{"openapi":"3.0.1","info":{"title":"Enhanced Eligibility API","description":"Enhanced Eligibility provides real-time eligibility verification for medical benefit inquiries and optional Coverage Discovery workflows when additional coverage needs to be researched asynchronously.\n\nTiming guidance:\n- Real-Time Eligibility is synchronous, but payer and clearinghouse response time dominate the end-to-end latency.\n- The downstream clearinghouse timeout for real-time requests is 2 minutes to tolerate slower payer connectivity and heavy-volume periods.\n- Request deduplication is customer-configurable and determines whether a request is sent to the clearinghouse or short-circuited by replaying a prior transaction response.\n- RTCOB and Coverage Insight also use a separate non-configurable 72-hour request cache. When that cache is hit, the path is marked as skipped instead of creating a new downstream submission.\n- Coverage Discovery is asynchronous because some paths involve chained clearinghouse work and additional connected workflow dependencies.\n- Most non-Coverage-Insight discovery paths are near real time relative to traditional discovery workflows, with RTCOB typically being the longest of those paths.\n- Customers with strict turnaround sensitivity should evaluate Coverage Insight enrollment carefully.\n- Coverage Discovery paths and add-ons are enabled per customer and are not included automatically.\n\nPrimary integration patterns:\n1. Submit a real-time eligibility request as JSON or raw X12 and receive a normalized JSON response.\n2. If enrolled in Coverage Discovery, inspect the real-time response `link` header for related discovery task resources when discovery is automatically triggered from the real-time request/response.\n3. For advanced use cases, submit Coverage Discovery requests directly when you already possess a processed canonical eligibility request and, when needed, a processed eligibility response, and want asynchronous follow-up processing using a callback URL or by polling the discovery task resource.\n4. When using direct discovery, the X12 workflow is often easier than the canonical JSON workflow because it accepts the processed `x12-270` and `x12-271` rather than requiring mapping into both canonical models.\n","version":"v0.2.0"},"servers":[{"url":"https://sandbox-apigw.optum.com","description":"Sandbox server (uses test data)"},{"url":"https://apigw.optum.com","description":"Production server (uses live data)"}],"tags":[{"name":"Eligibility Requests","description":"Submit new real-time eligibility transactions. These endpoints accept either a normalized JSON request or a raw X12 270 payload and return a normalized JSON eligibility response. When a customer is enrolled in integrated Coverage Discovery, these operations may also return related discovery task links in the response headers.\n"},{"name":"Eligibility Transactions","description":"Retrieve previously processed real-time eligibility transactions. Use these endpoints to list transactions, filter by status, date range, patient details, or correlation metadata, and fetch a single transaction record by id for audit, troubleshooting, and downstream workflows.\n"},{"name":"Coverage Discovery","description":"Create and retrieve asynchronous Coverage Discovery tasks. Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. These endpoints support direct submission using either normalized eligibility data or raw X12 payloads, dry-run validation of enrolled discovery paths, polling for task status, and callback-based delivery of completed discovery results.\n"},{"name":"Healthcheck","description":"Verify service availability for the Enhanced Eligibility workflow. Use this endpoint to confirm the API is reachable and the underlying system is healthy before or during integration operations.\n"}],"paths":{"/rcm/eligibility/v1":{"post":{"operationId":"postEligibility","tags":["Eligibility Requests"],"summary":"Submit a new eligibility request","security":[{"oAuth":["create_txn"]}],"description":"## Overview\nProvided a valid request, this endpoint submits a new real-time transaction for processing.\nThe response is JSON and includes the raw `x12-271` response string so clients can extract the payer's original EDI response if needed.\nReal-time response time is driven primarily by payer and clearinghouse latency. The downstream clearinghouse timeout is 2 minutes to accommodate slower payer connectivity and heavy-volume periods.\nIf your organization is enrolled in deduplication, that feature is evaluated before clearinghouse submission. Deduplication is customer-configurable, including the lookback window and whether prior-month requests are excluded. When a duplicate is found, the clearinghouse is skipped and the transaction `sourceType` is `duplicate`.\n## Coverage Discovery Integration\nIf you are enrolled in Coverage Discovery at the time of the request and your configured discovery conditions are met, the Coverage Discovery workflow will be started automatically. Common examples include real-time responses with `status.value` of `ineligible` or `patient_unknown`, or response-side HMO plan information that qualifies an HMO discovery path. In this scenario, the response `link` header contains one or more related Coverage Discovery task resource paths, e.g.:\n`</coverage-discovery/0716e3e8-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Task 1\"; rel=\"related\", </coverage-discovery/0e565a58-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Task 2\"; rel=\"related\"`\nParse this header as RFC 8288-style link values. When more than one discovery task is created, multiple related links may be returned in the same header.\nWhen discovery is triggered from this JSON real-time endpoint, the submitted request body is used as the `canonicalEligibilityRequest` later referenced by Coverage Discovery. If response-side facts are needed, the normalized real-time response body is used as `canonicalEligibilityResponse`.\nEach related resource can be retrieved through the `/coverage-discovery/{id}` endpoint.\nIf conditions are not met, the `link` response header will not contain any related `/coverage-discovery` references.\n### Callback Solution With Consolidated Real-Time Eligibility and Coverage Discovery Responses\nIf you are enrolled in the consolidated callback capability, you may receive the **Real-Time Eligibility (RTE)** response together with the **Coverage Discovery** response.\nWhen enabled, the abbreviated eligibility transaction will be included in the corresponding Coverage Discovery record.\n\n ⚠️ **Note:** This integrated response is **only available via callback** and **only if your organization is enrolled in this capability**.\n\nRefer to the `/coverage-discovery/{id}` response examples for data model references.","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/header-subtenant-id"},{"in":"header","name":"x-optum-eligibility-disable-value-add","schema":{"type":"array","items":{"type":"string","enum":["deduplication"],"example":"deduplication"},"example":"deduplication"},"description":"(Optional) A comma-delimited list of strings that disable value-added features on a request-by-request basis. `deduplication` disables the customer-configured request deduplication feature for that request only. If you specify a value-added feature that you are not enrolled in, it will be ignored."}],"requestBody":{"$ref":"#/components/requestBodies/EligibilityRequest"},"responses":{"200":{"$ref":"#/components/responses/EligibilityResponse"},"400":{"$ref":"#/components/responses/BadRequestError"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/real-time/x12":{"post":{"operationId":"postEligibilityX12","tags":["Eligibility Requests"],"summary":"Submit a new x12-270 eligibility request","security":[{"oAuth":["create_txn"]}],"description":"## Overview\nProvided a valid request, this endpoint accepts a raw EDI X12 270 payload and submits a new real-time transaction for processing.\nThe response uses the same normalized JSON model returned by the JSON real-time endpoint. Both real-time endpoints return JSON, and that JSON includes the raw `x12-271` response string so clients can extract the payer's original EDI response if needed.\nReal-time response time is driven primarily by payer and clearinghouse latency. The downstream clearinghouse timeout is 2 minutes to accommodate slower payer connectivity and heavy-volume periods.\nIf your organization is enrolled in deduplication, that feature is evaluated before clearinghouse submission. Deduplication is customer-configurable, including the lookback window and whether prior-month requests are excluded. When a duplicate is found, the clearinghouse is skipped and the transaction `sourceType` is `duplicate`.\n## Coverage Discovery Integration\nIf you are enrolled in Coverage Discovery at the time of the request and your configured discovery conditions are met, the Coverage Discovery workflow will be started automatically. Common examples include real-time responses with `status.value` of `ineligible` or `patient_unknown`, or response-side HMO plan information parsed from the returned `x12-271`. In this scenario, the response `link` header contains one or more related Coverage Discovery task resource paths, e.g.:\n`</coverage-discovery/0716e3e8-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Task 1\"; rel=\"related\", </coverage-discovery/0e565a58-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Task 2\"; rel=\"related\"`\nParse this header as RFC 8288-style link values. When more than one discovery task is created, multiple related links may be returned in the same header.\nWhen discovery is triggered from this X12 real-time endpoint, the submitted `x12-270` is used to derive the `canonicalEligibilityRequest` used by Coverage Discovery. If response-side facts are needed, the normalized JSON response and its embedded `x12-271` are used as `canonicalEligibilityResponse`.\nEach related resource can be retrieved through the `/coverage-discovery/{id}` endpoint.\nIf conditions are not met, the `link` response header will not contain any related `/coverage-discovery` references.\n### Callback Solution With Consolidated Real-Time Eligibility and Coverage Discovery Responses\nIf you are enrolled in the consolidated callback capability, you may receive the **Real-Time Eligibility (RTE)** response together with the **Coverage Discovery** response.\nWhen enabled, the abbreviated eligibility transaction will be included in the corresponding Coverage Discovery record.\n\n ⚠️ **Note:** This integrated response is **only available via callback** and **only if your organization is enrolled in this capability**.\n\nRefer to the `/coverage-discovery/{id}` response examples for data model references.","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/header-subtenant-id"},{"in":"header","name":"x-optum-eligibility-disable-value-add","schema":{"type":"array","items":{"type":"string","enum":["deduplication"],"example":"deduplication"},"example":"deduplication"},"description":"(Optional) A comma-delimited list of strings that disable value-added features on a request-by-request basis. `deduplication` disables the customer-configured request deduplication feature for that request only. If you specify a value-added feature that you are not enrolled in, it will be ignored."}],"requestBody":{"$ref":"#/components/requestBodies/EligibilityRequestX12"},"responses":{"200":{"$ref":"#/components/responses/EligibilityResponseX12"},"400":{"$ref":"#/components/responses/BadRequestError"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/transactions":{"get":{"tags":["Eligibility Transactions"],"summary":"Find all eligibility transactions","security":[{"oAuth":["read_txn"]}],"description":"Returns matching eligibility transactions. You can use the query parameters listed below to filter the results. If no query parameters are provided, all eligibility transactions will be returned in paginated form.\n","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/query-status"},{"$ref":"#/components/parameters/query-hash"},{"$ref":"#/components/parameters/query-correlationid"},{"$ref":"#/components/parameters/query-patientFirstName"},{"$ref":"#/components/parameters/query-patientLastName"},{"$ref":"#/components/parameters/query-patientAccountNumber"},{"$ref":"#/components/parameters/query-medicalRecordNumber"},{"$ref":"#/components/parameters/query-memberId"},{"$ref":"#/components/parameters/query-patientDateOfBirth"},{"$ref":"#/components/parameters/query-npi"},{"$ref":"#/components/parameters/query-payerId"},{"$ref":"#/components/parameters/query-start-date-time"},{"$ref":"#/components/parameters/query-end-date-time"},{"$ref":"#/components/parameters/query-sort-txns"},{"$ref":"#/components/parameters/query-offset"},{"$ref":"#/components/parameters/query-limit"},{"$ref":"#/components/parameters/query-return-total-count"}],"responses":{"200":{"description":"OK","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"},"link":{"$ref":"#/components/headers/link"},"x-total-count":{"$ref":"#/components/headers/total-count"}},"content":{"application/json":{"schema":{"type":"array","items":{"$ref":"#/components/schemas/Transaction"}}}}},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/transactions/{id}":{"get":{"tags":["Eligibility Transactions"],"summary":"Find eligibility transaction by ID","security":[{"oAuth":["read_txn"]}],"description":"Returns an individual transaction with the corresponding ID, if found.","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/path-txn-id"}],"responses":{"200":{"description":"OK","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Transaction"}}}},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"404":{"$ref":"#/components/responses/NotFoundError"},"422":{"$ref":"#/components/responses/UnprocessableEntityError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/coverage-discovery":{"post":{"operationId":"postDiscovery","tags":["Coverage Discovery"],"summary":"Submit new discovery task(s)","security":[{"oAuth":["create_coveragediscovery"]}],"description":"\n## Overview\n\n__You must be enrolled in the Coverage Discovery feature in order to use this system.__\n\nCoverage Discovery paths and add-ons are enabled per customer and are not included automatically.\n\nCoverage Discovery is an async process that initializes discovery paths based on the task(s) enabled for the customer and on the details of the provided `canonicalEligibilityRequest` and, when available, `canonicalEligibilityResponse`. `canonicalEligibilityRequest` is always required. `canonicalEligibilityResponse` is optional for request-only qualification paths, but should be supplied when path qualification or request-building depends on response-side facts such as response status, payer context, HMO plan information, or Medicare QMB/MBI data. This direct JSON workflow is intended for advanced use cases where the client already has the processed canonical eligibility models available. If successful, the initial response is either a 202 Accepted receipt for a single record or a 207 Multi-Status response if more than one record was produced from the request and the customer has more than one enabled task.\n\nCoverage Discovery is asynchronous because some paths involve chained clearinghouse work and additional connected workflow dependencies. Most non-Coverage-Insight paths are near real time relative to traditional discovery workflows, while RTCOB is typically the longest of those near-real-time paths. Customers with strict turnaround sensitivity should evaluate Coverage Insight enrollment carefully.