Eligibility API Tips



  • You will see the serviceTypeCode value on all the responses, and is repeated several times in the benefitsInformation object depending on the length of the response and the business lines of the payer. Visit Service Type Codes for a complete list of the service type codes.
  • If the payer supports only a single category of inquiry in the Eligibility requests, you will see serviceCode 30 for Health Benefit Plan Coverage. Some payers typically give a serviceCode 30 to affirm that the patient has active health insurance coverage.
  • Some payers will reply with shorter responses than others; the Eligibility API Response body example is a briefer one that you can see by testing the tradingPartnerServiceId value of AETNA in the request.
  • The insuranceTypeCode denotes the type of insurance policy within a specific insurance program. Payers can support numerous types.
  • For a more in-depth breakdown of each JSON object, see Eligibility response.