Eligibility API Reference
This page contains information about return values and errors, as well as details about each API call.
Host Names
In the HTTP requests documented below, use the following host:
- sandbox.services.apexedi.com for testing
Valid credentials are required for both production and testing. The https protocol is required for both testing and production. When submitting eligibility test requests to the sandbox system, use payer ID TST01 for medical eligibility, and TST02 for dental
Return Values and Errors
The HTTP status code indicates the success or failure of the call. On successful calls, the body of the response is encoded as a JSON object. On failed calls, the body of the response generally contains additional information. In some cases, it is simply an error message. In other cases, particularly when a submission has errors, the response contains structured error information encoded as JSON.
| Common Error Responses |
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Invalid or Missing Vendor Credentials
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Client Has Not Accepted Business Associate Agreement The client must accept a Business Associate Agreement (BAA) with Apex EDI before submitting personal health information (PHI) to Apex EDI. If the client has not accepted a BAA, then attempts by a vendor to call the API on behalf of the client will fail with a 401 error. This condition can be detected in software by the vendor by parsing as an integer the portion of the text in the body of the response before the first colon (:). If this integer is 201, then the client has not yet accepted a BAA. If there is no colon in the body of the response, the portion of the message before the first color is not an integer, or the value of the integer is not 201, then the cause of the authorization error is something other than a failure on the part of the client to accept a BAA.
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Calling API With Incorrect REST Verb - GET when POST is required
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An Apex Service is Unresponsive
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Invalid vendorSiteId Used
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Parameter Has No Content for VendorSiteId
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Bad Request. Some fields are not formatted properly
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Eligibility Submission Failure. One or more required fields missing.
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API Calls
GetEligibilityPayers
/api/v3/payers/get_list_of_eligibility?vendorSiteId=<vendorSiteId>&type=<payertype>
where eligibility payertype = dental or medical, and vendorSiteId is the assigned Vendor Site ID
Curl Example
curl -X POST https://sandbox.services.apexedi.com/api/v3/payers/get_list_of_eligibility?vendorSiteId=XXSiteId&type=dental
curl -X POST https://sandbox.services.apexedi.com/api/v3/payers/get_list_of_eligibility?vendorSiteId=XXSiteId&type=medical
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>"
--header "Content-Type: application/json"
Responses
See GetPayers for examples of return data
SubmitEligibilityRequests
/api/v3/eligibility/submit?vendorSiteId=<vendorSiteId>
where vendorSiteId is the assigned Vendor Site ID
The body of the HTTP request is a JSON object with required Eligibility fields.
If the request is not well-formed, then the HTTP status code will be 400, and the body of the response will contain information about the errors. If the request is well-formed, then the status will be 200, and the response will indicate which, if any, of the requests were accepted for transmission.
When submitting eligibility test requests on the sandbox system, the payer ID TST01 must be used for medical requests, and TST02> for dental requests.
The member ID of the subscriber controls what will be returned. This is true, even if the benefits are being requested for a dependent. When using a test payer, the following member IDs may be used to auto-generate various errors and response scenarios:
Member IDs for Testing Using the Eligibility Test Payer |
||
|---|---|---|
| MemberId | Auto Generated Response | |
| 1001 | envelope errors | |
| 1002 | payer errors | |
| 1003 | payee errors | |
| 1004 | subscriber errors | |
| 1005 | dependent errors | |
| 1006 | syntax error | |
| 1007 | complex benefits will be returned | |
| 1008 | Simple benefits will be returned after a delay of approximately 65 seconds. Note that there will be a 65 second delay for each patient (subscriber or dependent) when 1008 is the subscriber member ID. | |
| 1009-1999 | Reserved for Future Use | |
Any other MemberId (letters or numbers) |
Simple benefits will be returned | |
Curl Example
curl -X POST https://sandbox.services.apexedi.com/api/V3/eligibility/submit?vendorSiteId=XXSiteId ^
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>" ^
--header "Content-Type: application/json" ^
--data <Eligibility request as json>
Example Eligibility JSON Request (minimum required fields only)
For a list of many variations of example Eligibility Requests click here
{
"BenefitInquiries": [
{
"Payers": [
{
"CommonName": "Test Payer",
"EntityType": "Organization",
"Payees": [
{
"CommonName": "LASTNAME",
"EntityType": "Individual",
"FirstName": "FIRSTNAME",
"NationalProviderId": "1234567893",
"Subscribers": [
{
"Dependents": null,
"RequestedBenefits": [
{
"IsFamilyBenefit": false,
"Type": [
"HealthBenefitPlanCoverage"
]
}],
"BirthDate": "1981/08/21",
"CommonName": "LastName",
"FirstName": "Dave",
"Gender": "Male",
"MemberId": "112233445566",
"PayeeTraceNumber": {
"Number": "SingleSubServiceSingle-01",
"OriginatorID": "1923457658"
}
}],
"Type": "Facility"
}],
"PayerId": "TST01",
"Type": "Payer"
}],
"RequestType": "Request"
}],
"NOTE: Change IsTest to false for live payers": "",
"IsTest": true
}
Responses
Successful submission, request accepted.