\nCoverage Discovery paths may also participate in customer-configured deduplication. This can be enabled per path rather than uniformly across every path. RTCOB and Coverage Insight additionally use a separate non-configurable 72-hour request cache. When that cache is hit, the path is added to `discoveryPaths.skipped` instead of creating a new downstream submission.\nTo test if the request meets conditions to generate tasks, see the Dry Run section. \n\nSupported task types are `serial` and `chained`. In `serial` tasks, multiple qualified paths may be initialized under the same task. In `chained` tasks, later paths may depend on the outcome of earlier paths.\n\n## Async Delivery Flow\n\n1. Submit the Coverage Discovery request.\n2. If `dryRun` is `false`, the API accepts work for asynchronous processing.\n3. For single-task execution, a `202 Accepted` response includes a `location` header for the created discovery task resource.\n4. For multi-task execution, a `207 Multi-Status` response returns per-task results, and accepted items include an `href` for each created task resource.\n5. Your callback endpoint later receives the completed task payload asynchronously at `callbackUrl`.\n6. If needed, you can poll `/coverage-discovery/{id}` using the task resource returned in `location` or `href`.\n\n## Dry Run\nTo validate that your request meets expected conditions for the paths enabled for your customer, include `dryRun = true` in the request body. In dry-run mode, the request does not execute discovery, does not create task records, and does not send a callback. Instead, the endpoint validates the request against the enrolled discovery paths. The response indicates which paths qualified and which did not.\n\nIf successful, the first response is a receipt with either a 200 status for a single task or 207 if the request produced more than one per-task outcome. If no paths qualify, a 422 will be returned for a single task, and a 207 for multi-task responses that include one or more 422 results (see `DryRunMultiStatusMixedResponse` example).\n\n### Callback API\nDue to the long-running nature of the discovery process, completed task responses are communicated asynchronously to `request.callbackUrl`. `callbackUrl` is required on this request body, including when `dryRun` is `true`. If this is your first time using callbacks via Swagger, check out the __\"Callbacks\"__ tab next to __\"Parameters\"__.\n\nThe API specified in the `callbackUrl` that will receive the asynchronous response once discovery finishes must meet the customer-specific whitelisting requirements defined by your team. Please reach out to support if you need to configure whitelisting. This API must meet the callback structure documented in the \"CustomerCallbacks\" tab.\n\nYour callback implementation should treat deliveries as asynchronous webhook-style notifications and should be prepared to process the same task idempotently if a delivery is retried. The callback payload uses the same `CoverageDiscoveryTask` model returned by `GET /coverage-discovery/{id}`. The most important fields for most clients are the task `id`, task `status`, any error or failure details, and the embedded real-time eligibility content when callback consolidation is enabled.\n\nIf you are unsure about the details of your request and how they might produce eligible discovery paths, you can use `dryRun` to test the request without executing any transactions. When `dryRun` is enabled, the response is synchronous and the callback is not invoked.\n","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/header-subtenant-id"}],"requestBody":{"$ref":"#/components/requestBodies/DiscoveryRequest"},"callbacks":{"response":{"{$request.body#/callbackUrl}":{"post":{"parameters":[{"$ref":"#/components/parameters/header-tenant-id"},{"$ref":"#/components/parameters/header-correlation-id"}],"requestBody":{"content":{"application/json":{"schema":{"$ref":"#/components/schemas/CoverageDiscoveryTask"},"examples":{"Successful Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccess"},"Successful Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime"},"Successful Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedSuccess"},"Failure Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailure"},"Failure Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime"},"Failure Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedFailure"}}}}},"responses":{"204":{"description":"Return `204 No Content` after successfully accepting and processing the callback payload."}}}}}},"responses":{"200":{"$ref":"#/components/responses/DiscoveryDryRunResponse"},"202":{"$ref":"#/components/responses/DiscoveryAcceptedResponse"},"207":{"$ref":"#/components/responses/DiscoveryMultiStatusResponse"},"400":{"$ref":"#/components/responses/BadRequestError"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"422":{"$ref":"#/components/responses/UnprocessableEntityDiscoveryError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}},"get":{"operationId":"getAllDiscoveries","tags":["Coverage Discovery"],"summary":"Find all discovery tasks","security":[{"oAuth":["read_coveragediscovery"]}],"description":"Retrieves discovery tasks based on the supplied query parameters. When no parameters are provided, the endpoint returns the full set of discovery tasks, delivered in paginated form.\n","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/query-correlationid"},{"$ref":"#/components/parameters/query-task-status"},{"$ref":"#/components/parameters/query-start-date-time"},{"$ref":"#/components/parameters/query-end-date-time"},{"$ref":"#/components/parameters/query-sort-discovery"},{"$ref":"#/components/parameters/query-offset"},{"$ref":"#/components/parameters/query-limit"}],"responses":{"200":{"description":"OK","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"},"link":{"$ref":"#/components/headers/link"}},"content":{"application/json":{"schema":{"type":"array","items":{"$ref":"#/components/schemas/CoverageDiscoveryTask"}}}}},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/coverage-discovery/x12":{"post":{"operationId":"postDiscoveryX12","tags":["Coverage Discovery"],"summary":"Submit new discovery task(s) with EDI","security":[{"oAuth":["create_coveragediscovery"]}],"description":"\n## Overview\n\n__You must be enrolled in the Coverage Discovery feature in order to use this system.__\n\nCoverage Discovery paths and add-ons are enabled per customer and are not included automatically.\n\nCoverage Discovery is an async process that initializes discovery paths based on the task(s) enabled for the customer and on the details of the provided `x12-270` and `x12-271`. Both fields are required. This direct X12 workflow is often simpler than the canonical JSON discovery workflow because it allows clients to submit the processed X12 pair without mapping into two canonical models. If successful, the initial response is either a 202 Accepted receipt for a single record or a 207 Multi-Status response if more than one record was produced from the request and the customer has more than one enabled task.\n\nCoverage Discovery is asynchronous because some paths involve chained clearinghouse work and additional connected workflow dependencies. Most non-Coverage-Insight paths are near real time relative to traditional discovery workflows, while RTCOB is typically the longest of those near-real-time paths. Customers with strict turnaround sensitivity should evaluate Coverage Insight enrollment carefully.\nCoverage Discovery paths may also participate in customer-configured deduplication. This can be enabled per path rather than uniformly across every path. RTCOB and Coverage Insight additionally use a separate non-configurable 72-hour request cache. When that cache is hit, the path is added to `discoveryPaths.skipped` instead of creating a new downstream submission.\nTo test if the request meets conditions to generate tasks, see the Dry Run section.\n\n## Async Delivery Flow\n\n1. Submit the Coverage Discovery request.\n2. If `dryRun` is `false`, the API accepts work for asynchronous processing.\n3. For single-task execution, a `202 Accepted` response includes a `location` header for the created discovery task resource.\n4. For multi-task execution, a `207 Multi-Status` response returns per-task results, and accepted items include an `href` for each created task resource.\n5. Your callback endpoint later receives the completed task payload asynchronously at `callbackUrl`.\n6. If needed, you can poll `/coverage-discovery/{id}` using the task resource returned in `location` or `href`.\n\n## Dry Run\nTo validate that your request meets expected conditions for the paths enabled for your customer, include `dryRun = true` in the request body. In dry-run mode, the request does not execute discovery, does not create task records, and does not send a callback. Instead, the endpoint validates the request against the enrolled discovery paths. The response indicates which paths qualified and which did not.\n\nIf successful, the first response is a receipt with either a 200 status for a single task or 207 if the request produced more than one per-task outcome. If no paths qualify, a 422 will be returned for a single task, and a 207 for multi-task responses that include one or more 422 results (see `DryRunMultiStatusMixedResponse` example).\n\n### Callback API\nDue to the long-running nature of the discovery process, completed task responses are communicated asynchronously to `request.callbackUrl`. `callbackUrl` is required on this request body, including when `dryRun` is `true`.\n\nThe API specified in the `callbackUrl` that will receive the asynchronous response once discovery finishes must meet the customer-specific whitelisting requirements defined by your team. Please reach out to support if you need to configure whitelisting. This API must meet the callback structure documented in the \"CustomerCallbacks\" tab.\n\nYour callback implementation should treat deliveries as asynchronous webhook-style notifications and should be prepared to process the same task idempotently if a delivery is retried. The callback payload uses the same `CoverageDiscoveryTask` model returned by `GET /coverage-discovery/{id}`. The most important fields for most clients are the task `id`, task `status`, any error or failure details, and the embedded real-time eligibility content when callback consolidation is enabled.\n\nIf you are unsure about the details of your request and how they might produce eligible discovery paths, you can use `dryRun` to test the request without executing any transactions. When `dryRun` is enabled, the response is synchronous and the callback is not invoked.\n","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/header-subtenant-id"}],"requestBody":{"$ref":"#/components/requestBodies/DiscoveryRequestX12"},"callbacks":{"response":{"{$request.body#/callbackUrl}":{"post":{"parameters":[{"$ref":"#/components/parameters/header-tenant-id"},{"$ref":"#/components/parameters/header-correlation-id"}],"requestBody":{"content":{"application/json":{"schema":{"$ref":"#/components/schemas/CoverageDiscoveryTask"},"examples":{"Successful Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccess"},"Successful Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime"},"Successful Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedSuccess"},"Failure Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailure"},"Failure Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime"},"Failure Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedFailure"}}}}},"responses":{"204":{"description":"Return `204 No Content` after successfully accepting and processing the callback payload."}}}}}},"responses":{"200":{"$ref":"#/components/responses/DiscoveryDryRunResponse"},"202":{"$ref":"#/components/responses/DiscoveryAcceptedResponse"},"207":{"$ref":"#/components/responses/DiscoveryMultiStatusResponse"},"400":{"$ref":"#/components/responses/BadRequestError"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"422":{"$ref":"#/components/responses/UnprocessableEntityDiscoveryError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/coverage-discovery/{id}":{"get":{"operationId":"getDiscoveryById","tags":["Coverage Discovery"],"summary":"Find discovery task by ID","security":[{"oAuth":["read_coveragediscovery"]}],"description":"Returns an individual discovery response with the corresponding ID, if found.","parameters":[{"$ref":"#/components/parameters/header-correlation-id"},{"$ref":"#/components/parameters/path-discovery-task-id"}],"responses":{"200":{"$ref":"#/components/responses/DiscoveryResponse"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"403":{"$ref":"#/components/responses/ForbiddenError"},"404":{"$ref":"#/components/responses/NotFoundError"},"422":{"$ref":"#/components/responses/UnprocessableEntityError"},"5XX":{"$ref":"#/components/responses/UnexpectedError"}}}},"/rcm/eligibility/v1/healthcheck":{"get":{"tags":["Healthcheck"],"summary":"Validate the status of the system","description":"A healthcheck of the Enhanced Eligibility workflow","security":[{"oAuth":["read_healthcheck"]}],"operationId":"healthcheck","responses":{"200":{"$ref":"#/components/responses/HealthcheckHealthyResponse"},"401":{"$ref":"#/components/responses/PermissionDeniedError"},"500":{"$ref":"#/components/responses/HealthcheckUnhealthyResponse"}}}}},"components":{"securitySchemes":{"oAuth":{"type":"oauth2","description":"This API uses OAuth 2 with the client_credentials grant flow. [More info](https://api.example.com/docs/auth)","flows":{"clientCredentials":{"tokenUrl":"/apip/auth/v2/token","scopes":{"read_txn":"read transactions","create_txn":"submit a new transaction request","read_coveragediscovery":"read coverage discovery tasks","create_coveragediscovery":"submit a new coverage discovery task","read_healthcheck":"check the status of the system"}}}}},"parameters":{"header-tenant-id":{"in":"header","name":"x-optum-tenant-id","schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"required":true,"description":"The unique ID of the tenant that invoking user belongs to. Used to enforce data tenancy."},"header-correlation-id":{"in":"header","name":"x-optum-correlation-id","schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"required":false,"description":"(Optional) A unique identifier value that is attached to the response that allow reference to the original request. Differs from `x-optum-trace-id` as the correlation-id is stored within the datastore for future queryability."},"header-subtenant-id":{"in":"header","name":"x-optum-subtenant-id","schema":{"type":"string","example":"5e2f9f4f-6f1d-4b37-92b5-6c5a9d1f8a21"},"required":false,"description":"(Optional) Identifies an Optum-assigned sub-tenant configuration for your organization. Include this header only when Optum has provided a value for a specific enabled customer configuration. Clients must not generate or infer this value."},"header-trace-id":{"in":"header","name":"x-optum-trace-id","schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"required":false,"description":"(Optional) A unique identifier value that is attached to the response that allow reference to the original request"},"query-task-status":{"in":"query","name":"status","required":false,"explode":false,"schema":{"type":"string","enum":["success","failure","pending"],"example":"pending","description":"(Optional) When provided, only discovery tasks with the specified status will be returned. Valid values are 'success', 'failure', and 'pending'."