--- title: "POST /change/medicalnetwork/eligibility/v3" method: POST path: "/change/medicalnetwork/eligibility/v3" tags: ["Real-time eligibility check"] --- # POST /change/medicalnetwork/eligibility/v3 `POST /change/medicalnetwork/eligibility/v3` Submit a real-time 270/271 eligibility check in JSON format ## Headers - `X-Forwarded-For` string — **(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. ## Request body - EligibilityCheckRequestContent - `controlNumber` string — Stedi generates a control number for each eligibility check, so you don’t need to include this property in your request. - `dependents` RequestDependent[] — 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. - `additionalIdentification` AdditionalIdentificationDependent — Use this object when you need to provide an additional identification number for the dependent. This is rarely required for standard eligibility checks. - `agencyClaimNumber` string — 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. - `contractNumber` string — The contract number for an existing contract between the payer and the provider requesting the eligibility check. - `healthInsuranceClaimNumber` string — This property is never used in practice. - `identificationCardSerialNumber` string — 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. - `insurancePolicyNumber` string — The insurance policy number. - `medicalRecordIdentificationNumber` string — The medical record identification number. - `memberIdentificationNumber` string — 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. - `patientAccountNumber` string — The patient account number. - `planNetworkIdentificationNumber` string — The plan network identification number. - `planNumber` string — The insurance plan number. - `policyNumber` string — The insurance group or policy number. - `address` RequestDependentAddress — 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. - `address1` string, required — The first line of the address. - `address2` string — The second line of the address. - `city` string, required — 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. For example, `TN` for Tennessee or `NB` for New Brunswick. - `beginningCardIssueDate` string — 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. - `beginningPlanIssueDate` string — 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. - `birthSequenceNumber` string — 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. - `dateOfBirth` string — 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. - `eligibilityCategory` string — The eligibility category for the dependent. - `endCardIssueDate` string — 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. - `endPlanIssueDate` string — 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. - `firstName` string — The dependent's first name. - `gender` 'M' | 'F' - `groupNumber` string — The group number for the dependent's insurance plan. - `healthCareCodeInformation` HealthCareInformation[] — Information about the dependent's health care diagnosis. You can include up to eight entries in this array. The first array entry must have `diagnosisTypeCode` set to `ABK`. All subsequent entries must have `diagnosisTypeCode` set to `ABF`. - `diagnosisCode` string, required — The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed. - `diagnosisTypeCode` 'BK' | 'ABK' | 'BF' | 'ABF', required — 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. Note that ICD-9 codes are **deprecated** and should no longer be used in eligibility checks. - `idCard` string — The dependent's insurance card number. - `idCardIssueDate` string — The date the insurance card was issued. Use to specify a single date. - `individualRelationshipCode` '01' | '19' | '34' — The dependent's relationship to the subscriber. You can set this to `01` - Spouse, `19` - Child, `34` - Other Adult. - `issueNumber` string — The issue number for the dependent's insurance policy. - `lastName` string — The dependent's last name. **Don't** include the dependent's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `memberId` string — This shape is deprecated: This property is no longer used. - `middleName` string — The dependent's middle name or middle initial. - `planIssueDate` string — The date the insurance plan begins. Use to specify a single date. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SK' | 'SU' — 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. 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 - `providerIdentifier` string — 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. - `referenceIdentificationQualifier` '9K' | 'D3' | 'EI' | 'HPI' | 'PXC' | 'SY' | 'TJ' — The type of `providerIdentifier` you are using. Use for providers that are not requesting the eligibility check, such as the referring provider. - Set to `HPI` when the National Provider ID is mandated for use. - Set to `PXC` if you're identifying a type of specialty associated with services provided to the dependent. 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 - `ssn` string — The dependent's social security number. Don't use this for Federally-administered programs, such as Medicare. - `suffix` string — 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. - `eligibilitySearchId` string — 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. - `encounter` Encounter — 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. - `beginningDateOfService` string — The beginning date of service. If you include this value, you must also include the `endDateOfService`. - `dateOfService` string — 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. - `diagnosisCodePointer` string[] — 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. - `endDateOfService` string — The end date of service. If you include this value, you must also include the `beginningDateOfService`. - `industryCode` '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' — 