There is one response for each submitted patient request. In this case, only one patient request was submitted. If multiple requests are submitted, some may be accepted and others not. The call to eligibility/submit returns an instance of the submit result response, which includes an array of Response objects. If the response object returned does not contain responses for all patients in the request, then the status will be "ResultsIncomplete" and follow-up calls to will need to be made to eligibility/get_responses using the same Request ID.
The information returned by eligibility/get_responses is built up incrementally as responses are received. get_responses will always return all responses returned in any previous call to submit or get_responses, plus any additional responses that may have been received since the last call to submit or get_responses. As mentioned above, while all responses will typically be available soon after the initial request submission, in some cases responses may be delayed for a few hours or days, and in extreme cases a response for a particular patient may never become available. It is strongly recommended that requests include PayeeTraceNumbers for each patient in the request - either subscriber or dependent. You can then match a response with the request. This is particularly helpful when multiple requests are submitted together, or benefits for multiple dependents are requested. Please the PayeeTraceNumber field in the above example. Every submission or response request will return one of three statuses:
AllInvalid: The request must be corrected and resubmitted
ResultsComplete: All requests were successfully submitted and all responses have been received
ResultsIncomplete: All requests were successfully submitted, but the responses have not all been received
- HttpStatusCode: 200 (OK)
- Member ID 1007 was used which generates complex benefits
- Body:
{ "RequestId": 1663349, "Status": "ResultsComplete", "Responses": [ { "GroupControlNumber": null, "TradingPartnerId": null, "Payers": [ { "Type": "Payer", "EntityType": "Organization", "CommonName": "Test Payer", "FirstName": null, "MiddleName": null, "Suffix": null, "PayerId": "TST01", "CmsPlanId": null, "EmployersIdNumber": null, "NationalProviderId": null, "ElectronicTransmitterIdNumber": null, "NationalPayerIdNumber": null, "TaxIdNumber": null, "NaicId": null, "Payees": [ { "Type": "Facility", "EntityType": "Individual", "ProviderRole": null, "CommonName": "LASTNAME", "FirstName": "FIRSTNAME", "MiddleName": null, "Suffix": null, "NationalProviderId": "1234567893", "EmployersIdNumber": null, "TaxIdNumber": null, "CmsPlanId": null, "SocialSecurityNumber": null, "PharmacyNumber": null, "PayerId": null, "ServiceProviderNumber": null, "StateLicenseNumber": null, "StateIssuingLicense": null, "MedicareProviderNumber": null, "MedicaidProviderNumber": null, "PriorIdNumber": null, "PersonalIdNumber": null, "FacilityIdNumber": null, "FacilityNetworkIdNumber": null, "SubmitterIdNumber": null, "ContractNumber": null, "DevicePin": null, "ProviderPlanNetworkId": null, "UserId": null, "ReceivingProviderTaxonomyCode": null, "PhysicalAddress": null, "Errors": null, "Subscribers": [ { "EntityType": null, "CaseNumber": null, "Dependents": null, "ClearinghouseTraceNumber": { "OriginatorID": "9APEXEDI99", "OriginatorSecondaryID": "", "Number": "1672003" }, "PayeeTraceNumber": { "OriginatorID": "1923457658", "OriginatorSecondaryID": null, "Number": "SingleSubServiceSingle-01" }, "PayerTraceNumber": null, "IsInsured": false, "CommonName": "LastName", "FirstName": "Dave", "MiddleName": null, "Suffix": null, "PhysicalAddress": null, "BirthDate": "1981-08-21T00:00:00", "Gender": "Male", "Benefits": [ { "Type": "CoInsurance", "TypesOfService": [ "MedicalCare", "HealthBenefitPlanCoverage", "Hospital", "HospitalEmergencyMedical", "EmergencyServices" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL PLUS", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "NotApplicable", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "ActiveCoverage", "TypesOfService": [ "Hospice", "HospitalInpatient", "HospitalOutpatient", "Maternity", "Pharmacy", "ProfessionalPhysicianVisitOffice", "VisionOptometry", "DurableMedicalEquipment", "MentalHealth", "UrgentCare" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL PLUS", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "HospitalEmergencyMedical", "EmergencyServices" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "NotApplicable", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "Hospice", "HospitalInpatient", "HospitalOutpatient", "Maternity", "DurableMedicalEquipment" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "UrgentCare" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": [ "ACME FLASHCARE FACILITIES, URGENT CARE FACILITIES" ], "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "UrgentCare" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": [ "ACME JUVENILE CARE FACILITIES" ], "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "ProfessionalPhysicianVisitOffice" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.1, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": [ "PRIMARY CARE PROVIDER OFFICE VISIT" ], "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "Pharmacy" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.2, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": [ "TIER 1" ], "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "CoInsurance", "TypesOfService": [ "ProfessionalPhysicianVisitOffice" ], "LevelOfCoverage": null, "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": null, "BenefitAmount": null, "PatientResponsibilityPercentage": 0.0, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": [ "PREVENTIVE PRIMARY CARE PROVIDER OFFICE VISIT" ], "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Deductible", "TypesOfService": [ "MedicalCare" ], "LevelOfCoverage": "Individual", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": "Remaining", "BenefitAmount": 1982.03, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Deductible", "TypesOfService": [ "MedicalCare", "Pharmacy" ], "LevelOfCoverage": "Family", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": "CalendarYear", "BenefitAmount": 2700.0, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Deductible", "TypesOfService": [ "MedicalCare" ], "LevelOfCoverage": "Family", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": "Remaining", "BenefitAmount": 1982.03, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Deductible", "TypesOfService": [ "Pharmacy" ], "LevelOfCoverage": "Individual", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL", "BenefitTimePeriod": "Remaining", "BenefitAmount": 2700.0, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "Yes", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, "CoverageListId": null, "DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Deductible", "TypesOfService": [ "MedicalCare", "Pharmacy" ], "LevelOfCoverage": "Individual", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL PLUS", "BenefitTimePeriod": "CalendarYear", "BenefitAmount": 2700.0, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Unknown", "Amount": 0.0 }, "AuthenticationOrCertificationRequired": null, "PlanInNetwork": "No", "ReferralNumber": null, "PriorAuthorizationNumber": null, "Procedure": null, "DeliverySchedules": null, "PlanNumber": null, "GroupOrPolicyNumber": null, "MemberId": null, "MemberIdSuffix": null, "GroupNumber": null, "PolicyNumber": null, "AlternativeListId": null, 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"DrugFormularyNumber": null, "MedicaidAssistanceCategory": null, "MedicaidRecipientId": null, "HealthInsuranceClaimNumber": null, "PlanNetworkIdNumber": null, "PlanOrGroupName": null, "DischargeDate": null, "PeriodDates": null, "CompletionDate": null, "CobDate": null, "PlanDate": null, "BenefitDates": null, "PcpDate": null, "LatestVisitDate": null, "EligibilityDates": null, "DateAdded": null, "PlanBeginDate": null, "AdmissionDate": null, "ServiceDate": null, "LastUpdateDate": null, "StatusDate": null, "Errors": null, "Messages": null, "AdditionalInformation": null, "BenefitEntities": null }, { "Type": "Limitations", "TypesOfService": [ "Chiropractic" ], "LevelOfCoverage": "Individual", "PlaceOfService": null, "TypeOfInsurance": null, "PlanCoverageDescription": "ACME MEDICAL PLUS", "BenefitTimePeriod": "CalendarYear", "BenefitAmount": 0.0, "PatientResponsibilityPercentage": null, "BenefitQuantity": { "Unit": "Visits", "Amount": 15.0 }, "AuthenticationOrCertificationRequired": null, 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"2022-06-17T08:13:47.339Z", "ResponseType": "BenefitResponse" } ], "ValidationResults": [], "ErrorResponses": [], "InterchangeStatuses": [] }
GetEligibilityResponses
/api/v3/eligibility/get_responses?vendorSiteId=<vendorSiteId>&requestId=<requestId>
where vendorSiteId is the assigned Vendor Site ID
The body of the HTTP request is a JSON object with Eligibility response fields. Please see the response objects for SubmitEligibilityRequests above.