}},"query-status":{"in":"query","name":"status","required":false,"explode":false,"schema":{"type":"array","items":{"enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"]}},"description":"(Optional) The status of the eligibility transaction. Valid values match `Transaction.status.value`."},"query-start-date-time":{"in":"query","name":"startDateTime","required":false,"schema":{"type":"string","example":"2017-07-21T17:32:28Z"},"description":"(Optional) The start date for the report. Start date must be before the end date"},"query-end-date-time":{"in":"query","name":"endDateTime","required":false,"schema":{"type":"string","example":"2017-09-21T17:32:28Z"},"description":"(Optional) The end date for the report. Must occur after the provided start date"},"query-hash":{"in":"query","name":"hash","required":false,"schema":{"type":"string"},"description":"(Optional) A generated value for determining the uniqueness of a transaction. This value is a hashed concatenation of demographic data on the transaction"},"query-sort-txns":{"in":"query","name":"sort","required":false,"explode":false,"schema":{"type":"array","items":{"enum":["processedDate","-processedDate"]},"example":["-processedDate"]},"description":"(Optional) The property to order the results of the report by. Defaults to '-processedDate', negative sign is 'desc'"},"query-sort-discovery":{"in":"query","name":"sort","required":false,"explode":false,"schema":{"type":"array","items":{"enum":["startDateTime","-startDateTime"]},"example":["-startDateTime"]},"description":"(Optional) The property to order the results of the report by. Defaults to '-startDateTime', negative sign is 'desc'"},"query-offset":{"in":"query","name":"offset","required":false,"schema":{"type":"integer"},"description":"(Optional) Pagination. The offset number to retrieve, which is determined by the limit. For example,if limit is 30 and offset is 0, then the response data will include records 1~30; If offset is 30 and limit is 30 then the response data will include records 30~59."},"query-limit":{"in":"query","name":"limit","schema":{"type":"integer","nullable":true,"minimum":1,"maximum":100,"example":30},"description":"(Optional) Number of transactions to return per page. Must be greater than 0 and less than or equal to 100. Defaults to 30."},"query-return-total-count":{"in":"query","name":"returnTotalCount","schema":{"type":"boolean","nullable":true,"example":true},"description":"(Optional) Whether or not to return the total number of records matching the supplied query parameters under the x-total-number HTTP response header. Defaults to false"},"query-correlationid":{"in":"query","name":"correlationId","schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"description":"(Optional) The correlationId associated with the original request."},"query-patientFirstName":{"in":"query","name":"patientFirstName","schema":{"type":"string","example":"Jane"},"description":"(Optional) Patient's first name."},"query-patientLastName":{"in":"query","name":"patientLastName","schema":{"type":"string","example":"Doe"},"description":"(Optional) Patient's last name."},"query-patientAccountNumber":{"in":"query","name":"patientAccountNumber","schema":{"type":"string","example":"38300904"},"description":"(Optional) Patient's account number."},"query-medicalRecordNumber":{"in":"query","name":"medicalRecordNumber","schema":{"type":"string","example":"194570"},"description":"(Optional) Medical Record Number."},"query-memberId":{"in":"query","name":"memberId","schema":{"type":"string","example":"XKY933M53442"},"description":"(Optional) Member Id."},"query-patientDateOfBirth":{"in":"query","name":"patientDateOfBirth","schema":{"type":"string","example":"1995-01-15"},"description":"(Optional) Patient's date of birth."},"query-npi":{"in":"query","name":"npi","schema":{"type":"string","example":"1234567890"},"description":"(Optional) NPI of the primary care provider."},"query-payerId":{"in":"query","name":"payerId","schema":{"type":"string","example":"12345"},"description":"(Optional) Payer ID (CHC ID)."},"path-txn-id":{"in":"path","name":"id","description":"The unique ID of the target transaction","required":true,"schema":{"type":"string","example":"36743735-3303-4d9d-9f21-20dd5f6d7ab2"}},"path-discovery-task-id":{"in":"path","name":"id","description":"The unique ID of the target discovery task","required":true,"schema":{"type":"string","example":"36743735-3303-4d9d-9f21-20dd5f6d7ab2"}}},"headers":{"tenantid":{"schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"description":"The unique ID of the tenant that invoking user belongs to. Used to enforce data tenancy."},"correlationid":{"schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"description":"A unique identifier value that is attached to the response that allow reference to the original request. Differs from `x-optum-trace-id` as the correlation-id is stored within the datastore for future queryability."},"subtenantid":{"schema":{"type":"string","example":"5e2f9f4f-6f1d-4b37-92b5-6c5a9d1f8a21"},"description":"(Optional) Identifies an Optum-assigned sub-tenant configuration for your organization. Include this header only when Optum has provided a value for a specific enabled customer configuration. Clients must not generate or infer this value."},"location":{"schema":{"type":"string","example":"/coverage-discovery/09876z5y-43x2-1w09-v8u7-tr6543s210qp"},"description":"Relative path of the created Coverage Discovery task resource. Clients can `GET` this path to poll task status when they are not relying solely on callback delivery."},"link":{"schema":{"type":"string","example":"</?limit=30&offset=2>; rel=\"next\""},"description":"RFC 8288-style pagination link header used by list endpoints such as `GET /transactions` and `GET /coverage-discovery`. This header is separate from the related-task `link` header used by real-time eligibility responses."},"rte-link":{"schema":{"type":"string","example":"</coverage-discovery/0716e3e8-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Default Discovery Task\"; rel=\"related\", </coverage-discovery/0e565a58-87ee-11ee-b9d1-0242ac120002>; title=\"coverage discovery - Chained Discovery Task\"; rel=\"related\""},"description":"(Optional) RFC 8288-style related-resource link header returned by real-time eligibility POST responses when Coverage Discovery task(s) are spawned. The header may include one or more related task paths. Each related path can be used with `GET /coverage-discovery/{id}` to retrieve task status. If you are enrolled in Coverage Discovery and this header is absent, no Coverage Discovery task was initiated for that transaction."},"traceid":{"schema":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"description":"A unique identifier value that is attached to the response that allow reference to the original request."},"total-count":{"schema":{"type":"string","example":"1440"},"description":"The total number of records associated with the query. For example, with the query `?correlationId=123456579`, `x-total-count` returns the total amount of records associated with the given correlationId."}},"requestBodies":{"EligibilityRequest":{"description":"New real-time eligibility transaction request.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/EligibilityRequest"},"examples":{"Eligibility Request Minimal":{"$ref":"#/components/examples/EligibilityRequestMinimal"},"Eligibility Request Expanded":{"$ref":"#/components/examples/EligibilityRequestExpanded"},"RTE JSON Request Feeding Coverage Discovery":{"$ref":"#/components/examples/RTEEligibilityRequestCoverageDiscoveryCandidate"},"RTE JSON Request Feeding HMO Discovery":{"$ref":"#/components/examples/RTEEligibilityRequestHMOCandidate"}}}},"required":true},"EligibilityRequestX12":{"description":"New real-time eligibility transaction request using raw X12.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/EligibilityRequestX12"},"examples":{"RTE X12 Request Feeding Coverage Discovery":{"$ref":"#/components/examples/RTEEligibilityRequestX12CoverageDiscoveryCandidate"},"RTE X12 Request Feeding HMO Discovery":{"$ref":"#/components/examples/RTEEligibilityRequestX12HMOCandidate"}}}},"required":true},"DiscoveryRequest":{"description":"New Coverage Discovery request using normalized eligibility request and response payloads.","content":{"application/json":{"schema":{"type":"object","description":"`canonicalEligibilityRequest` and `callbackUrl` are required. `canonicalEligibilityResponse` is optional for request-only qualification paths, but should be supplied when path qualification or request-building depends on response-side facts such as response status, payer context, HMO plan information, or Medicare QMB/MBI data. Set `dryRun` to `true` to validate paths without creating discovery records.","required":["canonicalEligibilityRequest","callbackUrl"],"properties":{"canonicalEligibilityRequest":{"$ref":"#/components/schemas/EligibilityRequest"},"canonicalEligibilityResponse":{"allOf":[{"$ref":"#/components/schemas/Transaction"},{"type":"object","properties":{"metadata":{"type":"object","properties":{"canonicalizerVersion":{"type":"string","example":"1.0.0","description":"version of the clearinghouse to canonical mapper"},"clearinghouse":{"type":"string","enum":["CLR","CI","IMN"],"example":"IMN","description":"clearinghouse that processed the request"},"clearinghouseRequest":{"type":"string","description":"A stringified version of the JSON request sent to the clearinghouse","example":"{\"type\":\"clearinghouseRequest\",\"foo\":\"bar\"}"},"clearinghouseResponse":{"type":"string","description":"A stringified version of the JSON response received from the clearinghouse","example":"{\"type\":\"clearinghouseResponse\",\"foo\":\"bar\"}"},"customerRequest":{"type":"string","description":"A stringified version of the JSON request sent by the customer","example":"{\"type\":\"customerRequest\",\"foo\":\"bar\"}"},"x12-270":{"type":"string","description":"The received 270 message for the transaction"}},"description":"Data captured during the processing of an Eligibility Transaction."}}},{"description":"Optional canonical transaction response that was previously processed by the RCMC Eligibility engine. Supply this when the configured paths rely on response-side facts. HMO is a response-required path."}]},"callbackUrl":{"type":"string","example":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses","description":"The URL of the consumer-owned API that will receive an asynchronous callback once discovery finishes. This field is required on the request body, including when `dryRun` is `true`. When `dryRun` is `true`, the callback is not invoked. The URL must meet the customer-specific whitelisting requirements defined by your team and the callback structure documented in the \"CustomerCallbacks\" tab. Your callback handler should be prepared to process retries idempotently.\n"},"dryRun":{"type":"boolean","example":false,"description":"When set to true, no discovery paths will be initialized, but instead will evaluate the request and respond with the discovery paths that are configured and meet validation requirements. Use this as a tool to test the request input."}}},"examples":{"Coverage Discovery Request":{"$ref":"#/components/examples/CoverageDiscoveryRequest"},"Coverage Discovery Request Request Only":{"$ref":"#/components/examples/CoverageDiscoveryRequestRequestOnly"},"Coverage Discovery Request HMO Response Driven":{"$ref":"#/components/examples/CoverageDiscoveryRequestHMO"},"Coverage Discovery Request Medicare Response Driven":{"$ref":"#/components/examples/CoverageDiscoveryRequestMedicareQMB"},"Dry Run Request":{"$ref":"#/components/examples/CoverageDiscoveryRequestDryRun"}}}}},"DiscoveryRequestX12":{"description":"New Coverage Discovery request using raw X12 request and response payloads.","content":{"application/json":{"schema":{"type":"object","description":"`x12-270`, `x12-271`, and `callbackUrl` are required. These fields represent the original eligibility inquiry and response in raw X12 form. Set `dryRun` to `true` to validate paths without creating discovery records.","required":["x12-270","x12-271","callbackUrl"],"properties":{"x12-270":{"type":"string","description":"Raw X12 270 eligibility inquiry payload."},"x12-271":{"type":"string","description":"Raw X12 271 eligibility response payload."},"callbackUrl":{"type":"string","example":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses","description":"The URL of the consumer-owned API that will receive an asynchronous callback once discovery finishes. This field is required on the request body, including when `dryRun` is `true`. When `dryRun` is `true`, the callback is not invoked. The URL must meet the customer-specific whitelisting requirements defined by your team and the callback structure documented in the \"CustomerCallbacks\" tab. Your callback handler should be prepared to process retries idempotently.\n"},"dryRun":{"type":"boolean","example":false,"description":"When set to true, no discovery paths will be initialized, but instead will evaluate the request and respond with the discovery paths that are configured and meet validation requirements. Use this as a tool to test the request input."}}},"examples":{"Coverage Discovery Request":{"$ref":"#/components/examples/CoverageDiscoveryRequestX12"},"Dry Run Request":{"$ref":"#/components/examples/CoverageDiscoveryRequestX12DryRun"}}}}}},"responses":{"BadRequestError":{"description":"Bad request.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"},"example":["Failed Precondition - Field 'example' is required"]}}},"PermissionDeniedError":{"description":"Unauthorized.","headers":{"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"}},"content":{"application/json":{"schema":{"type":"object","properties":{"error":{"type":"string","example":"invalid_product"},"error_description":{"type":"string","example":"Permission Denied."},"traceId":{"type":"string","example":"942537e6-d544-ed7c-469b-a27efc4a6cff"}}}}}},"NotFoundError":{"description":"Not found.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"},"example":["Not Found - record not found"]}}},"UnexpectedError":{"description":"Unexpected error.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"}}}},"ForbiddenError":{"description":"Forbidden.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"},"example":["invalid tenant id"]}}},"UnprocessableEntityError":{"description":"Unprocessable Entity.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"},"example":["Unprocessable Entity - Unable to deserialize record"]}}},"UnprocessableEntityDiscoveryError":{"description":"Unprocessable Entity.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"},"example":["Unprocessable Resource - Task chained discover task: No discovery paths qualified for execution. Please use the dryRun field to validate your input produces the expected paths prior to submitting the next request."]}}},"ConflictError":{"description":"Conflict.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Error"}}}},"EligibilityResponse":{"description":"OK. Returns the normalized real-time eligibility response. If Coverage Discovery was automatically started, the response `link` header contains related discovery task resource path(s).","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"},"link":{"$ref":"#/components/headers/rte-link"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Transaction"},"examples":{"RTE Response Patient Unknown":{"$ref":"#/components/examples/RTEEligibilityResponsePatientUnknown"},"RTE Response Ineligible":{"$ref":"#/components/examples/RTEEligibilityResponseIneligible"},"RTE Response HMO":{"$ref":"#/components/examples/RTEEligibilityResponseHMO"}}}}},"EligibilityResponseX12":{"description":"OK. Returns a normalized JSON representation of the X12 271 response, not a raw X12 payload.