBRA coverage ends. - `completion` string — The completion date. - `coordinationOfBenefits` string — The coordination of benefits date. - `dateOfDeath` string — The date of death. - `dateOfLastUpdate` string — The date when the plan information was last updated. - `discharge` string — The discharge date. - `discharges` DtpDate[] — The date(s) when the patient was discharged. - `date` string — A single date. - `endDate` string — The end date of a range. - `startDate` string — The beginning date of a range. - `effectiveDateOfChange` string — The effective date of change. - `eligibility` string — Plan eligibility dates. - `eligibilityBegin` string — The date when the patient is first eligible for benefits under the plan. - `eligibilityEnd` string — The date when the patient is no longer eligible for benefits under the plan. - `enrollment` string — The date when the patient is enrolled in the plan. - `issue` string — The issue date. - `latestVisitOrConsultation` string — 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. - `periodEnd` string — The end of a period. - `periodStart` string — The start of a period. - `plan` string — Only included when multiple plans apply to the patient or multiple plan periods apply. - `planBegin` string — Only included when multiple plans apply to the patient or multiple plan periods apply. - `planEnd` string — The date coverage from the plan ends. - `policyEffective` string — The date when the policy becomes effective. - `policyExpiration` string — The date when the policy expires. - `premiumPaidToDateEnd` string — The end of period when the plan premium payments are up-to-date. - `premiumPaidtoDateBegin` string — The start of the period when the plan premium was paid in full. - `primaryCareProvider` string — The primary care provider date. - `service` string — The service date or dates. - `status` string — The status date. - `benefitsRelatedEntities` BenefitsRelatedEntity[] — 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) - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `contactInformation` ContactInformation - `contacts` Contacts[] — The contact information. - `communicationMode` 'Electronic Data Interchange Access Number' | 'Electronic Mail' | 'Facsimile' | 'Telephone' | 'Uniform Resource Locator (URL)' | 'Telephone Extension' | 'Work Phone Number' — Payers may sometimes return other non-compliant values. - `communicationNumber` string — The communication number referenced in `communicationMode`. It includes the country or area code when applicable. 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`. - `name` string — The name of the contact person. - `entityFirstname` string — The first name of the entity, if the entity is a person. - `entityIdentification` '24' | '34' | '46' | 'FA' | 'FI' | 'II' | 'MI' | 'NI' | 'PI' | 'PP' | 'SV' | 'XV' | 'XX' — 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. - `entityIdentificationValue` string — The identification number for the entity, qualified by the code in `entityIdentification`. - `entityIdentifier` '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' — Code identifying an organizational entity, a physical location, property or an individual. - `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. Payers may sometimes return other non-compliant values. - `entityMiddlename` string — The middle name or initial of the entity, if the entity is a person. - `entityName` string — The last name (if the entity is a person) or the business name (if the entity is an organization). - `entityRelationship` '01' | '02' | '27' | '41' | '48' | '65' | '72' — Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `entitySuffix` string — The name suffix, such as Sr. Jr. or III. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `providerInformation` ProviderInformation - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SB' | 'SK' | 'SU' — 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. - `referenceIdentification` string — The provider's taxonomy code. - `benefitsServiceDelivery` BenefitsServiceDelivery[] - `deliveryOrCalendarPatternCode` '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)' — The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`. Payers may sometimes return other non-compliant values. - `deliveryOrCalendarPatternQualifier` '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)' — The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`. Payers may sometimes return other non-compliant values. - `deliveryOrCalendarPatternQualifierCode` '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' — 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. - `deliveryPatternTimeCode` '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)' — The