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). - `medicalProcedures` MedicalProcedure[] — Use only when you need to send multiple procedure codes in a single request. Otherwise, use the `encounter.procedureCode` and `encounter.productOrServiceIDQualifier` properties. - `diagnosisCodePointer` string[] — The diagnosis code pointer. - `procedureCode` string, required — The procedure code. - `procedureModifiers` string[] — Procedure modifiers that provide additional information related to the service. - `productOrServiceIDQualifier` 'AD' | 'CJ' | 'HC' | 'ID' | 'IV' | 'N4' | 'ZZ', required — 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. - `priorAuthorizationOrReferralNumber` string — The prior authorization or referral number for a particular benefit or procedure. - `procedureCode` string — The procedure code. - `procedureModifiers` string[] — The procedure modifier that provides additional information related to the performance of the service. - `productOrServiceIDQualifier` 'AD' | 'CJ' | 'HC' | 'ID' | 'IV' | 'N4' | 'ZZ' — 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. - `referenceIdentificationQualifier` '9F' | 'G1' — The type of information you provided in the `priorAuthorizationOrReferralNumber` property. You can set this to `9F` - Referral Number or `G1` - Prior Authorization Number. - `serviceTypeCodes` RequestEligibilityServiceTypeCode[] — 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. - `externalPatientId` string — 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. - `informationReceiverName` InformationReceiverName - `address` RequestProviderAddress — Address information for the provider. - 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. - You must include at least the `address1` and `city` properties. - `address1` string, required — The first line of the address. - `address2` string — The second line of the address. - `city` string, required — 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. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contactNumber` string - `contractNumber` string - `devicePinNumber` string - `facilityIdNumber` string - `facilityNetworkIdNumber` string - `federalTaxpayerIdentificationNumber` string - `informationReceiverAdditionalIdentifierState` string - `medicaidProviderNumber` string — The provider's Medicaid provider number. - `medicareProviderNumber` string - `nationalProviderIdentifier` string - `priorIdentifierNumber` string - `providerPlanNetworkIdNumber` string - `socialSecurityNumber` string - `stateLicenceNumber` string - `submitterIdNumber` string - `portalPassword` string — 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. - `portalUsername` string — The username that the provider uses to log in to the payer's portal. This is not commonly used. - `provider` Provider, required — 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. - You must provide the `organizationName` (if the entity is an organization), or `firstName` and `lastName` (if the provider is an individual). - 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`. - Don't include additional properties, such as `taxId` or `address`, unless they are specifically required or suggested by the payer. - `address` RequestProviderAddress — Address information for the provider. - 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. - You must include at least the `address1` and `city` properties. - `address1` string, required — The first line of the address. - `address2` string — The second line of the address. - `city` string, required — 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. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contactNumber` string — The provider's contract number. Only include when required by a payer. This shape is deprecated: Use `contractNumber` instead. - `contractNumber` string — The provider's contract number. Only include when required by a payer. - `devicePinNumber` string — The provider's electronic device pin number. Only include when required by a payer. - `employersId` string — 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. - `facilityIdNumber` string — The ID number for the provider's facility. Only include when required by a payer. - `facilityNetworkIdNumber` string — The provider's facility network identification number. Only include when required by a payer. - `firstName` string — The provider's first name. This property is required if the provider is an individual. - `informationReceiverAdditionalIdentifierState` string — The two-character state ID of the state that assigned the `stateLicenseNumber`. Only include when required by a payer. - `lastName` string — The provider's last name. This property is required if the provider is an individual. - `medicaidProviderNumber` string — The provider's Medicaid provider number. Only include when required by a payer. - `medicareProviderNumber` string — The provider's Medicare provider number. Only include when required by a payer. - `npi` string — 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. - `organizationName` string — The provider's business name. This property is required if the provider is not an individual. - `payorId` string — Only used for payer-to-payer transactions, which are not currently supported. Do not use. - `pharmacyProcessorNumber` string — 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. - `priorIdentifierNumber` string — The provider's prior identifier number. Only include when required by a payer. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SB' | 'SK' | 'SU' - `providerPlanNetworkIdNumber` string — The provider's plan network identification number. Only include when required by a payer. - `providerType` 'payer' | 'third-party administrator' | 'employer' | 'hospital' | 'facility' | 'gateway provider' | 'plan sponsor' | 'provider' — Identify the type of provider. - `referenceIdentification` string — 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. - `serviceProviderNumber` string — 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. - `servicesPlanID` string - `ssn` string — The provider's Social Security Number (SSN). - 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. - If the payer has instructed you to send an EIN but the provider operates using their SSN, use provider.taxId instead of this field. - Don't use this for Federally-administered programs, such as Medicare. - `stateLicenceNumber` string — The provider's state license number. If you include this information, you must also include the `informationReceiverAdditionalIdentifierState`. Only include when required by a payer. - `submitterIdNumber` string — The provider's submitter identification number. Only include when required by a payer. - `taxId` string — 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. - `submitterTransactionIdentifier` string — This property is only relevant for asynchronous batch eligibility checks. - `subscriber` RequestSubscriber, required — 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. - `additionalIdentification` AdditionalIdentificationSubscriber — 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. - `agencyClaimNumber` string — 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. - `contractNumber` string — The contract number for an existing contract between the payer and the provider requesting the eligibility check. - `healthInsuranceClaimNumber` string — The health insurance claim number. - `identificationCardSerialNumber` string — 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. - `insurancePolicyNumber` string — The insurance policy number. - `medicalRecordIdentificationNumber` string — The medical record identification number. - `memberIdentificationNumber` string — This property is never used in practice. Supply the subscriber's member ID in `subscriber.memberId`. - `patientAccountNumber` string — The patient account number. - `planNetworkIdentificationNumber` string — The plan network identification number. - `planNumber` string — The insurance plan number. - `policyNumber` string — The insurance group or policy number. - `address` RequestSubscriberAddress — Address information for the subscriber. When providing address information: - The `address1` and `city` properties are **required** for standard eligibility checks and MBI lookups with SSN. We also recommend including `state` for member identification. - 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`. - `address1` string — The first line of the address. Required for all payers except payer ID `MBILUNOSSN`. - `address2` string — The second line of the address. - `city` string — The city. Required for all payers except payer ID `MBILUNOSSN`. - `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. For example, `TN` for Tennessee or `NB` for New Brunswick. - `beginningCardIssueDate` string — 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. - `beginningPlanIssueDate` string — 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. - `birthSequenceNumber` string — 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. - `caseNumber` string — The case number associated with the subscriber. - `coverageLevelCode` string — This property is no longer used. - `dateOfBirth` string — The subscriber's date of birth. - `endCardIssueDate` string — 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. - `endPlanIssueDate` string — 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. - `firstName` string — The patient's first name. - `gender` 'M' | 'F' - `groupNumber` string — The group number associated with the subscriber's insurance policy. - `healthCareCodeInformation` HealthCareInformation[] — Information about the subscriber's health care diagnosis. You can include up to eight entries in this array. The first array entry must have `diagnosisTypeCode` set to `ABK`. All subsequent entries must have `diagnosisTypeCode` set to `ABF`. - `diagnosisCode` string, required — The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed. - `diagnosisTypeCode` 'BK' | 'ABK' | 'BF' | 'ABF', required — 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. Note that ICD-9 codes are **deprecated** and should no longer be used in eligibility checks. - `idCard` string — 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. - `idCardIssueDate` string — The date the subscriber's insurance card was issued. Use to specify a single date. - `lastName` string — The subscriber's last name. **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `medicaidRecipientIdentificationNumber` string — 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`. - `memberId` string — The member ID for the subscriber's insurance policy. - `middleName` string — The patient's middle name or middle initial. - `planIssueDate` string — The date the subscriber's insurance plan begins. Use to specify a single date. - `providerCode` 'AD' | 'AT' | 'BI' | 'CO' | 'CV' | 'H' | 'HH' | 'LA' | 'OT' | 'P1' | 'P2' | 'PC' | 'PE' | 'R' | 'RF' | 'SK' | 'SU' — 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. This property is **required** when the `providerIdentifier` and `referenceIdentificationQualifier` properties are populated. 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 - `providerIdentifier` string — 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. If you set the `referenceIdentificationQualifier` to `PXC`, then this property should contain the provider's taxonomy code. - `referenceIdentificationQualifier` '9K' | 'D3' | 'EI' | 'HPI' | 'PXC' | 'SY' | 'TJ' — Use this for providers that are not requesting the eligibility check. This is the type of `providerIdentifier` you are providing. - Set to `HPI` when the National Provider ID is mandated for use. - Set to `PXC` if you're identifying a type of specialty associated with services provided to the subscriber. 