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"},"link":{"$ref":"#/components/headers/rte-link"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/TransactionMedicare"},"examples":{"RTE Response Patient Unknown":{"$ref":"#/components/examples/RTEEligibilityResponsePatientUnknown"},"RTE Response Ineligible":{"$ref":"#/components/examples/RTEEligibilityResponseIneligible"},"RTE Response HMO":{"$ref":"#/components/examples/RTEEligibilityResponseHMO"}}}}},"DiscoveryAcceptedResponse":{"description":"Accepted. The request was accepted for asynchronous Coverage Discovery processing. Use the `location` header to poll the created task resource if needed.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"},"location":{"$ref":"#/components/headers/location"}},"content":{"application/json":{"schema":{"type":"object","properties":{"id":{"type":"string","example":"d0747d80-ed4e-4af9-b127-1277fb472c44","description":"Unique identifier of the newly created task record."},"name":{"type":"string","example":"serial discover task","description":"Customer-appointed name that ascribes meaning and/or business need for task. Defined during enrollment. If no name is provided by customer, the Product team will provide a default value."}}}}}},"DiscoveryMultiStatusResponse":{"description":"Multi-Status. The request produced multiple per-task outcomes. Each item contains the task-specific status and, for accepted items, an `href` to the created discovery task resource.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"type":"array","description":"List of per-task results returned when a request produces multiple task outcomes.","items":{"$ref":"#/components/schemas/DiscoveryMultiStatusItem"}},"examples":{"MultiStatus Response":{"$ref":"#/components/examples/MultiStatusResponseSuccess"},"DryRun MultiStatus Response":{"$ref":"#/components/examples/DryRunMultiStatusSuccessful"},"DryRun MultiStatus Mixed Response":{"$ref":"#/components/examples/DryRunMultiStatusMixedResponse"}}}}},"DiscoveryDryRunResponse":{"description":"OK. Synchronous dry-run validation result. No Coverage Discovery task record was created and no callback will be delivered.","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-subtenant-id":{"$ref":"#/components/headers/subtenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/CoverageDiscoveryDryRunResult"},"examples":{"DryRun Serial Response Two Tasks Pending":{"$ref":"#/components/examples/DryRunSerialTwoPending"},"DryRun Serial Response All Pending":{"$ref":"#/components/examples/DryRunSerialAllPending"}}}}},"DiscoveryResponse":{"description":"OK","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/CoverageDiscoveryTask"},"examples":{"Successful Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccess"},"Successful Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialSuccessRealTime"},"Successful Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedSuccess"},"Failure Serial Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailure"},"Failure Serial Task With Real Time Response":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskSerialFailureRealTime"},"Failure Chained Task":{"$ref":"#/components/examples/GetCoverageDiscoveryTaskChainedFailure"}}}}},"HealthcheckHealthyResponse":{"description":"OK","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"type":"object","properties":{"status":{"type":"string","example":"ok"}}}}}},"HealthcheckUnhealthyResponse":{"description":"Internal Server Error","headers":{"x-optum-tenant-id":{"$ref":"#/components/headers/tenantid"},"x-optum-correlation-id":{"$ref":"#/components/headers/correlationid"},"x-optum-trace-id":{"$ref":"#/components/headers/traceid"}},"content":{"application/json":{"schema":{"type":"object","properties":{"status":{"type":"string","example":"unhealthy"}}}}}}},"schemas":{"Error":{"description":"The base object model for errors returned from the workflow","type":"array","items":{"type":"string","example":"Internal - An unknown error occurred"}},"CoverageDiscoveryDryRunPath":{"type":"object","properties":{"name":{"type":"string","description":"The configured discovery path name."},"description":{"type":"string","description":"A brief description of the discovery path."},"reason":{"type":"string","description":"Why the path failed validation or is included in the returned set."}}},"CoverageDiscoveryDryRunResult":{"type":"object","description":"Synchronous validation result returned when `dryRun` is `true`. No task record is created.","properties":{"successful":{"type":"array","description":"Discovery paths whose rules validated successfully during the dry run.","items":{"$ref":"#/components/schemas/CoverageDiscoveryDryRunPath"}},"unsuccessful":{"type":"array","description":"Discovery paths that failed validation during the dry run.","items":{"$ref":"#/components/schemas/CoverageDiscoveryDryRunPath"}},"pending":{"type":"array","description":"Discovery paths that would be attempted if the request were executed.","items":{"$ref":"#/components/schemas/CoverageDiscoveryDryRunPath"}}}},"DiscoveryAcceptedReceipt":{"type":"object","description":"Accepted task creation receipt.","properties":{"id":{"type":"string","description":"Unique identifier of the newly created task record."},"name":{"type":"string","description":"Customer-appointed name that ascribes meaning and/or business need for the task."}}},"DiscoveryMultiStatusItem":{"type":"object","description":"Per-task result returned within a 207 response.","properties":{"status":{"type":"integer","description":"HTTP status code associated with the individual task result."},"body":{"oneOf":[{"$ref":"#/components/schemas/DiscoveryAcceptedReceipt"},{"$ref":"#/components/schemas/CoverageDiscoveryDryRunResult"},{"type":"string","description":"Error message for the individual task result."}]},"href":{"type":"string","description":"Relative resource path for a created task. Present for accepted task-creation results."}}},"EligibilityRequest":{"type":"object","description":"Standalone JSON representation of a standard 270 eligibility request. This schema is fully inlined into this spec so the API definition stands on its own.","required":["controlNumber","subscriber"],"properties":{"submitterTransactionIdentifier":{"type":"string","description":"BHT03"},"controlNumber":{"type":"string","minLength":9,"maxLength":9,"description":"Segment: ISA, Element: ISA13, Notes: Required, Interchange Control Number - must be exactly 9 positive unsigned numeric characters.","example":"123456789"},"tradingPartnerServiceId":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI","example":"serviceId"},"tradingPartnerName":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name"},"provider":{"type":"object","properties":{"organizationName":{"type":"string","minLength":0,"maxLength":60,"description":"Loop: 2100B Segment: NM1, Element: NM103","example":"provider_name"},"firstName":{"type":"string","minLength":0,"maxLength":35,"description":"Loop: 2100B Segment: NM1, Element: NM104"},"lastName":{"type":"string","minLength":0,"maxLength":60,"description":"Loop: 2100B Segment: NM1, Element: NM103"},"npi":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=XX Centers for Medicare and Medicaid Services National Provider Identifier","example":"0123456789"},"serviceProviderNumber":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=SV Service Provider Number","example":"54321"},"payorId":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=PI Payor Identification"},"taxId":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=FI Federal Taxpayer's Identification Number"},"ssn":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=34 Social Security Number"},"pharmacyProcessorNumber":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=PP Pharmacy Processor Number"},"servicesPlanID":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=XV Centers for Medicare and Medicaid Services PlanID"},"employersId":{"type":"string","minLength":0,"maxLength":80,"description":"Loop: 2100B Segment: NM1, Element: NM109, Notes: NM108=24 Employer's Identification Number"},"providerCode":{"type":"string","description":"Loop: 2100B Segment: PRV, Element: PRV01","example":"AD","enum":["AD","AT","BI","CO","CV","H","HH","LA","OT","P1","P2","PC","PE","R","RF","SB","SK","SU"]},"referenceIdentification":{"type":"string","description":"Loop: 2100B Segment: PRV, Element: PRV03","example":"54321g"},"providerType":{"type":"string","description":"Loop: 2100B Segment: NM1, Element: NM101","enum":["payer","third-party administrator","employer","hospital","facility","gateway provider","plan sponsor","provider"]}}},"portalUsername":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: User Identification REF01=JD"},"portalPassword":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: Personal Identification Number (PIN) REF01=4A"},"informationReceiverName":{"type":"object","properties":{"stateLicenceNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=0B State License Number"},"medicareProviderNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1C Medicare Provider Number"},"medicaidProviderNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1D Medicaid Provider Number"},"facilityIdNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=1J Facility ID Number"},"contactNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=CT Contact Number"},"devicePinNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=EL Electronic Device Pin Number"},"submitterIdNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=EO Submitter Identification Number"},"nationalProviderIdentifier":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=HPI Centers for Medicare and Medicaid Services National Provider Identifier"},"providerPlanNetworkIdNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=N5 Provider Plan Network Identification Number"},"facilityNetworkIdNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=N7 Facility Network Identification Number"},"priorIdentifierNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=Q4 Prior Identifier Number"},"socialSecurityNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number"},"federalTaxpayerIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF02, Notes: REF01=TJ Federal Taxpayer's Identification Number"},"informationReceiverAdditionalIdentifierState":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100B, Segment: REF, Element: REF03, Notes: REF01=0B REF02=stateLicenceNumber"},"address":{"type":"object","properties":{"address1":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N301, Notes: Required, Address Information","example":"123 address1"},"address2":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N302, Notes: Address Information"},"city":{"type":"string","minLength":0,"maxLength":30,"description":"Segment: N4, Element: N401, Notes: Required, city","example":"city1"},"state":{"type":"string","minLength":0,"maxLength":2,"description":"Segment: N4, Element: N402, Notes: state example: TN, WA","example":"wa"},"postalCode":{"type":"string","minLength":0,"maxLength":15,"description":"Segment: N4, Element: N403","example":"981010000"},"countryCode":{"type":"string","description":"Segment: N4, Element: N404"},"locationIdentifier":{"type":"string","description":"Segment: N4, Element: N406"},"countrySubDivisionCode":{"type":"string","description":"Segment: N4, Element: N407, Notes: Country SubDivision Code"}}}}},"subscriber":{"type":"object","properties":{"birthSequenceNumber":{"type":"string","minLength":0,"maxLength":9,"pattern":"^[0-9]+$","description":"Loop: 2100C Segment: INS, Element: INS17, Notes: Birth Sequence Number"},"caseNumber":{"type":"string","minLength":0,"maxLength":50,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2100C Segment: REF, Element: REF02, Notes: REF01=3H Case Number"},"medicaidRecipientIdentificationNumber":{"type":"string","minLength":0,"maxLength":80,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2110C Segment: REF, Element: REF02, Notes: REF01=NQ Medicaid Recipient Identification Number"},"spendDownAmount":{"type":"string","minLength":0,"maxLength":18,"description":"Loop: 2110C Segment: ATM, Element: ATM02, Notes: ATM01=R Spend Down"},"spendDownTotalBilledAmount":{"type":"string","minLength":0,"maxLength":18,"description":"Loop: 2110C Segment: ATM, Element: ATM02, Notes: ATM01=PB Billed Amount"},"coverageLevelCode":{"type":"string","minLength":0,"maxLength":3,"description":"Loop: 2110C Segment: EQ, Element: EQ03, Notes: Retired, Not Used"},"memberId":{"type":"string","minLength":0,"maxLength":80,"pattern":"^[A-Za-z0-9-]+$","description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM109, Notes: NM108=MI","example":"0000000000"},"firstName":{"type":"string","minLength":0,"maxLength":35,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM104","example":"johnOne"},"middleName":{"type":"string","minLength":0,"maxLength":25,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM105"},"lastName":{"type":"string","minLength":0,"maxLength":60,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM103","example":"doeOne"},"suffix":{"type":"string","minLength":0,"maxLength":10,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM107"},"gender":{"type":"string","minLength":0,"maxLength":1,"description":"Loop: 2100C and 2100D, Segment: DMG, Element: DMG03","example":"M","enum":["M","F"]},"dateOfBirth":{"type":"string","description":"Loop: 2100C and 2100D, Segment: DMG, Element: DMG02, Notes: date of birth in YYYYMMDD","example":"18800102"},"ssn":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number"},"groupNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=6P Group Number","example":"1111111111"},"idCard":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=HJ Identity Card Number"},"providerCode":{"type":"string","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV01","enum":["AD","AT","BI","CO","CV","H","HH","LA","OT","P1","P2","PC","PE","R","RF","SK","SU"]},"referenceIdentificationQualifier":{"type":"string","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV02","enum":["9K","D3","EI","HPI","PXC","SY","TJ"]},"providerIdentifier":{"type":"string","minLength":0,"maxLength":50,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV03, Notes: Provider Identifier"},"beginningCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired"},"endCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired"},"idCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=D8 Retired"},"planIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=D8 Retired"},"beginningPlanIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired"},"endPlanIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired"},"healthCareCodeInformation":{"type":"array","minItems":0,"maxItems":8,"description":"Loop: 2100C and 2100D, Segment: HI, Notes: Health Care Diagnosis","items":{"type":"object","properties":{"diagnosisTypeCode":{"type":"string","description":"Loop: 2100C and 2100D, Segment: HI, Element: HI01-1, Notes: Diagnosis Type Code","enum":["BK","ABK","BF","ABF"]},"diagnosisCode":{"type":"string","minLength":0,"maxLength":30,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2100C