name of the `deliveryPatternTimeCode`. Payers may sometimes return other non-compliant values. - `deliveryPatternTimeQualifier` '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)' — The name of the `deliveryPatternTimeCode`. Payers may sometimes return other non-compliant values. - `deliveryPatternTimeQualifierCode` 'A' | 'B' | 'C' | 'D' | 'E' | 'F' | 'G' | 'Y' — A code specifying the time for routine shipments or deliveries. Payers may sometimes return other non-compliant values. - `numOfPeriods` string — The number of periods in the time period. For example, `12` when the `timePeriodQualifier` is `Hour`. - `quantity` string — The quantity of the benefit. For example, `10` when the `quantityQualifier` is `Visits`. - `quantityQualifier` 'Days' | 'Units' | 'Hours' | 'Month' | 'Visits' — The name of the `quantityQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values. - `quantityQualifierCode` 'DY' | 'FL' | 'HS' | 'MN' | 'VS' — Code specifying the type of quantity. Payers may sometimes return other non-compliant values. - `sampleSelectionModulus` string — Specifies the sampling frequency, based on the unit of measure. For example `every 2 months` or `once per calendar year`. - `timePeriodQualifier` 'Hour' | 'Day' | 'Years' | 'Service Year' | 'Calendar Year' | 'Year to Date' | 'Contract' | 'Episode' | 'Visit' | 'Outlier' | 'Remaining' | 'Exceeded' | 'Not Exceeded' | 'Lifetime' | 'Lifetime Remaining' | 'Month' | 'Week' — The name of the `timePeriodQualifierCode`. For example, `Calendar Year`. Payers may sometimes return other non-compliant values. - `timePeriodQualifierCode` '6' | '7' | '21' | '22' | '23' | '24' | '25' | '26' | '27' | '28' | '29' | '30' | '31' | '32' | '33' | '34' | '35' — Code specifying the time period for the benefit information. Payers may sometimes return other non-compliant values. - `unitForMeasurementCode` 'Days' | 'Months' | 'Visits' | 'Week' | 'Years' — The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values. - `unitForMeasurementQualifier` 'Days' | 'Months' | 'Visits' | 'Week' | 'Years' — The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values. - `unitForMeasurementQualifierCode` 'DA' | 'MO' | 'VS' | 'WK' | 'YR' — Code specifying the unit of measurement for the quantity. Payers may sometimes return other non-compliant values. - `code` '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' — 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. - `compositeMedicalProcedureIdentifier` CompositeMedicalProcedureIdentifier — Identifies relevant medical procedures by their standard codes and modifiers (if applicable). - `diagnosisCodePointer` string[] — The diagnosis code pointer. - `procedureCode` string — 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`. - `procedureModifiers` string[] — Procedure modifiers that provides additional information related to the performance of the service. - `productOrServiceID` string — 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`. - `productOrServiceIDQualifier` string — The name of the `productOrServiceIDQualifierCode`. For example, `American Dental Association`. - `productOrServiceIDQualifierCode` string — 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 - `coverageLevel` 'Children Only' | 'Dependents Only' | 'Employee and Children' | 'Employee Only' | 'Employee and Spouse' | 'Family' | 'Individual' | 'Spouse and Children' | 'Spouse Only' — The full name of the coverage level code. Payers may sometimes return other non-compliant values. - `coverageLevelCode` 'CHD' | 'DEP' | 'ECH' | 'EMP' | 'ESP' | 'FAM' | 'IND' | 'SPC' | 'SPO' — Code indicating the level of coverage for the patient. This 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`. Payers may sometimes return other non-compliant values. - `eligibilityAdditionalInformationList` EligibilityAdditionalInformation[] — Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response. - `codeCategory` '44' — Payers may sometimes return other non-compliant values. - `codeListQualifier` string — The name of the `codeListQualifierCode`. For example `Mutually Defined` when the code is set to `ZZ`. - `codeListQualifierCode` 'GR' | 'NI' | 'ZZ' — Payers may sometimes return other non-compliant values. - `industry` string — The name of the `industryCode`. For example `Pharmacy` when the code is `01`. - `industryCode` string — 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. - `injuredBodyPartName` string — Description of injured body parts. - `headerLoopIdentifierCode` string — The loop header identifier number in the `LS` segment of the original X12 EDI transaction. - `inPlanNetworkIndicator` 'Yes' | 'No' | 'Unknown' | 'Not Applicable' — The name of the in-plan network indicator code. Payers may sometimes return other non-compliant values. - `inPlanNetworkIndicatorCode` 'Y' | 'N' | 'U' | 'W' — Code indicating whether the benefit is in-network or out-of-network. Can be `Y` - Yes, `N` - No, `U` - Unknown, or `W` - Not Applicable 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. 