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 - `spendDownAmount` string — 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. - `spendDownTotalBilledAmount` string — The subscriber's spend down total billed amount. - `ssn` string — 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. - `suffix` string — 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. - `tradingPartnerName` string — The payer's name, such as Cigna or Aetna. - `tradingPartnerServiceId` string, required — The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list. - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record. - 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`. ## Response `200` EligibilityCheck 200 response - EligibilityCheckResponseContent - `benefitsInformation` BenefitsInformation[] — 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. 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. The 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. Visit [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. - `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. - `benefitsRelatedEntity` BenefitsRelatedEntity — 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. - `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. - `eligibilityAdditionalInformation` EligibilityAdditionalInformation - `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. - `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. - `controlNumber` string — An identifier for the payer's response. - `dependents` ResponseDependent[] — 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. 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. - `aaaErrors` EligibilityCheckDependentError[] - `code` '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' — 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. - `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. - `eligibilitySearchId` string — 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. - `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.** - `id` string — 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. - `implementationTransactionSetSyntaxError` string — The implementation transaction set error code provided in `IK502` of the 999 transaction. - `meta` EligibilityMetaDataJSON — 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. - `billerId` string — The biller ID Stedi assigns to this request. - `outboundTraceId` string — 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. - `senderId` string — The sender ID Stedi assigns to this request. - `submitterId` string — The submitter ID Stedi assigns to this request. - `traceId` string — The transaction identifier the payer sends in the response. This should be the same as the `outboundTraceId`. - `payer` Payer — 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. - `aaaErrors` EligibilityCheckPayerError[] - `code` '04' | '41' | '42' | '79' | '80' | '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' | '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.** - `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. - `employersId` string — Deprecated; The payer's identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used. - `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` PlanDateInformation — 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. - `added` string — Added date. Payers may return this information in the case of retroactive eligibility. - `admission` string — The admission date or dates. - `benefit` string — The benefit date. - `benefitBegin` string — The benefit begin date. - `benefitEnd` string — The benefit end date. - `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. 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. - `latestVisitOrConsultation` string — The latest visit or consultation date. - `periodEnd` string — The end of a period. - `periodStart` string — The start of a period. - `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. - `primaryCareProvider` string — The primary care provider 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 - `planStatus` PlanStatus[] — Please use `benefitsInformation` instead. - `planDetails` string - `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. - `status` string - `statusCode` string - `provider` 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. - `reassociationKey` string - `status` string — 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. - `subscriber` ResponseSubscriber — 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. - `aaaErrors` EligibilityCheckSubscriberError[] - `code` '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' — 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. - `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. - `subscriberTraceNumbers` SubscriberTraceNumber[] — 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. - `originatingCompanyIdentifier` string — The identifier of the organization that assigned the trace number. - `referenceIdentification` string — The unique trace number assigned to the transaction. - `secondaryReferenceIdentification` string — Identifies a subdivision within the organization that assigned the trace number. - `traceType` string — The full name of the `traceTypeCode`. For example `Current Transaction Trace Numbers`. - `traceTypeCode` string — 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). - `tradingPartnerServiceId` string — 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. - `transactionSetAcknowledgement` string — 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). - `warnings` Warning[] — Issues with your eligibility request that could affect the results, or information about the response. For example, warnings can help explain why the request was rejected. - `code` string — The warning code. - `description` string — The warning description. - `x12` string — 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. ## Other responses - `400` — EligibilityCheck400Error 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/c156a60615bb/schema)