and 2100D, Segment: HI, Element: HI01-2, Notes: Diagnosis Code"}}}},"address":{"type":"object","properties":{"address1":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N301, Notes: Required, Address Information","example":"123 address1"},"address2":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N302, Notes: Address Information"},"city":{"type":"string","minLength":0,"maxLength":30,"description":"Segment: N4, Element: N401, Notes: Required, city","example":"city1"},"state":{"type":"string","minLength":0,"maxLength":2,"description":"Segment: N4, Element: N402, Notes: state example: TN, WA","example":"wa"},"postalCode":{"type":"string","minLength":0,"maxLength":15,"description":"Segment: N4, Element: N403","example":"981010000"},"countryCode":{"type":"string","description":"Segment: N4, Element: N404"},"locationIdentifier":{"type":"string","description":"Segment: N4, Element: N406"},"countrySubDivisionCode":{"type":"string","description":"Segment: N4, Element: N407, Notes: Country SubDivision Code"}}},"additionalIdentification":{"type":"object","properties":{"planNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=18 Plan Number"},"policyNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1L Group or Policy Number"},"memberIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1W Member Identification Number"},"contractNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=CT Contract Number"},"medicalRecordIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EA Medical Record Identification Number"},"patientAccountNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EJ Patient Account Number"},"healthInsuranceClaimNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=F6 Health Insurance (HIC) Number"},"identificationCardSerialNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=GH Identification Card Serial Number"},"insurancePolicyNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=IG Insurance Policy Number"},"planNetworkIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=N6 Plan Network Identification Number"},"agencyClaimNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=Y4 Agency Claim Number"}}}}},"dependents":{"type":"array","minItems":1,"description":"Loop: 2000D, Notes: Dependent Detail","items":{"type":"object","properties":{"birthSequenceNumber":{"type":"string","minLength":0,"maxLength":9,"pattern":"^[0-9]+$","description":"Loop: 2100D Segment: INS, Element: INS17, Notes: Birth Sequence Number"},"individualRelationshipCode":{"type":"string","description":"Loop: 2100D Segment: INS, Element: INS02","enum":["01","19","34"]},"issueNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100D Segment: REF, Element: REF02, Notes: REF01=IF Issue Number"},"eligibilityCategory":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100D Segment: REF, Element: REF02, Notes: REF01=MRC Eligibility Category"},"memberId":{"type":"string","minLength":2,"maxLength":80,"pattern":"^[A-Za-z0-9-]+$","description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM109, Notes: NM108=MI","example":"0000000000"},"firstName":{"type":"string","minLength":0,"maxLength":35,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM104","example":"janeOne"},"middleName":{"type":"string","minLength":0,"maxLength":25,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM105"},"lastName":{"type":"string","minLength":0,"maxLength":60,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM103","example":"doeOne"},"suffix":{"type":"string","minLength":0,"maxLength":10,"description":"Loop: 2100C and 2100D, Segment: NM1, Element: NM107"},"gender":{"type":"string","minLength":0,"maxLength":1,"description":"Loop: 2100C and 2100D, Segment: DMG, Element: DMG03","example":"F","enum":["M","F"]},"dateOfBirth":{"type":"string","description":"Loop: 2100C and 2100D, Segment: DMG, Element: DMG02, Notes: date of birth in YYYYMMDD","example":"18160421"},"ssn":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=SY Social Security Number"},"groupNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=6P Group Number","example":"1111111111"},"idCard":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=HJ Identity Card Number"},"providerCode":{"type":"string","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV01","enum":["AD","AT","BI","CO","CV","H","HH","LA","OT","P1","P2","PC","PE","R","RF","SK","SU"]},"referenceIdentificationQualifier":{"type":"string","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV02","enum":["9K","D3","EI","HPI","PXC","SY","TJ"]},"providerIdentifier":{"type":"string","minLength":0,"maxLength":50,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2100C and 2100D, Segment: PRV, Element: PRV03, Notes: Provider Identifier"},"beginningCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired"},"endCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=RD8 Retired"},"idCardIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=102, DTP02=D8 Retired"},"planIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=D8 Retired"},"beginningPlanIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired"},"endPlanIssueDate":{"type":"string","description":"Loop: 2110C and 2110D, Segment: DTP, Element: DTP03, Notes: DTP01=291, DTP02=RD8 Retired"},"healthCareCodeInformation":{"type":"array","minItems":0,"maxItems":8,"description":"Loop: 2100C and 2100D, Segment: HI, Notes: Health Care Diagnosis","items":{"type":"object","properties":{"diagnosisTypeCode":{"type":"string","description":"Loop: 2100C and 2100D, Segment: HI, Element: HI01-1, Notes: Diagnosis Type Code","enum":["BK","ABK","BF","ABF"]},"diagnosisCode":{"type":"string","minLength":0,"maxLength":30,"pattern":"^[A-Za-z0-9]+$","description":"Loop: 2100C and 2100D, Segment: HI, Element: HI01-2, Notes: Diagnosis Code"}}}},"address":{"type":"object","properties":{"address1":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N301, Notes: Required, Address Information","example":"123 address1"},"address2":{"type":"string","minLength":0,"maxLength":55,"description":"Segment: N3, Element: N302, Notes: Address Information"},"city":{"type":"string","minLength":0,"maxLength":30,"description":"Segment: N4, Element: N401, Notes: Required, city","example":"city1"},"state":{"type":"string","minLength":0,"maxLength":2,"description":"Segment: N4, Element: N402, Notes: state example: TN, WA","example":"wa"},"postalCode":{"type":"string","minLength":0,"maxLength":15,"description":"Segment: N4, Element: N403","example":"981010000"},"countryCode":{"type":"string","description":"Segment: N4, Element: N404"},"locationIdentifier":{"type":"string","description":"Segment: N4, Element: N406"},"countrySubDivisionCode":{"type":"string","description":"Segment: N4, Element: N407, Notes: Country SubDivision Code"}}},"additionalIdentification":{"type":"object","properties":{"planNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=18 Plan Number"},"policyNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1L Group or Policy Number"},"memberIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=1W Member Identification Number"},"contractNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=CT Contract Number"},"medicalRecordIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EA Medical Record Identification Number"},"patientAccountNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=EJ Patient Account Number"},"healthInsuranceClaimNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=F6 Health Insurance (HIC) Number"},"identificationCardSerialNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=GH Identification Card Serial Number"},"insurancePolicyNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=IG Insurance Policy Number"},"planNetworkIdentificationNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=N6 Plan Network Identification Number"},"agencyClaimNumber":{"type":"string","minLength":0,"maxLength":50,"description":"Loop: 2100C and 2100D, Segment: REF, Element: REF02, Notes: REF01=Y4 Agency Claim Number"}}}}}},"encounter":{"type":"object","properties":{"beginningDateOfService":{"type":"string","description":"Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=RD8, Date Expressed in Format YYYYMMDD."},"endDateOfService":{"type":"string","description":"Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=RD8, Date Expressed in Format YYYYMMDD."},"dateOfService":{"type":"string","description":"Loop: 2100C and 2100D, Segment: DTP, Element: DTP03, Notes: DTP01=291 and DTP02=D8, Date Expressed in Format YYYYMMDD."},"serviceTypeCodes":{"type":"array","minItems":0,"maxItems":99,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ01, Notes: Service Type Codes.","items":{"type":"string","enum":["1","2","3","4","5","6","7","8","9","10","11","12","13","14","15","16","17","18","19","20","21","22","23","24","25","26","27","28","30","32","33","34","35","36","37","38","39","40","41","42","43","44","45","46","47","48","49","50","51","52","53","54","55","56","57","58","59","60","61","62","63","64","65","66","67","68","69","70","71","72","73","74","75","76","77","78","79","80","81","82","83","84","85","86","87","88","89","90","91","92","93","94","95","96","97","98","99","A0","A1","A2","A3","A4","A5","A6","A7","A8","A9","AA","AB","AC","AD","AE","AF","AG","AH","AI","AJ","AK","AL","AM","AN","AO","AQ","AR","B1","B2","B3","BA","BB","BC","BD","BE","BF","BG","BH","BI","BJ","BK","BL","BM","BN","BP","BQ","BR","BS","BT","BU","BV","BW","BX","BY","BZ","C1","CA","CB","CC","CD","CE","CF","CG","CH","CI","CJ","CK","CL","CM","CN","CO","CP","CQ","DG","DM","DS","GF","GN","GY","IC","MH","NI","ON","PT","PU","RN","RT","TC","TN","UC"]}},"priorAuthorizationOrReferralNumber":{"type":"string","description":"Loop: 2110C and 2110D, Segment: REF, Element: REF02, Notes: Prior Authorization or Referral Number"},"referenceIdentificationQualifier":{"type":"string","description":"Loop: 2110C and 2110D, Segment: REF, Element: REF01, Notes: Prior Authorization or Referral Number","enum":["9F","G1"]},"industryCode":{"type":"string","description":"Loop: 2110C and 2110D, Segment: III, Element: III02, Notes: III01=ZZ Industry Code","enum":["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"]},"productOrServiceIDQualifier":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1, Notes: Composite Medical Procedure Identifier - Product or Service ID Qualifier","enum":["AD","CJ","HC","ID","IV","N4","ZZ"]},"procedureCode":{"type":"string","minLength":0,"maxLength":48,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-2, Notes: Composite Medical Procedure Identifier - Procedure Code"},"procedureModifiers":{"type":"array","minItems":0,"maxItems":4,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier","items":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier"}},"diagnosisCodePointer":{"type":"array","minItems":0,"maxItems":4,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer","items":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer"}},"medicalProcedures":{"type":"array","minItems":0,"maxItems":98,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1-3, Notes: Composite Medical Procedure Identifier","items":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-1, Notes: Composite Medical Procedure Identifier - Product or Service ID Qualifier","enum":["AD","CJ","HC","ID","IV","N4","ZZ"]},"procedureCode":{"type":"string","minLength":0,"maxLength":48,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-2, Notes: Composite Medical Procedure Identifier - Procedure Code"},"procedureModifiers":{"type":"array","minItems":0,"maxItems":4,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier","items":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ02-3, Notes: Composite Medical Procedure Identifier - Procedure Modifier"}},"diagnosisCodePointer":{"type":"array","minItems":0,"maxItems":4,"description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer","items":{"type":"string","description":"Loop: 2110C and 2110D, Segment: EQ, Element: EQ05, Notes: Composite Diagnosis Code Pointer"}}}}}}}}},"EligibilityRequestX12":{"type":"object","description":"Raw X12 270 request payload. The corresponding response is returned as normalized JSON, not as raw X12.","properties":{"x12-270":{"type":"string","example":"ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*EMDEON         *220304*0343*^*00501*123456789*0*T*:~GS*HS*LLX1210001*MTEXE*20131015*2219*123456789*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*1*123456789*9877281234~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~DTP*291*RD8*20210101-20211231~EQ*30~SE*20*0001~GE*1*123456789~IEA*1*123456789~"}}},"Transaction":{"type":"object","description":"The base object model for the `/transactions` endpoints and the canonical model for Enhanced Eligibility","properties":{"id":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20","description":"The unique ID of the transaction"},"sourceId":{"type":"string","example":"9fb77454-8c58-4345-aa50-43f133e06d20","description":"The id of the transaction that spawned this record. If empty, this transaction has no parent."},"sourceType":{"type":"string","enum":["new","historical","duplicate","autosubmit"],"example":"new","description":"How the transaction was created. `new` means the transaction was submitted through the Real-Time Eligibility flow. `duplicate` means customer-configured deduplication found a prior matching request, skipped clearinghouse submission, and returned the previous response. `autosubmit` means the transaction was generated by Coverage Discovery path execution. `historical` means the record originated from historical retrieval rather than a newly created request."},"correlationId":{"type":"string","description":"An ID provided by the consumer at the time of transaction processing"},"processedDate":{"type":"string","example":"2017-07-21T17:32:28Z","description":"The time the transaction was processed by the system"},"status":{"type":"object","description":"The outcome of the transaction","properties":{"value":{"type":"string","enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"],"example":"eligible"},"description":{"type":"string","example":"Eligible with insurance","description":"A human readable representation of the 'value' field."}}},"errors":{"type":"array","items":{"type":"string"},"description":"A list of errors that occurred during process"},"benefits":{"type":"array","items":{"type":"object","example":{"service":"Urgent Care","networkClass":"inNetwork","benefitType":"family","name":"copay","type":"string","scope":"common","benefitQualifier":"DY"},"properties":{"service":{"type":"string","example":"Urgent Care","description":"Text description of service type code"},"networkClass":{"type":"string","enum":["inNetwork","outNetwork"],"example":"inNetwork","description":"Whether the benefit conditions apply to 'in' or 'out' of network"},"benefitType":{"type":"string","enum":["individual","family"],"example":"individual","description":"Benefit type maps to either individual or family"},"name":{"type":"string","example":"copay","description":"Benefit field name"},"value":{"type":"string","description":"Benefit field value"},"type":{"type":"string","enum":["string","date","number","percent","monetary","phone"],"description":"Benefit field data type"},"scope":{"type":"string","enum":["common","service"],"example":"common","description":"Benefit field relates either to a service type or is common (not related to a service type)"},"insuranceType":{"type":"string","enum":["AllPayers","Medicaid","Medicare"],"example":"AllPayers","description":"Insurance classification: Medicare, Medicaid, or AllPayers"},"benefitQualifier":{"type":"string","example":"DY (value of the benefit is in days)","description":"Benefit field code identifying type or source"}}},"description":"Detailed benefit information for each service returned by the payer"},"patient":{"type":"object","properties":{"dateOfBirth":{"type":"string","format":"date","example":"1880-01-02"},"dateOfDeath":{"type":"string","format":"date","example":"1880-01-02"},"eligibilityCategory":{"type":"string","description":"Expresses the eligibility category of the member to properly administer health benefits and coverage (from Department of Defense)"},"firstName":{"type":"string","example":"John"},"gender":{"type":"string","example":"M"},"lastName":{"type":"string","example":"Doe"},"memberId":{"type":"string","example":"4784784"},"middleName":{"type":"string","example":"Dave"},"militaryPersonnel":{"type":"boolean","example":false},"mrn":{"type":"string","example":"657883"},"phone":{"type":"string","example":"1234567890"},"relationship":{"type":"string","example":"child"},"ssn":{"type":"string","example":"555443333"},"suffix":{"type":"string","example":"Mr."