CAcairhealth

POST /api/eligibility/v4

Changed on

Provides real-time access to patient eligibility benefits information, including out-of-pocket max remaining/YTD, service-level benefits (with in-network/out-of-network and individual/family breakdown), and optional coordination of benefits (COB) check.

Request

  • Base URL
    https://forecaster.cairhealth.com
  • URL
    https://forecaster.cairhealth.com/api/eligibility/v4
  • Auth
    HTTP bearer

Request body

patientFirstNamestring required

Patient first name

patientLastNamestring required

Patient last name

patientDOBstring required

Patient Date of Birth, formatted as MM-DD-YYYY

patientMemberIdstring required

Member ID of patient's insurance policy

dateOfCoveragestring required

Date to request coverage information. Formatted as MM-DD-YYYY

payerIdstring required

Payer ID. Accepts either the Stedi Payer ID (e.g. 'KMQTZ', 'HGJLR') or the Primary Payer ID (e.g. '87726') from the platform or the Fetch Enrollments API

providerIdstring required

Billing Provider ID. Accepts either the CAIR logical provider ID (from /admin/provider/<id>) or the clearinghouse provider ID from the Fetch Enrollments API

mockRequestboolean

Optional flag to only return mock data

serviceTypeCodesstring[]

Service type codes to request coverage information for

procedureCodesstring[]

CPT or CDT codes to check coverage for

procedureCodesType'CPT' | 'CDT'

Type of procedure codes being provided. Must be either 'CPT' or 'CDT'

runCobCheckboolean

Whether to run a coordination of benefits check

Response

Eligibility check successful

payerNamestring

Name of the insurance payer

status'Active Coverage' | 'Inactive'

Coverage status

memberIdstring

Member ID of the subscriber

groupNamestring

Group name from the plan

groupNumberstring

Group number from the plan

insuranceTypestring

Type of insurance (e.g. PPO, HMO, Commercial)

planNamestring

Name of the plan

eligibilityBeginDatestring

Eligibility begin date (YYYY-MM-DD)

responseobject

Map of service type codes to benefit information

messagestring

Overall message about the eligibility check

Changes