How to Determine Co-pay without a Card

Here is an example snippet from the Eligibility API in sandbox using tradingPartnerServiceId as UHC:

            "code": "B",
            "name": "Co-Payment",
            "coverageLevelCode": "IND",
            "coverageLevel": "Individual",
            "serviceTypeCodes": [
            "serviceTypes": [
            "timeQualifierCode": "7",
            "timeQualifier": "Day",
            "benefitAmount": "12",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable"

Request: please use standard HTTP responses to indicate the result of a request. For example, a request to the Eligibility API that has multiple invalid values returns a 200 status code, but the response has an error key with details on the error fields (this should be a 400 status code to indicate issues with the request parameters). Additionally, if the Authorization header is not sent, a 400 status code is returned, although a 403 unauthorized status code would be much more clear what the issue is.

There are a few reasons for why we use the status codes we do today. For the Eligibility API, it is possible to get back errors from applications downstream of the API itself. Those might come back from Change Healthcare clearinghouse where our payer connections are configured or from the payer. These errors would come back as 200 status because we successfully made the connection to the downstream entity and the request is being rejected by a different system.

As for the error with the missing Authorization header, a 400 Bad Request might describe the error. Your authentication is not invalid, but a basic requirement of the request is not being met. All requests must have the Authorization header, so any request without the header would be considered a 400 Bad Request. If you send the Authorization header with an invalid or expired token, you will receive a 401 Unauthorized.