},"agencyClaimNumber":{"type":"string","example":"WC1234567"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}},"description":"The patient details captured on the eligibility response"},"payer":{"type":"object","properties":{"aaaSource":{"type":"string","example":"Additional Text From Payer"},"certificationNumber":{"type":"string","example":"9999999999","description":"10 digits"},"contactExtension":{"type":"string","example":"7657"},"contactName":{"type":"string","example":"Contact Example"},"description":{"type":"string","example":"HEALTHFIRST-MANAGED MEDICAID"},"email":{"type":"string","example":"payer.email@email.com"},"fax":{"type":"string","example":"8009999999"},"name":{"type":"string","example":"HEALTHFIRST"},"phone":{"type":"string","example":"8009252272"},"thirdPartyAdminstrator":{"type":"object","properties":{"name":{"type":"string","example":"BCBSM TPA"},"phone":{"type":"string","example":"8009252272"}}},"url":{"type":"string","example":"payerwebsite.com"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}},"chcId":{"type":"string","example":"09876z5y-43x2-1w09-v8u7-tr6543s210qp"}},"description":"Represents data about the payer that is on record for the eligibility request"},"plan":{"type":"object","description":"Detailed information about the Subscriber’s plan, group, and policy","properties":{"beginDate":{"type":"string","format":"date","example":"2008-01-02"},"dateOfDecision":{"type":"string","format":"date","example":"2008-01-02"},"endDate":{"type":"string","format":"date","example":"2008-01-02"},"benefitFirstBilledDate":{"type":"string","format":"date","example":"2008-01-02"},"groupOrPolicyNumber":{"type":"string","example":"8888888888"},"insuranceType":{"type":"string","example":"Health Maintenance Organization (HMO)"},"lastBilledDate":{"type":"string","format":"date","example":"2008-01-02"},"medicalAssistanceCategory":{"type":"string","example":"999"},"otherAdditionalCoverageQualifier":{"type":"string","example":"PHARMACY"},"otherCoverage":{"type":"string","example":"FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY"},"otherProductDescription":{"type":"string","example":"HealthPlan"},"planBeginDate":{"type":"string","format":"date","example":"2008-01-02"},"planCoverageDescription":{"type":"string","example":"HEALTHFIRST-MANAGED MEDICAID"},"description":{"type":"string","example":"Plan Description"},"name":{"type":"string","example":"Cigna PPO"},"number":{"type":"string","example":"S5768 135"},"ppo":{"type":"string","example":"Dr. T Test","description":"Preferred provider organization"},"productDescription":{"type":"string","example":"HEALTHFIRST-MANAGED MEDICAID"},"dependentMemberID":{"type":"string","example":"M20220314"},"familyUnitNumber":{"type":"string","example":"01"},"identificationCardSerialNumber":{"type":"string","example":"ICSN0001"},"insurancePolicyNumber":{"type":"string","example":"ICSN0001"},"subscriberPremiumPaidEndDate":{"type":"string","format":"date","example":"2008-01-01"},"aca":{"type":"object","properties":{"hixMessage":{"type":"string","example":"HIX Grace Period"},"periodStart":{"type":"string","format":"date","example":"2008-01-01"},"periodEnd":{"type":"string","format":"date","example":"2008-01-01"}}},"case":{"type":"object","description":"Used to clarify plan level details","properties":{"type":{"type":"string","description":"Reference Information as defined for a Reference Identification Qualifier"},"description":{"type":"string","example":"Free form text"}}},"gatewayProvider":{"type":"object","properties":{"name":{"type":"string","example":"Gateway Provider A"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}}},"group":{"type":"object","properties":{"name":{"type":"string","example":"FLORIDA MEDICAID"},"number":{"type":"string","example":"FLMCD000"},"policyName":{"type":"string","example":"FLMPOL256"}}},"hmo":{"type":"object","description":"Health maintenance organization details","properties":{"name":{"type":"string","example":"Cigna HMO"},"planNumber":{"type":"string","example":"CIG991122"}}},"hra":{"type":"object","description":"Health reimbursement arrangement details","properties":{"balance":{"type":"string","example":"90"},"employerPledge":{"type":"string","example":"500"},"paid":{"type":"string","example":"400"},"priorCarryover":{"type":"string","example":"100"}}},"hsa":{"type":"object","description":"Health savings account details","properties":{"balance":{"type":"string","example":"500"},"employerPledge":{"type":"string","example":"800"},"paid":{"type":"string","example":"200"},"priorCarryover":{"type":"string","example":"0"}}},"ipa":{"type":"object","description":"Individual practice association details","properties":{"name":{"type":"string","example":"AETNA CHOICE POS II"},"contactName":{"type":"string","example":"MERITAIN HEALTH CUSTOMER SERVICE"},"id":{"type":"string","example":"IPAID"},"phone":{"type":"string","example":"8009252272"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}}},"otherPayer":{"type":"object","description":"Additional Payer Associated with Patient","properties":{"groupNumber":{"type":"string","example":"CIG998877"},"policyNumber":{"type":"string","example":"CIGNA PPO"}}},"planNetworkIdentification":{"type":"object","properties":{"description":{"type":"string","example":"Free form qualifier"},"number":{"type":"string","example":"PNIN08549"}}},"policy":{"type":"object","description":"Information about the plan policy","properties":{"name":{"type":"string","example":"Cigna PPO","description":"Plan description from the payer"},"number":{"type":"string","example":"S5768 135","description":"Group or policy number associated with the plan mapping to the policy reference identifier from the payer"}}},"preferredProviderOrg":{"type":"object","description":"Details about the preferred provider organization","properties":{"name":{"type":"string","example":"Dr. T Test"},"contactName":{"type":"string","example":"Test Contact Name"},"id":{"type":"string","example":"452114586"},"phone":{"type":"string","example":"8009252272"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}}},"primaryCareProvider":{"type":"object","properties":{"providerName":{"type":"string","example":"Provider Name"},"physician":{"type":"string","example":"ALBERTO BRIZUELA-DUCHARNE"},"npi":{"type":"string","example":"1649790841"},"phoneNumber":{"type":"string","example":"8009252272"},"dateRange":{"type":"string","example":"2022-01-01"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}}}}},"subscriber":{"type":"object","properties":{"agencyNumber":{"type":"string","example":"WC1234567"},"anniversaryDate":{"type":"string","format":"date","example":"1880-01-02"},"dateOfBirth":{"type":"string","format":"date","example":"1880-01-02"},"employer":{"type":"string","example":"Optum"},"firstName":{"type":"string","example":"johnOne"},"gender":{"type":"string","example":"M"},"idCardNumber":{"type":"string","example":"5678 1234-A"},"lastName":{"type":"string","example":"doeOne"},"memberId":{"type":"string","example":"12345921601"},"middleName":{"type":"string","example":"mOne"},"militaryPersonnel":{"type":"boolean","example":false},"mrn":{"type":"string","example":"657883"},"priorIdNumber":{"type":"string","example":"4784784","description":"The prior identification number (memberId)"},"ssn":{"type":"string","example":"555443333"},"suffix":{"type":"string","example":"Mr."},"premiumPaidEndDate":{"type":"string","format":"date","example":"2020-01-02"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string","example":["1234 Main Street"]}},"city":{"type":"string","example":"Dallas"},"county":{"type":"string","example":"Harris County"},"state":{"type":"string","example":"TX"},"subdivisionCode":{"type":"string","example":"TX"},"zip":{"type":"string","example":"77001"}}}},"description":"Subscriber data that originated from the Payer"},"x12-271":{"type":"string","description":"Raw X12 271 eligibility response payload returned for the transaction.","example":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~"}}},"CoverageDiscoveryTask":{"type":"object","description":"The base object model for the `/coverage-discovery` endpoints","properties":{"id":{"type":"string","example":"36743735-3303-4d9d-9f21-20dd5f6d7ab2","description":"The unique ID of the task"},"status":{"type":"string","enum":["success","failure","pending"],"example":"success","description":"The current state of the discovery task. `pending` means at least one path has not completed. `success` means at least one path produced eligible coverage and no paths remain pending. `failure` means no path produced eligible coverage and no paths remain pending."},"tenantName":{"type":"string","example":"Customer Name"},"traceId":{"type":"string","example":"4c22f47b-1cca-7f48-373c-af7d887443b0,"},"correlationId":{"type":"string","example":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,"},"name":{"type":"string","example":"serial discover task","description":"Customer-configured task name assigned during enrollment to identify the overall discovery workflow. This root name identifies the configured task, not an individual path. Examples include `Medicaid + HMO` for a chained task or `Commercial + HMO + RTCOB` for a serial task."},"type":{"type":"string","example":"serial","enum":["serial","chained"]},"startDateTime":{"type":"string","format":"date-time","example":"2017-07-21T17:32:28Z","description":"The time that the discovery task was initiated"},"endDateTime":{"type":"string","format":"date-time","example":"2017-07-21T17:32:28Z","description":"The time the discovery task finished. Omitted while the task status is `pending`."},"realTime":{"type":"object","description":"The abbreviated parent Real-Time transaction response that triggered or accompanied the Coverage Discovery workflow. This object is populated only when a customer is enrolled in Integrated Coverage Discovery and selects the `Include RealTime Response` capability. Use this object for parent RTE context. Use `discoveryPaths.*[].transaction` for the child transactions produced by discovery path execution.","properties":{"id":{"type":"string","example":"ccf9a2c8-2e36-4c93-b0ec-743859e569cc"},"name":{"type":"string","example":"Real Time"},"timestamp":{"type":"string","format":"date-time","description":"The date-time the parent transaction was executed"},"transaction":{"type":"object","properties":{"id":{"type":"string","description":"The unique ID of the parent transaction response from the Real Time Flow."},"status":{"type":"string","enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"],"description":"The normalized outcome of the parent transaction."},"chcPayerId":{"type":"string","description":"The CHC PayerID used in the submission of the transaction"},"x12-271":{"type":"string","description":"The raw x12-271 response from the parent Real-Time transaction."}},"description":"Abbreviated parent real-time transaction details."}}},"discoveryPaths":{"type":"object","description":"A list of routes that are automatically generated based on customer configuration and supplied input data to attempt to find positive patient coverage.","properties":{"successful":{"type":"array","items":{"type":"object","properties":{"id":{"type":"string","example":"ee7612c4-d400-4b48-83e3-c05875ee8b1f"},"name":{"type":"string","description":"The name of the discovery path that ran for this record. Typical values include `Medicare`, `Commercial`, `RTCOB`, `CoverageInsight`, `Medicaid`, `HMO`, and dynamic Search Option names such as `Search - <generated value>`."},"description":{"type":"string","description":"A brief description of the path"},"timestamp":{"type":"string","format":"date-time","description":"The date-time the path was executed"},"transaction":{"type":"object","properties":{"id":{"type":"string","description":"The unique ID of the transaction"},"status":{"type":"string","enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"],"description":"The normalized outcome of the discovery-path transaction."},"chcPayerId":{"type":"string","description":"The CHC PayerID used in the submission of the transaction"},"x12-271":{"type":"string","description":"The x12-271 response from the submitted transaction"}}}}},"description":"A list of successful discovery paths. A path is deemed \"successful\" when the nested child `transaction.status` is `eligible`.\n"},"unsuccessful":{"type":"array","items":{"type":"object","properties":{"id":{"type":"string","example":"ee7612c4-d400-4b48-83e3-c05875ee8b1f"},"name":{"type":"string","description":"The name of the discovery path that ran for this record. Typical values include `Medicare`, `Commercial`, `RTCOB`, `CoverageInsight`, `Medicaid`, `HMO`, and dynamic Search Option names such as `Search - <generated value>`."},"description":{"type":"string","description":"A brief description of the path"},"timestamp":{"type":"string","format":"date-time","description":"The date-time the path was executed"},"transaction":{"type":"object","properties":{"id":{"type":"string","description":"The unique ID of the transaction"},"status":{"type":"string","enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"],"description":"The normalized outcome of the discovery-path transaction."},"chcPayerId":{"type":"string","description":"The CHC PayerID used in the submission of the transaction"},"x12-271":{"type":"string","description":"The raw x12-271 response from the child discovery-produced transaction."}}}}},"description":"A list of unsuccessful discovery paths. A path is deemed \"unsuccessful\" when the nested child `transaction.status` is anything other than `eligible`, including `ineligible`, `patient_unknown`, `payer_unavailable`, `payer_not_in_system`, and `processing_error`. These child transaction statuses are often the main operational signal for retry or resubmission decisions.\n"},"pending":{"type":"array","items":{"type":"object","properties":{"id":{"type":"string","example":"ee7612c4-d400-4b48-83e3-c05875ee8b1f"},"name":{"type":"string","description":"The name of the discovery path"},"description":{"type":"string","description":"A brief description of the path"},"timestamp":{"type":"string","format":"date-time","description":"The date-time the path entered the pending state."},"transaction":{"type":"object","example":{},"description":"Empty while the discovery path has not executed."}}},"description":"A list of discovery paths that have yet to be executed."