When to use Dependent Object

A Dependent can be considered the patient for an Eligibility query. Two straightforward criteria together determine how a dependent is managed for an Eligibility request and any follow-up medical claims:

  • The patient is defined as a dependent on an insurance policy member's subscription;
  • The dependent patient cannot be uniquely identified in the payer's medical membership database or any information other than in the subscriber's policy.

If the patient is the stated dependent on a member's policy but can also be uniquely identified by the payer through having an existing Member ID or other insurance identification, the dependent must be identified in the Subscriber object for any related medical claims. They will be considered the Subscriber for the medical claim purposes.

See Eligibility JSON to EDI mappings and Eligibility OpenAPI Spec for more information.