Request with Known tradingPartnerServiceId
Here is an example of a minimal Eligibility request with sandbox values for the tradingPartnerServiceId and organizationName.
```json
{
"controlNumber":"000000001",
"tradingPartnerServiceId`": "serviceId",
"provider":
{
"organizationName": "happy_doctors_group",
"npi": "0123456789"
},
"subscriber": {
"firstName": "johnone",
"lastName": "doeOne",
"dateOfBirth": "18800102"
},
"encounter": {
"dateOfService": "20100101"
}
}
```
The Eligibility response provides the complete status of the requested patient's medical insurance. It can provide details of medical coverage for dozens of medical specialties, or it can simply confirm that the patient has current medical insurance (or otherwise). This information is provided:
- where you can expect to find it
- what the medical benefits look like
- how the Eligibility response describes medical benefits for medical services
You may receive lengthy responses to our Medical Network APIs, due to the many data points that a payer or trading partner provides in the query response. It reflects the needs to inform the provider about the various financial components of the patient's insurance coverage — existence of copays and co-insurance payments; deductible amounts; possible dependents information; coverage levels, and much more.
{
"meta": {
"senderId": "APIM_Marketplace_SBX_Native_ExrHHlUnWaTxwjVs",
"applicationMode": "sandbox",
"traceId": "2b8983bf-6298-4e18-1274-0d653803337a"
},
"controlNumber": "123456789",
"reassociationKey": "123456789",
"tradingPartnerServiceId": "serviceId",
"provider": {
"providerName": "provider_name",
"entityIdentifier": "Provider",
"entityType": "Non-Person Entity",
"npi": "0123456789"
},
"subscriber": {
"firstName": "johnOne",
"lastName": "doeOne",
"gender": "M",
"entityIdentifier": "Insured or Subscriber",
"entityType": "Person",
"dateOfBirth": "18800102",
"ssn": "111111111"
},
"subscriberTraceNumbers": [
{
"traceTypeCode": "1",
"traceType": "Current Transaction Trace Numbers",
"referenceIdentification": "123456789",
"originatingCompanyIdentifier": "9EMDEON999"
}
],
"payer": {
"entityIdentifier": "Payer",
"entityType": "Non-Person Entity",
"name": "Unknown",
"payorIdentification": "serviceId"
},
"planInformation": {
"socialSecurityNumber": "111111111"
},
"planDateInformation": {
"plan": "20160818-20160818"
},
"planStatus": [
{
"statusCode": "1",
"status": "Active Coverage",
"planDetails": "QMB",
"serviceTypeCode": [
"30"
],
"serviceTypeCodes": [
"30"
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "QM",
"insuranceType": "Qualified Medicare Beneficiary",
"planCoverage": "QMB",
"benefitsDateInformation": {
"benefit": "20160818-20160818"
}
},
{
"code": "R",
"name": "Other or Additional Payor",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"planCoverage": "MEDICARE PART A",
"benefitsDateInformation": {
"plan": "20160818-20160818"
}
},
{
"code": "R",
"name": "Other or Additional Payor",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "MB",
"insuranceType": "Medicare Part B",
"planCoverage": "MEDICARE PART B",
"benefitsDateInformation": {
"plan": "20160818-20160818"
}
}
],
"x12": "ISA*00* *01*SomePwd *ZZ*EMDEON *ZZ*TPG00000 *250923*0425*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*946380841*005010X279A1~BHT*0022*11*2b8983bf-6298-4e18-1274-0d653803337a*20250923*0425~HL*1**20*1~NM1*PR*2*Unknown*****PI*serviceId~HL*2*1*21*1~NM1*1P*2*provider_name*****XX*0123456789~HL*3*2*22*0~TRN*1*123456789*9EMDEON999*~NM1*IL*1*doeOne*johnOne***~REF*SY*111111111~DMG*D8*18800102*M~DTP*291*RD8*20160818-20160818~EB*1*IND*30*QM*QMB~DTP*292*RD8*20160818-20160818~EB*R*IND*30*MA*MEDICARE PART A~DTP*291*RD8*20160818-20160818~EB*R*IND*30*MB*MEDICARE PART B~DTP*291*RD8*20160818-20160818~SE*19*946380841~GE*1*123456789~IEA*1*123456789~"
}
{
"meta": {
"senderId": "IN_APIP_MN_CHC_TestApp2",
"applicationMode": "sandbox",
"traceId": "0b02b29a-9440-daed-30f8-353b8e605cdf"
},
"controlNumber": "123456789",
"reassociationKey": "123456789",
"tradingPartnerServiceId": "serviceId",
"provider": {
"providerName": "provider_name",
"entityIdentifier": "Provider",
"entityType": "Non-Person Entity",
"npi": "0123456789"
},
"subscriber": {
"firstName": "johnOne",
"lastName": "doeOne",
"gender": "M",
"entityIdentifier": "Insured or Subscriber",
"entityType": "Person",
"dateOfBirth": "18800102",
"ssn": "111111111"
},
"subscriberTraceNumbers": [
{
"traceTypeCode": "1",
"traceType": "Current Transaction Trace Numbers",
"referenceIdentification": "123456789",
"originatingCompanyIdentifier": "9EMDEON999"
}
],
"payer": {
"entityIdentifier": "Payer",
"entityType": "Non-Person Entity",
"name": "Unknown",
"payorIdentification": "serviceId"
},
"planInformation": {
"socialSecurityNumber": "111111111"
},
"planDateInformation": {
"plan": "20160818-20160818"
},
"planStatus": [
{
"statusCode": "1",
"status": "Active Coverage",
"planDetails": "QMB",
"serviceTypeCode": [
"30"
],
"serviceTypeCodes": [
"30"
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "QM",
"insuranceType": "Qualified Medicare Beneficiary",
"planCoverage": "QMB",
"benefitsDateInformation": {
"benefit": "20160818-20160818"
}
},
{
"code": "R",
"name": "Other or Additional Payor",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"planCoverage": "MEDICARE PART A",
"benefitsDateInformation": {
"plan": "20160818-20160818"
}
},
{
"code": "R",
"name": "Other or Additional Payor",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"insuranceTypeCode": "MB",
"insuranceType": "Medicare Part B",
"planCoverage": "MEDICARE PART B",
"benefitsDateInformation": {
"plan": "20160818-20160818"
}
}
],
Updated 2 days ago