},"skipped":{"type":"array","items":{"type":"object","properties":{"id":{"type":"string","example":"ee7612c4-d400-4b48-83e3-c05875ee8b1f"},"name":{"type":"string","description":"The name of the discovery path"},"description":{"type":"string","description":"A brief description of the path"},"timestamp":{"type":"string","format":"date-time","description":"The date-time the path was evaluated and marked as skipped."},"reason":{"type":"string","description":"The reason why the path was skipped"}}},"description":"A list of skipped discovery paths. A path is considered \"skipped\" if there was an error building the path's requests, if another path resulted in found coverage before the skipped path executed, or if an RTCOB or Coverage Insight request matched the fixed 72-hour request cache and therefore did not create a new downstream submission. Cached requests are represented as skipped because the downstream response is not replayed from that cache layer.\n"}}}}},"TransactionMedicare":{"type":"object","description":"Medicare eligibility transaction derived from an X12 271 response (005010X279A1). This model represents the normalized API view of the payer response.\n","properties":{"id":{"type":"string","description":"System-generated transaction identifier","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"correlationId":{"type":"string","description":"Correlation identifier provided by the consumer in the request header and echoed back in the response. Not derived from X12.\n","example":"corr-8b7c2f3a-1c9e-4d3b-a6f5-112233445566"},"sourceType":{"type":"string","enum":["new","historical","duplicate","autosubmit"],"description":"How the transaction was created. `new` means the transaction was submitted through the Real-Time Eligibility flow. `duplicate` means customer-configured deduplication found a prior matching request, skipped clearinghouse submission, and returned the previous response. `autosubmit` means the transaction was generated by Coverage Discovery path execution. `historical` means the record originated from historical retrieval rather than a newly created request.","example":"new"},"processedDate":{"type":"string","format":"date-time","description":"Time the 271 response was processed by the system","example":"2022-03-04T03:43:00Z"},"status":{"type":"object","description":"Normalized eligibility outcome derived from the X12 271.","properties":{"value":{"type":"string","enum":["eligible","ineligible","payer_unavailable","payer_not_in_system","processing_error","patient_unknown"],"example":"eligible"},"description":{"type":"string"}}},"patient":{"type":"object","description":"Subscriber/patient information from NM1*IL, DMG, N3, N4","properties":{"firstName":{"type":"string","example":"JOHNONE"},"lastName":{"type":"string","example":"DOEONE"},"middleName":{"type":"string","example":"M"},"memberId":{"type":"string","description":"Medicare beneficiary identifier","example":"0000000000"},"gender":{"type":"string","example":"F"},"dateOfBirth":{"type":"string","format":"date","example":"1880-01-02"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string"},"example":["123 address1"]},"city":{"type":"string","example":"SEATTLE"},"state":{"type":"string","example":"WA"},"zip":{"type":"string","example":"98101"}}}}},"subscriber":{"type":"object","description":"Subscriber details. For Medicare responses, the subscriber is the patient, so this object mirrors `patient` when both are present.\n","properties":{"firstName":{"type":"string","example":"JOHNONE"},"lastName":{"type":"string","example":"DOEONE"},"memberId":{"type":"string","example":"0000000000"},"gender":{"type":"string","example":"F"},"dateOfBirth":{"type":"string","format":"date","example":"1880-01-02"}}},"payer":{"type":"object","description":"Primary and additional payer information from the 271","properties":{"name":{"type":"string","example":"CMSMED"},"phone":{"type":"string","example":"0000000000"},"url":{"type":"string","example":"www.testwebsite.com"},"otherPayer":{"type":"object","description":"Additional payer from LS/2120 loop","properties":{"name":{"type":"string","example":"extra healthy insurance"},"address":{"type":"object","properties":{"lines":{"type":"array","items":{"type":"string"},"example":["123 address1"]},"city":{"type":"string","example":"Nashville"},"state":{"type":"string","example":"TN"},"zip":{"type":"string","example":"37203"}}}}}}},"plan":{"type":"object","description":"Medicare plan and pharmacy information","properties":{"insuranceType":{"type":"string","enum":["Medicare"],"example":"Medicare"},"beginDate":{"type":"string","format":"date","description":"Coverage start date (DTP*291)","example":"2004-11-01"},"endDate":{"type":"string","format":"date","description":"Coverage end date (DTP*291 RD8)","example":"2021-12-31"},"number":{"type":"string","description":"Plan identifier from REF*18","example":"S5601"},"description":{"type":"string","description":"Plan description from REF*N6","example":"SilverScript SmartRx"}}},"benefits":{"type":"array","description":"Benefits derived from EB, DTP, and MSG segments","items":{"type":"object","properties":{"service":{"type":"string","description":"Service type derived from EB03","example":"Health Coverage"},"name":{"type":"string","description":"Benefit name derived from EB01","example":"copay"},"value":{"type":"string","example":"1484"},"type":{"type":"string","enum":["string","date","number","percent","monetary"],"example":"monetary"},"insuranceType":{"type":"string","enum":["Medicare"],"example":"Medicare"},"benefitQualifier":{"type":"string","description":"EB segment qualifiers (EB01 / EB06 / EB09)","example":"EB01=C"}}}},"x12-271":{"type":"string","description":"Raw X12 271 eligibility response payload.","example":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~"}}}},"examples":{"EligibilityRequestMinimal":{"value":{"controlNumber":"098756329","tradingPartnerServiceId":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"subscriber":{"memberId":"12313423","firstName":"johnOne","lastName":"doeOne","dateOfBirth":"18800102","ssn":"144334555"}}},"EligibilityRequestExpanded":{"value":{"submitterTransactionIdentifier":"1-622233a9-6fca5eb41ae6862b269452c9","controlNumber":"123456789","tradingPartnerServiceId":"CIGNA","tradingPartnerName":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789","serviceProviderNumber":"54321","providerCode":"AD","referenceIdentification":"54321g","providerType":"provider"},"portalUsername":"portal-user","portalPassword":"portal-password","informationReceiverName":{"submitterIdNumber":"SUBMITTER01","nationalProviderIdentifier":"0123456789","informationReceiverAdditionalIdentifierState":"WA","address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"}},"subscriber":{"birthSequenceNumber":"1","caseNumber":"CASE12345","medicaidRecipientIdentificationNumber":"MCD1234567","spendDownAmount":"25.00","spendDownTotalBilledAmount":"100.00","memberId":"0000000000","firstName":"johnOne","middleName":"M","lastName":"doeOne","suffix":"Jr","gender":"M","dateOfBirth":"18800102","ssn":"555443333","groupNumber":"1111111111","idCard":"card123","providerCode":"AD","referenceIdentificationQualifier":"PXC","providerIdentifier":"54321","idCardIssueDate":"20210101","planIssueDate":"20210101","healthCareCodeInformation":[{"diagnosisTypeCode":"BK","diagnosisCode":"A123"}],"address":{"address1":"123 address1","address2":"APT 4","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456","memberIdentificationNumber":"MID998877","patientAccountNumber":"PAT445566","insurancePolicyNumber":"INS123456","planNetworkIdentificationNumber":"NET9001"}},"dependents":[{"individualRelationshipCode":"19","memberId":"DEP0000001","firstName":"janeOne","middleName":"Q","lastName":"doeOne","gender":"F","dateOfBirth":"18160421","groupNumber":"1111111111","healthCareCodeInformation":[{"diagnosisTypeCode":"BF","diagnosisCode":"B456"}],"address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456"}}],"encounter":{"beginningDateOfService":"20100101","endDateOfService":"20100102","dateOfService":"20100101","serviceTypeCodes":["30","35"],"priorAuthorizationOrReferralNumber":"AUTH123","referenceIdentificationQualifier":"9F","industryCode":"01","productOrServiceIDQualifier":"HC","procedureCode":"99213","procedureModifiers":["25"],"diagnosisCodePointer":["1"],"medicalProcedures":[{"productOrServiceIDQualifier":"HC","procedureCode":"99214","procedureModifiers":["59"],"diagnosisCodePointer":["1"]}]}}},"CoverageDiscoveryRequest":{"value":{"canonicalEligibilityRequest":{"submitterTransactionIdentifier":"1-622233a9-6fca5eb41ae6862b269452c9","controlNumber":"123456789","tradingPartnerServiceId":"CIGNA","tradingPartnerName":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789","serviceProviderNumber":"54321","providerCode":"AD","referenceIdentification":"54321g","providerType":"provider"},"portalUsername":"portal-user","portalPassword":"portal-password","informationReceiverName":{"submitterIdNumber":"SUBMITTER01","nationalProviderIdentifier":"0123456789","informationReceiverAdditionalIdentifierState":"WA","address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"}},"subscriber":{"birthSequenceNumber":"1","caseNumber":"CASE12345","medicaidRecipientIdentificationNumber":"MCD1234567","spendDownAmount":"25.00","spendDownTotalBilledAmount":"100.00","memberId":"0000000000","firstName":"johnOne","middleName":"M","lastName":"doeOne","suffix":"Jr","gender":"M","dateOfBirth":"18800102","ssn":"555443333","groupNumber":"1111111111","idCard":"card123","providerCode":"AD","referenceIdentificationQualifier":"PXC","providerIdentifier":"54321","idCardIssueDate":"20210101","planIssueDate":"20210101","healthCareCodeInformation":[{"diagnosisTypeCode":"BK","diagnosisCode":"A123"}],"address":{"address1":"123 address1","address2":"APT 4","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456","memberIdentificationNumber":"MID998877","patientAccountNumber":"PAT445566","insurancePolicyNumber":"INS123456","planNetworkIdentificationNumber":"NET9001"}},"dependents":[{"individualRelationshipCode":"19","memberId":"DEP0000001","firstName":"janeOne","middleName":"Q","lastName":"doeOne","gender":"F","dateOfBirth":"18160421","groupNumber":"1111111111","healthCareCodeInformation":[{"diagnosisTypeCode":"BF","diagnosisCode":"B456"}],"address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456"}}],"encounter":{"beginningDateOfService":"20100101","endDateOfService":"20100102","dateOfService":"20100101","serviceTypeCodes":["30","35"],"priorAuthorizationOrReferralNumber":"AUTH123","referenceIdentificationQualifier":"9F","industryCode":"01","productOrServiceIDQualifier":"HC","procedureCode":"99213","procedureModifiers":["25"],"diagnosisCodePointer":["1"],"medicalProcedures":[{"productOrServiceIDQualifier":"HC","procedureCode":"99214","procedureModifiers":["59"],"diagnosisCodePointer":["1"]}]}},"canonicalEligibilityResponse":{"id":"9fb77454-8c58-4345-aa50-43f133e06d20","payer":{"chcPayerId":"CMSHSP"},"plan":{"hmo":{"name":"Cigna HMO","planNumber":"CIG991122"}},"processedDate":"2017-07-21T17:32:28Z","status":{"value":"ineligible"},"subscriber":{"dateOfBirth":"1880-01-02"}},"callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses"}},"RTEEligibilityRequestCoverageDiscoveryCandidate":{"value":{"controlNumber":"123456789","tradingPartnerServiceId":"AETNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"informationReceiverName":{"address":{"state":"TX"}},"subscriber":{"memberId":"SUB123","firstName":"JOHN","lastName":"DOE","dateOfBirth":"19500102","ssn":"111223333","additionalIdentification":{"patientAccountNumber":"PAN-1001"},"address":{"address1":"123 Main St","city":"Dallas","state":"TX","postalCode":"75001"}},"encounter":{"dateOfService":"20250115","serviceTypeCodes":["30"]}}},"RTEEligibilityRequestHMOCandidate":{"value":{"controlNumber":"2233445566","tradingPartnerServiceId":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"subscriber":{"memberId":"HMO123456","firstName":"JOHN","lastName":"DOE","dateOfBirth":"19800101","address":{"address1":"123 Main St","city":"Hartford","state":"CT","postalCode":"06103"}},"encounter":{"dateOfService":"20240722","serviceTypeCodes":["30"]}}},"RTEEligibilityRequestX12CoverageDiscoveryCandidate":{"value":{"x12-270":"ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*EMDEON         *240722*1617*^*00501*000000001*0*T*:~GS*HS*AETNA*PROVIDERID*20240722*1617*1*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1234567890*20240722*1617~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*1*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*123456789~N3*123 MAIN ST~N4*DALLAS*TX*75001~DMG*D8*19500102*M~DTP*291*D8*20240722~EQ*30~SE*13*0001~GE*1*1~IEA*1*000000001~"}},"RTEEligibilityRequestX12HMOCandidate":{"value":{"x12-270":"ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*EMDEON         *240722*1705*^*00501*000000002*0*T*:~GS*HS*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*270*0002*005010X279A1~BHT*0022*13*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*1*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~DTP*291*D8*20240722~EQ*30~SE*13*0002~GE*1*2~IEA*1*000000002~"}},"RTEEligibilityResponsePatientUnknown":{"value":{"id":"rte-patient-unknown-123","sourceType":"new","payer":{"chcPayerId":"AETNA"},"processedDate":"2025-01-15T16:02:28Z","status":{"value":"patient_unknown"},"subscriber":{"memberId":"SUB123","dateOfBirth":"1950-01-02"},"x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *250115*1602*^*00501*000000010*0*T*:~GS*HB*AETNA*PROVIDERID*20250115*1602*10*X*005010X279A1~ST*271*0010*005010X279A1~BHT*0022*11*1234567890*20250115*1602~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*SUB123~DTP*291*D8*20250115~EB*I**30~MSG*Patient not found.~SE*13*0010~GE*1*10~IEA*1*000000010~"}},"RTEEligibilityResponseIneligible":{"value":{"id":"rte-ineligible-123","sourceType":"new","payer":{"chcPayerId":"CIGNA"},"processedDate":"2025-01-15T16:05:10Z","status":{"value":"ineligible"},"subscriber":{"memberId":"SUB123","dateOfBirth":"1950-01-02"},"x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *250115*1605*^*00501*000000011*0*T*:~GS*HB*CIGNA*PROVIDERID*20250115*1605*11*X*005010X279A1~ST*271*0011*005010X279A1~BHT*0022*11*1234567891*20250115*1605~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*1234567891*9876543210~NM1*IL*1*DOE*JOHN****MI*SUB123~DTP*291*D8*20250115~EB*6**30~MSG*Coverage not active for requested date of service.