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. Payers may sometimes return other non-compliant values. - `insuranceType` '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' — The full name of the insurance type code. Payers may sometimes return other non-compliant values. - `insuranceTypeCode` '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' — Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `name` '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' — The full name of the benefits information code. Payers may sometimes return other non-compliant values. - `planCoverage` string — 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. - `quantityQualifier` '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' — The name of the quantity qualifier code. Payers may sometimes return other non-compliant values. - `quantityQualifierCode` '8H' | '99' | 'CA' | 'CE' | 'D3' | 'DB' | 'DY' | 'HS' | 'LA' | 'LE' | 'M2' | 'MN' | 'P6' | 'QA' | 'S7' | 'S8' | 'VS' | 'YY' — Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values. - `serviceTypeCodes` ResponseEligibilityServiceTypeCode[] — 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. - `serviceTypes` ResponseEligibilityServiceType[] — 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. - `timeQualifier` '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' — The name of the time period qualifier code. 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. Payers may sometimes return other non-compliant values. - `timeQualifierCode` '6' | '7' | '13' | '21' | '22' | '23' | '24' | '25' | '26' | '27' | '28' | '29' | '30' | '31' | '32' | '33' | '34' | '35' | '36' — Code indicating the time period for the benefit information. Payers may sometimes return other non-compliant values. - `trailerLoopIdentifierCode` string — The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction. - `confidence` Confidence - `level` 'REVIEW_NEEDED' | 'HIGH' - `reason` string — A reason for the confidence level. For example, `This record was identified as a low confidence match due to a DOB partial match`. - `dependent` DiscoveryResponseDependent — Common fields shared between subscriber and dependent structures in the eligibility response. - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `birthSequenceNumber` string — 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. - `dateOfBirth` string — The member's date of birth. - `dateTimePeriod` string — The military service date. - `dateTimePeriodFormatQualifier` 'D8' | 'RD8' — Payers may sometimes return other non-compliant values. - `description` string — Context that identifies the exact military unit. Used to report military service data. - `employmentStatusCode` 'AE' | 'AO' | 'AS' | 'AT' | 'AU' | 'CC' | 'DD' | 'HD' | 'IR' | 'LX' | 'PE' | 'RE' | 'RM' | 'RR' | 'RU' — Payers may sometimes return other non-compliant values. - `endDateTimePeriod` string — The military service end date. - `entityIdentifier` 'Dependent' — The entity identifier for the dependent. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `firstName` string — The member's first name. - `gender` 'M' | 'F' | 'U' - `governmentServiceAffiliationCode` 'A' | 'B' | 'C' | 'D' | 'E' | 'F' | 'G' | 'H' | 'I' | 'J' | 'K' | 'L' | 'M' | 'N' | 'O' | 'Q' | 'R' | 'S' | 'U' | 'W' — Payers may sometimes return other non-compliant values. - `groupDescription` string — Group name - `groupNumber` string — The group number associated with the insurance policy. - `healthCareDiagnosisCodes` HealthCareDiagnosisCode[] - `diagnosisCode` string — The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed. - `diagnosisTypeCode` string — 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. - `informationStatusCode` 'A' | 'C' | 'L' | 'O' | 'P' | 'S' | 'T' — Payers may sometimes return other non-compliant values. - `insuredIndicator` 'N' — Indicates the status of the insured. For the dependent, this is always `N`. - `lastName` string — The member's last name. - `maintenanceReasonCode` '25' — 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. - `maintenanceTypeCode` '001' — 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. - `memberId` string — This property will never be populated. Please use `subscriber.memberId` instead. - `middleName` string — The member's middle name or initial. - `militaryServiceRankCode` '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' — Payers