~SE*13*0011~GE*1*11~IEA*1*000000011~"}},"RTEEligibilityResponseHMO":{"value":{"id":"rte-hmo-123","sourceType":"new","payer":{"chcPayerId":"CIGNA"},"processedDate":"2024-07-22T17:05:00Z","status":{"value":"eligible"},"plan":{"hmo":{"name":"Cigna HMO","planNumber":"CIG991122"}},"subscriber":{"memberId":"HMO123456","dateOfBirth":"1980-01-01"},"x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~"}},"CoverageDiscoveryRequestRequestOnly":{"value":{"canonicalEligibilityRequest":{"submitterTransactionIdentifier":"txn-commercial-request-only","controlNumber":"123456789","tradingPartnerServiceId":"AETNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"informationReceiverName":{"address":{"state":"TX"}},"subscriber":{"memberId":"SUB123","firstName":"JOHN","lastName":"DOE","dateOfBirth":"19500102","ssn":"111223333","additionalIdentification":{"patientAccountNumber":"PAN-1001"},"address":{"address1":"123 Main St","city":"Dallas","state":"TX","postalCode":"75001"}},"encounter":{"dateOfService":"20250115","serviceTypeCodes":["30"]}},"callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses"}},"CoverageDiscoveryRequestHMO":{"value":{"canonicalEligibilityRequest":{"submitterTransactionIdentifier":"txn-hmo-response-driven","controlNumber":"123456789","tradingPartnerServiceId":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"subscriber":{"memberId":"HMO123","firstName":"JOHN","lastName":"DOE","dateOfBirth":"19800101"}},"canonicalEligibilityResponse":{"id":"resp-hmo-123","status":{"value":"ineligible"},"plan":{"hmo":{"name":"HMO-TEXAS"}},"payer":{"chcPayerId":"CIGNA"}},"callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses"}},"CoverageDiscoveryRequestMedicareQMB":{"value":{"canonicalEligibilityRequest":{"submitterTransactionIdentifier":"txn-medicare-qmb","controlNumber":"123456789","tradingPartnerServiceId":"AETNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789"},"subscriber":{"firstName":"JOHN","lastName":"DOE","dateOfBirth":"19500102","ssn":"111223333"}},"canonicalEligibilityResponse":{"id":"resp-medicare-123","status":{"value":"patient_unknown"},"payer":{"chcPayerId":"CMSHSP"},"benefits":[{"name":"QMBIndicator","value":"Y"},{"name":"mbi","value":"1EG4TE5MK73"}]},"callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses"}},"CoverageDiscoveryRequestX12":{"value":{"x12-270":"ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*EMDEON         *220304*0343*^*00501*123456789*0*T*:~GS*HS*LLX1210001*MTEXE*20131015*2219*123456789*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*1*123456789*9877281234~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~DTP*291*RD8*20210101-20211231~EQ*30~SE*20*0001~GE*1*123456789~IEA*1*123456789~","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~","callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses"}},"CoverageDiscoveryRequestDryRun":{"value":{"canonicalEligibilityRequest":{"submitterTransactionIdentifier":"1-622233a9-6fca5eb41ae6862b269452c9","controlNumber":"123456789","tradingPartnerServiceId":"CIGNA","tradingPartnerName":"CIGNA","provider":{"organizationName":"Example Medical Center","npi":"0123456789","serviceProviderNumber":"54321","providerCode":"AD","referenceIdentification":"54321g","providerType":"provider"},"portalUsername":"portal-user","portalPassword":"portal-password","informationReceiverName":{"submitterIdNumber":"SUBMITTER01","nationalProviderIdentifier":"0123456789","informationReceiverAdditionalIdentifierState":"WA","address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"}},"subscriber":{"birthSequenceNumber":"1","caseNumber":"CASE12345","medicaidRecipientIdentificationNumber":"MCD1234567","spendDownAmount":"25.00","spendDownTotalBilledAmount":"100.00","memberId":"0000000000","firstName":"johnOne","middleName":"M","lastName":"doeOne","suffix":"Jr","gender":"M","dateOfBirth":"18800102","ssn":"555443333","groupNumber":"1111111111","idCard":"card123","providerCode":"AD","referenceIdentificationQualifier":"PXC","providerIdentifier":"54321","idCardIssueDate":"20210101","planIssueDate":"20210101","healthCareCodeInformation":[{"diagnosisTypeCode":"BK","diagnosisCode":"A123"}],"address":{"address1":"123 address1","address2":"APT 4","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456","memberIdentificationNumber":"MID998877","patientAccountNumber":"PAT445566","insurancePolicyNumber":"INS123456","planNetworkIdentificationNumber":"NET9001"}},"dependents":[{"individualRelationshipCode":"19","memberId":"DEP0000001","firstName":"janeOne","middleName":"Q","lastName":"doeOne","gender":"F","dateOfBirth":"18160421","groupNumber":"1111111111","healthCareCodeInformation":[{"diagnosisTypeCode":"BF","diagnosisCode":"B456"}],"address":{"address1":"123 address1","city":"SEATTLE","state":"WA","postalCode":"981010000"},"additionalIdentification":{"planNumber":"PLAN001","policyNumber":"POL123456"}}],"encounter":{"beginningDateOfService":"20100101","endDateOfService":"20100102","dateOfService":"20100101","serviceTypeCodes":["30","35"],"priorAuthorizationOrReferralNumber":"AUTH123","referenceIdentificationQualifier":"9F","industryCode":"01","productOrServiceIDQualifier":"HC","procedureCode":"99213","procedureModifiers":["25"],"diagnosisCodePointer":["1"],"medicalProcedures":[{"productOrServiceIDQualifier":"HC","procedureCode":"99214","procedureModifiers":["59"],"diagnosisCodePointer":["1"]}]}},"canonicalEligibilityResponse":{"id":"9fb77454-8c58-4345-aa50-43f133e06d20","payer":{"chcPayerId":"CMSHSP"},"plan":{"hmo":{"name":"Cigna HMO","planNumber":"CIG991122"}},"processedDate":"2017-07-21T17:32:28Z","status":{"value":"ineligible"},"subscriber":{"dateOfBirth":"1880-01-02"}},"callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses","dryRun":true}},"CoverageDiscoveryRequestX12DryRun":{"value":{"x12-270":"ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*EMDEON         *220304*0343*^*00501*123456789*0*T*:~GS*HS*LLX1210001*MTEXE*20131015*2219*123456789*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*1*123456789*9877281234~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~DTP*291*RD8*20210101-20211231~EQ*30~SE*20*0001~GE*1*123456789~IEA*1*123456789~","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~","callbackUrl":"http://customer.apis.healthcare.com/rcmc/eligibility/coverage-discovery/responses","dryRun":true}},"DryRunSerialAllPending":{"value":{"successful":null,"unsuccessful":null,"pending":[{"name":"Medicare"},{"name":"HMO"},{"name":"Commercial"},{"name":"Medicaid"}]}},"DryRunSerialTwoPending":{"value":{"successful":null,"unsuccessful":null,"pending":[{"name":"Medicare"},{"name":"HMO"}]}},"DryRunMultiStatusSuccessful":{"value":[{"status":200,"body":{"successful":null,"unsuccessful":null,"pending":[{"name":"HMO"}]}},{"status":200,"body":{"successful":null,"unsuccessful":null,"pending":[{"name":"Medicare"},{"name":"HMO"}]}}]},"DryRunMultiStatusMixedResponse":{"value":[{"status":200,"body":{"successful":null,"unsuccessful":null,"pending":[{"name":"HMO"}]}},{"status":422,"body":"Unprocessable Resource - Task chained discover task: No discovery paths qualified for execution. Please use the dryRun field to validate your input produces the expected paths prior to submitting the next request."}]},"MultiStatusResponseSuccess":{"value":[{"status":202,"body":{"id":"e97357ea-f44a-4e90-9a3b-dd077166fa51","name":"chained discover task"},"href":"/coverage-discovery/e97357ea-f44a-4e90-9a3b-dd077166fa51"},{"status":202,"body":{"id":"84fa1bc0-aae9-45ec-b5bb-4982d630ef3a","name":"serial discover task"},"href":"/coverage-discovery/84fa1bc0-aae9-45ec-b5bb-4982d630ef3a"}]},"GetCoverageDiscoveryTaskSerialSuccess":{"value":{"id":"cd1505db-3cdf-4361-b515-52f86cd52a4c","status":"success","tenantName":"Customer Name","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"serial discover task","type":"serial","startDateTime":"2024-07-22T16:17:08Z","endDateTime":"2024-07-22T16:17:09Z","realTime":{},"discoveryPaths":{"pending":[],"skipped":[],"successful":[{"id":"239da46d-4c63-4365-a440-9f316bb0a069","name":"Commercial","timestamp":"2024-07-22T16:17:08Z","transaction":{"id":"611c1f2c-4b0a-49df-918b-5d40c8d41fc9","chcPayerId":"AETNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~"}}],"unsuccessful":[]}}},"GetCoverageDiscoveryTaskSerialSuccessRealTime":{"value":{"id":"cd1505db-3cdf-4361-b515-52f86cd52a4c","status":"success","tenantName":"","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"serial discover task","type":"serial","startDateTime":"2024-07-22T16:17:08Z","endDateTime":"2024-07-22T16:17:09Z","realTime":{"id":"ccf9a2c8-2e36-4c93-b0ec-743859e569cc","name":"Real Time","timestamp":"2024-07-22T16:17:08Z","transaction":{"id":"611c1f2c-4b0a-49df-918b-5d40c8d41fc9","chcPayerId":"AETNA","status":"patient_unknown","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *230101*1253*^*00501*000000001*0*T*:~GS*HB*EMDEON*TPG00000*20230101*1253*1*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*13*10001234*20230101*1253*TH~HL*1**20*1~NM1*PR*2*SOURCE NAME*****PI*SOURCEID~HL*2*1*21*1~NM1*1P*2*RECEIVER NAME*****PI*RECEIVERID~HL*3*2*22*0~NM1*IL*1*SUBSCRIBER NAME****MI*SUBSCRIBERID~DTP*291*RD8*20230101-20230101~EB*I**30~SE*10*0001~GE*1*1~IEA*1*000000001~"}},"discoveryPaths":{"pending":[],"skipped":[{"id":"","name":"Commercial","reason":"request does not meet path conditions","timestamp":"2024-07-22T17:05:59Z"},{"id":"","name":"Medicaid","reason":"parent path (Commercial) conditions not met","timestamp":"2024-07-22T17:05:59Z"}],"successful":[{"id":"18f36e9e-458b-417d-8222-6c57fdecf935","name":"Medicare","timestamp":"2024-07-22T17:05:58Z","transaction":{"id":"5d26c880-aa58-4e8d-9f5a-d20e1369145d","chcPayerId":"CMSHSP","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~\n"}},{"id":"7f0af208-4e93-4bb3-9ef5-1b34760d7a01","name":"HMO","timestamp":"2024-07-22T17:05:59Z","transaction":{"id":"9327e9c3-0f92-4575-9d48-8c26b38d0f0f","chcPayerId":"CIGNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~\n"}},{"id":"7f0af208-4e93-4bb3-9ef5-1b34760d7a01","name":"HMO","timestamp":"2024-07-22T17:05:59Z","transaction":{"id":"9327e9c3-0f92-4575-9d48-8c26b38d0f0f","chcPayerId":"CIGNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~\n"}},{"id":"7f0af208-4e93-4bb3-9ef5-1b34760d7a01","name":"HMO","timestamp":"2024-07-22T17:05:59Z","transaction":{"id":"9327e9c3-0f92-4575-9d48-8c26b38d0f0f","chcPayerId":"CIGNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~\n"}}]}}},"GetCoverageDiscoveryTaskSerialFailureRealTime":{"value":{"id":"cd1505db-3cdf-4361-b515-52f86cd52a4c","status":"failure","tenantName":"","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"serial discover task","type":"serial","startDateTime":"2024-07-22T16:17:08Z","endDateTime":"2024-07-22T16:17:09Z","realTime":{"id":"ccf9a2c8-2e36-4c93-b0ec-743859e569cc","name":"Real Time","timestamp":"2024-07-22T16:17:08Z","transaction":{"id":"611c1f2c-4b0a-49df-918b-5d40c8d41fc9","chcPayerId":"AETNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1617*^*00501*000000001*0*T*:~GS*HB*AETNA*PROVIDERID*20240722*1617*1*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1234567890*20240722*1617~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*1234567890*9876543210~NM1*IL*1*DOE*JOHN****MI*123456789~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*GOLD PLAN~MSG*Eligibility confirmed for AETNA Gold Plan.~SE*25*0001~GE*1*1~IEA*1*000000001~"}},"discoveryPaths":{"pending":[],"skipped":[{"id":"","name":"HMO","reason":"request does not meet path conditions","timestamp":"2024-07-22T17:07:12Z"}],"successful":[],"unsuccessful":[]}}},"GetCoverageDiscoveryTaskChainedSuccess":{"value":{"id":"fe3339a2-fbe4-47e9-8739-8d80d8e30f74","status":"success","tenantName":"","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"chained discover task","type":"chained","startDateTime":"2024-07-22T17:05:58Z","endDateTime":"2024-07-22T17:05:59Z","discoveryPaths":{"pending":[],"skipped":[{"id":"","name":"Commercial","reason":"request does not meet path conditions","timestamp":"2024-07-22T17:05:59Z"},{"id":"","name":"Medicaid","reason":"parent path (Commercial) conditions not met","timestamp":"2024-07-22T17:05:59Z"}],"successful":[{"id":"18f36e9e-458b-417d-8222-6c57fdecf935","name":"Medicare","timestamp":"2024-07-22T17:05:58Z","transaction":{"id":"5d26c880-aa58-4e8d-9f5a-d20e1369145d","chcPayerId":"CMSHSP","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~\n"}},{"id":"7f0af208-4e93-4bb3-9ef5-1b34760d7a01","name":"HMO","timestamp":"2024-07-22T17:05:59Z","transaction":{"id":"9327e9c3-0f92-4575-9d48-8c26b38d0f0f","chcPayerId":"CIGNA","status":"eligible","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000    *240722*1705*^*00501*000000002*0*T*:~GS*HB*CIGNA*PROVIDERID*20240722*1705*2*X*005010X279A1~ST*271*0002*005010X279A1~BHT*0022*11*2233445566*20240722*1705~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*1P*2*TEST PROVIDER*****XX*1234567890~HL*3*2*22*0~TRN*2*2233445566*0123456789~NM1*IL*1*DOE*JOHN****MI*HMO123456~N3*123 MAIN ST~N4*HARTFORD*CT*06103~DMG*D8*19800101*M~INS*Y*18*030*25~DTP*291*D8*20240722~EB*1**30*HMO PLAN~MSG*Eligibility confirmed for CIGNA HMO plan.~SE*25*0002~GE*1*2~IEA*1*000000002~\n"}}]}}},"GetCoverageDiscoveryTaskSerialFailure":{"value":{"id":"cb27966f-f2fc-4c53-936f-b5f6d6278069","status":"failure","tenantName":"","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"serial discover task","type":"serial","startDateTime":"2024-07-22T17:05:40Z","endDateTime":"2024-07-22T17:05:41Z","discoveryPaths":{"pending":[],"skipped":[],"successful":[],"unsuccessful":[{"id":"aa3711a8-a5c5-4ab9-8f3a-07a58706e1aa","name":"Medicare","timestamp":"2024-07-22T17:05:40Z","transaction":{"id":"23ab8447-0779-40ce-8171-2771015d9e46","chcPayerId":"CMSHSP","status":"processing_error"}},{"id":"b4f7cf8e-63fb-4f78-8a26-8d56946d08fc","name":"HMO","timestamp":"2024-07-22T17:05:40Z","transaction":{"id":"6a37eade-844a-49b2-b314-74a2119a61ef","payeridCHANGESARAH":"CIGNA","status":"processing_error"}},{"id":"55353a66-2c9c-4030-8609-7d43d41f0d6c","name":"Commercial","timestamp":"2024-07-22T17:05:40Z","transaction":{"id":"f0622b1a-e241-47e7-bf39-43e58fe76a33","chcPayerId":"AETNA","status":"processing_error"}},{"id":"e141bb4c-d754-495d-be76-9b9f6d73ff3e","name":"Medicaid","timestamp":"2024-07-22T17:05:40Z","transaction":{"id":"0823f041-21f7-47d1-ad6e-16911e4da4a2","chcPayerId":"ANTHEM","status":"patient_unknown","x12-271":"ISA*00*          *01*SomePwd   *ZZ*EMDEON         *ZZ*TPG00000       *220304*0343*^*00501*123456789*0*T*:~GS*HB*MTEXE*LLX1210001*20131015*2219*123456789*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*1-622233a9-6fca5eb41ae6862b269452c9*20220304*0343~HL*1**20*1~NM1*PR*2*CMS*****PI*CMSMED~HL*2*1*21*1~NM1*1P*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567893~HL*3*2*22*0~TRN*2*123456789*9877281234~TRN*2*1266798199*9MCK-TSHRT~NM1*IL*1*DOEONE*JOHNONE*M***MI*0000000000~N3*123 address1~N4*SEATTLE*WA*981010000~DMG*D8*18800102*F~INS*Y*18*001*25~DTP*307*RD8*20211020-20211020~EB*I**41^54~EB*1**88~EB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MA**26*1484~DTP*291*RD8*20210101-20211231~EB*C**30*MA**29*1484~DTP*291*RD8*20210101-20211231~EB*C**42^45*MA**26*0~DTP*292*RD8*20210101-20211231~EB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^4^40^42^50^51^52^53^62^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB~DTP*291*D8*20041101~MSG*0-Beneficiary insured due to age OASI~EB*C**30*MB**23*203~DTP*291*RD8*20210101-20211231~EB*C**30*MB**29*0~DTP*291*RD8*20210101-20211231~EB*A**30*MB**27**0.2~DTP*291*RD8*20210101-20211231~EB*C**42^67^AJ*MB**23*0~DTP*292*RD8*20210101-20211231~EB*A**42^67^AJ*MB**27**0~DTP*292*RD8*20210101-20211231~EB*R**88*OT~REF*18*S5601~REF*N6*203*SilverScript SmartRx~DTP*292*D8*20210101~LS*2120~NM1*PR*2*extra healthy insurance~N3*123 address1~N4*Nashville*TN*37203~PER*IC**TE*0000000000*UR*www.testwebsite.com~LE*2120~SE*50*0001~GE*1*123456789~IEA*1*123456789~\n"}}]}}},"GetCoverageDiscoveryTaskChainedFailure":{"value":{"id":"3d63a3ba-1a82-4866-887d-aaf8eeb0894d","status":"failure","tenantName":"","traceId":"4c22f47b-1cca-7f48-373c-af7d887443b0,","correlationId":"91d76432-ac2b-4ae2-b031-f8a6615a2df4,","name":"chained discover task","type":"chained","startDateTime":"2024-07-22T17:07:12Z","endDateTime":"2024-07-22T17:07:12Z","discoveryPaths":{"pending":[],"skipped":[{"id":"","name":"HMO","reason":"request does not meet path conditions","timestamp":"2024-07-22T17:07:12Z"}],"successful":[],"unsuccessful":[{"id":"294d4439-57fe-4b1f-834d-4e5c3b6211fc","name":"Medicare","timestamp":"2024-07-22T17:07:12Z","transaction":{"id":"0e4c24ac-cd79-44ae-be4a-1792cda0b505","payerIdCHANGE":"CMSHSP","status":"processing_error"}}]}}}}},"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}