may sometimes return other non-compliant values. - `planDescription` string — Plan name - `planNetworkDescription` string — Plan network name - `planNetworkIdNumber` string — The network identification number associated with the insurance policy. - `planNumber` string — The plan number associated with the insurance policy. - `relationToSubscriber` 'Spouse' | 'Child' | 'Employee' | 'Unknown' | 'Organ Donor' | 'Cadaver Donor' | 'Life Partner' | 'Other Relationship' — The name of the `relationToSubscriberCode`. For example, `Child` when the code is `19`. - `relationToSubscriberCode` '01' | '19' | '20' | '21' | '39' | '40' | '53' | 'G8' | 'Unknown' — 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. - `responseProvider` ResponseProvider — 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. - `aaaErrors` EligibilityCheckProviderError[] - `code` '15' | '41' | '43' | '44' | '45' | '46' | '47' | '48' | '50' | '51' | '79' | '97' | 'T4' — Payers may sometimes return other non-compliant values. - `description` string — The error description. - `field` string — The error type, `AAA`. - `followupAction` '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' — Payers may sometimes return other non-compliant values. - `location` string — The location of the error within the original X12 EDI response. - `possibleResolutions` string — 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.** - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `employersId` string — Deprecated; The provider's identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used. - `entityIdentifier` 'Provider' | 'Third-Party Administrator' | 'Employer' | 'Hospital' | 'Facility' | 'Gateway Provider' | 'Plan Sponsor' | 'Payer' — A code identifying the type of provider. Payers may sometimes return other non-compliant values. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `federalTaxpayersIdNumber` string — The Federal Taxpayer Identification Number (also known as an EIN). - `middleName` string — The provider's middle name. This applies to providers that are an individual. - `npi` string — The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). - `payorIdentification` string — The payer identification. - `pharmacyProcessorNumber` string — The pharmacy processor number. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SB' | 'SK' | 'SU' — 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. - `providerFirstName` string — The provider's first name. This applies to providers that are an individual. - `providerName` string — The provider's last name. This applies to providers that are an individual. - `providerOrgName` string — The provider's organization name. - `referenceIdentification` string — The Health Care Provider Taxonomy Code. - `serviceProviderNumber` string — The service provider number. This is an identification number assigned by the payer. - `servicesPlanID` string — The Centers for Medicare and Medicaid Services (CMS) Plan ID. - `ssn` string — The Social Security Number (SSN). - `suffix` string — The provider's name suffix, such as Jr., Sr., or III. - `ssn` string — The member's Social Security Number (SSN). - `startDateTimePeriod` string — The military service start date. - `suffix` string — The name suffix, such as Jr., Sr., or III. - `uniqueHealthIdentifier` string — The member's unique health identifier. - `payer` DiscoveryPayer - `centersForMedicareAndMedicaidPlanId` string — The payer's Centers for Medicare and Medicaid Services PlanID. - `contactInformation` ContactInformation - `contacts` Contacts[] — The contact information. - `communicationMode` 'Electronic Data Interchange Access Number' | 'Electronic Mail' | 'Facsimile' | 'Telephone' | 'Uniform Resource Locator (URL)' | 'Telephone Extension' | 'Work Phone Number' — Payers may sometimes return other non-compliant values. - `communicationNumber` string — The communication number referenced in `communicationMode`. It includes the country or area code when applicable. 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`. - `name` string — The name of the contact person. - `entityIdentifier` 'Third-Party Administrator' | 'Employer' | 'Gateway Provider' | 'Plan Sponsor' | 'Payer' — The entity identifier code for the payer. Payers may sometimes return other non-compliant values. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `etin` string — The payer's Electronic Transmitter Identification Number (ETIN). - `federalTaxpayersIdNumber` string — The payer's federal taxpayer's identification number. - `firstName` string — The payer's first name, when the payer is an individual (not commonly used). - `lastName` string — The payer's last name. Used when the payer is an individual (not commonly used). - `middleName` string — The payer's middle name or initial, when the payer is an individual (not commonly used). - `naic` string — The payer's National Association of Insurance Commissioners (NAIC) identification number. - `name` string — The payer's business name, when the payer is not a person. - `npi` string — The payer's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). - `payorIdentification` string — The payer identification. - `suffix` string — The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used). - `planDateInformation` DiscoveryPlanDateInformation - `added` string — Added date. Payers may return this information in the case of retroactive eligibility. - `admission` string — The admission date or dates. - `certification` string — The certification date. - `cobraBegin` string — The date when COBRA coverage begins. - `cobraEnd` string — The date when COBRA coverage ends. - `dateOfDeath` string — The date of death. Payers may return this information in the case of a deceased subscriber or dependent. - `dateOfLastUpdate` string — The date when the plan information was last updated. - `discharge` string — The discharge date. - `effectiveDateOfChange` string — The effective date of change. - `eligibility` string — Plan eligibility dates. - `eligibilityBegin` string — The date when the patient is first eligible for benefits under the plan. - `eligibilityEnd` string — The date when the patient is no longer eligible for benefits under the plan. - `enrollment` string — The date when the patient is enrolled in the plan. - `issue` string — The issue date. - `plan` string — Plan effective dates. - `planBegin` string — The date coverage from the plan begins. - `planEnd` string — The date coverage from the plan ends. - `policyEffective` string — The date when the policy becomes effective. - `policyExpiration` string — The date when the policy expires. - `premiumPaidToDateBegin` string — The start of the period when the plan premium was paid in full. - `premiumPaidToDateEnd` string — The end of period when the plan premium payments are up-to-date. - `service` string — The service date or dates. - `status` string — The status date. - `planInformation` PlanInformation — Additional identification for the subscriber's healthcare plan. - `agencyClaimNumber` string — The agency claim number, only used when the information source is a Property and Casualty payer. - `alternativeListId` string — The alternative list ID - identifies a list of alternative drugs with the associated formulary status for the patient. - `caseNumber` string — The case number - `centersForMedicareAndMedicaidServicesNPI` string — The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned by the Centers for Medicare and Medicaid Services - `classOfContractCode` string — The class of contract code - used to identify the applicable class of contract for claims processing. - `contractNumber` string — The contract number of a contract between the payer and the provider that requested the eligibility check. - `coverageListId` string — The coverage list ID - identifies a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string — The drug formulary number - `electronicDevicePin` string — The electronic device pin number - `eligibilityCategory` string — The eligibility category - `facilityIdNumber` string — The facility ID number - `facilityNetworkIdentificationNumber` string — The facility network identification number - `familyUnitNumber` string — The family unit number - `federalTaxpayersIdentificationNumber` string — The federal taxpayer's identification number - `groupDescription` string — The group description - `groupNumber` string — The group number - `hicNumber` string — 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. - `idCardNumber` string — The identity card number, used when the Identity Card Number is different than the Member Identification Number. - `idCardSerialNumber` string — 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. - `insurancePolicyNumber` string — The insurance policy number - `issueNumber` string — The issue number - `medicaidProviderNumber` string — The Medicaid provider number - `medicaidRecipientIdNumber` string — The Medicaid recipient identification number - `medicalAssistanceCategory` string — The medical assistance category - `medicalRecordIdentificationNumber` string — The medical record identification number - `medicareProviderNumber` string — The Medicare provider number - `memberId` string — The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer. - `patientAccountNumber` string — 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. - `personalIdentificationNumber` string — The personal identification number (PIN) - `planDescription` string — The plan description - `planNetworkIdDescription` string — The plan, group, or plan network name - `planNetworkIdNumber` string — The plan network identification number - `planNumber` string — The plan number - `policyNumber` string — The group or policy number - `priorAuthorizationNumber` string — The prior authorization number - `priorIdNumber` string — The prior identifier number - `referralNumber` string — The referral number - `socialSecurityNumber` string — The social security number - `stateLicenseNumber` string — The state license number - `submitterIdentificationNumber` string — The submitter identification number - `userIdentification` string — The user identification - `provider` DiscoveryResponseProvider - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `entityIdentifier` 'Provider' | 'Third-Party Administrator' | 'Employer' | 'Hospital' | 'Facility' | 'Gateway Provider' | 'Plan Sponsor' | 'Payer' — A code identifying the type of provider. Payers may sometimes return other non-compliant values. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `federalTaxpayersIdNumber` string — The Federal Taxpayer Identification Number (also known as an EIN). - `middleName` string — The provider's middle name. This applies to providers that are an individual. - `npi` string — The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). - `payorIdentification` string — The payer identification. - `pharmacyProcessorNumber` string — The pharmacy processor number. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SB' | 'SK' | 'SU' — 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. - `providerFirstName` string — The provider's first name. This applies to providers that are an individual. - `providerName` string — The provider's last name. This applies to providers that are an individual. - `providerOrgName` string — The provider's organization name. - `referenceIdentification` string — The Health Care Provider Taxonomy Code. - `serviceProviderNumber` string — The service provider number. This is an identification number assigned by the payer. - `servicesPlanID` string — The Centers for Medicare and Medicaid Services (CMS) Plan ID. - `ssn` string — The Social Security Number (SSN). - `suffix` string — The provider's name suffix, such as Jr., Sr., or III. - `subscriber` DiscoveryResponseSubscriber — Common fields shared between subscriber and dependent structures in the eligibility response. - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `birthSequenceNumber` string — 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. - `dateOfBirth` string — The member's date of birth. - `dateTimePeriod` string — The military service date. - `dateTimePeriodFormatQualifier` 'D8' | 'RD8' — Payers may sometimes return other non-compliant values. - `description` string — Context that identifies the exact military unit. Used to report military service data. - `employmentStatusCode` 'AE' | 'AO' | 'AS' | 'AT' | 'AU' | 'CC' | 'DD' | 'HD' | 'IR' | 'LX' | 'PE' | 'RE' | 'RM' | 'RR' | 'RU' — Payers may sometimes return other non-compliant values. - `endDateTimePeriod` string — The military service end date. - `entityIdentifier` 'Insured or Subscriber' — The entity identifier for the subscriber. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `firstName` string — The member's first name. - `gender` 'M' | 'F' | 'U' - `governmentServiceAffiliationCode` 'A' | 'B' | 'C' | 'D' | 'E' | 'F' | 'G' | 'H' | 'I' | 'J' | 'K' | 'L' | 'M' | 'N' | 'O' | 'Q' | 'R' | 'S' | 'U' | 'W' — Payers may sometimes return other non-compliant values. - `groupDescription` string — Group name - `groupNumber` string — The group number associated with the insurance policy. - `healthCareDiagnosisCodes` HealthCareDiagnosisCode[] - `diagnosisCode` string — The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed. - `diagnosisTypeCode` string — 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. - `informationStatusCode` 'A' | 'C' | 'L' | 'O' | 'P' | 'S' | 'T' — Payers may sometimes return other non-compliant values. - `insuredIndicator` 'Y' — Indicates the status of the insured. For the subscriber, this is always `Y`. - `lastName` string — The member's last name. - `maintenanceReasonCode` '25' — 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. - `maintenanceTypeCode` '001' — 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. - `memberId` string — The member ID for the insurance policy. - `middleName` string — The member's middle name or initial. - `militaryServiceRankCode` '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' — Payers may sometimes return other non-compliant values. - `planDescription` string — Plan name - `planNetworkDescription` string — Plan network name - `planNetworkIdNumber` string — The network identification number associated with the insurance policy. - `planNumber` string — The plan number associated with the insurance policy. - `relationToSubscriber` 'Self' — The name of the `relationToSubscriberCode`. For the subscriber, this is always `Self`. - `relationToSubscriberCode` '18' — For the subscriber, this is always `18` for Self. - `responseProvider` ResponseProvider — 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. - `aaaErrors` EligibilityCheckProviderError[] - `code` '15' | '41' | '43' | '44' | '45' | '46' | '47' | '48' | '50' | '51' | '79' | '97' | 'T4' — Payers may sometimes return other non-compliant values. - `description` string — The error description. - `field` string — The error type, `AAA`. - `followupAction` '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' — Payers may sometimes return other non-compliant values. - `location` string — The location of the error within the original X12 EDI response. - `possibleResolutions` string — 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.** - `address` Address - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city. - `countryCode` string — The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubDivisionCode` string — The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string — The United States or Canadian postal code, excluding punctuation and blanks. - `state` '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' — 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. - `employersId` string — Deprecated; The provider's identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used. - `entityIdentifier` 'Provider' | 'Third-Party Administrator' | 'Employer' | 'Hospital' | 'Facility' | 'Gateway Provider' | 'Plan Sponsor' | 'Payer' — A code identifying the type of provider. Payers may sometimes return other non-compliant values. - `entityType` 'Person' | 'Non-Person Entity' — The type of entity. Payers may sometimes return other non-compliant values. - `federalTaxpayersIdNumber` string — The Federal Taxpayer Identification Number (also known as an EIN). - `middleName` string — The provider's middle name. This applies to providers that are an individual. - `npi` string — The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). - `payorIdentification` string — The payer identification. - `pharmacyProcessorNumber` string — The pharmacy processor number. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SB' | 'SK' | 'SU' — 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. - `providerFirstName` string — The provider's first name. This applies to providers that are an individual. - `providerName` string — The provider's last name. This applies to providers that are an individual. - `providerOrgName` string — The provider's organization name. - `referenceIdentification` string — The Health Care Provider Taxonomy Code. - `serviceProviderNumber` string — The service provider number. This is an identification number assigned by the payer. - `servicesPlanID` string — The Centers for Medicare and Medicaid Services (CMS) Plan ID. - `ssn` string — The Social Security Number (SSN). - `suffix` string — The provider's name suffix, such as Jr., Sr., or III. - `ssn` string — The member's Social Security Number (SSN). - `startDateTimePeriod` string — The military service start date. - `suffix` string — The name suffix, such as Jr., Sr., or III. - `uniqueHealthIdentifier` string — The member's unique health identifier. - `meta` InsuranceDiscoveryMetadata — Metadata about the response. Stedi uses this data for tracking and troubleshooting. - `applicationMode` 'production' | 'test' | 'information' — 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. - `traceId` string — The unique ID Stedi assigns to this request. - `status` 'PENDING' | 'COMPLETE' | 'ERROR' - `warnings` Warning[] — Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests. - `code` string — The warning code. - `description` string — The warning description. ## Other responses - `400` — ValidationException 400 response - `403` — AccessDeniedException 403 response - `404` — ResourceNotFoundException 404 response - `429` — ThrottlingException 429 response - `500` — InternalFailureException 500 response - `503` — ServiceUnavailableException 503 response - `504` — GatewayTimeoutException 504 response --- [API](https://skmtc.net/stedi/apis/stedi-healthcare.md) · [All operations](https://skmtc.net/stedi/apis/stedi-healthcare/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/stedi/stedi-healthcare/revisions/4ba02a47bfc5/schema)