--- title: "Coordination Of Benefits" method: POST path: "/eligibility-checks/v1/coordination-of-benefits" tags: ["v1"] --- # Coordination Of Benefits `POST /eligibility-checks/v1/coordination-of-benefits` ## Request - Base URL: `https://pre-api.joincandidhealth.com` - URL: `https://pre-api.joincandidhealth.com/eligibility-checks/v1/coordination-of-benefits` - Auth: HTTP bearer Sends a coordination of benefits check through Stedi to determine whether a patient has coverage overlap across multiple payers and, if so, which payer is primary. Medicare and Medicare Advantage plans are not supported. ## Request body - PreEncounterEligibilityChecksV1CoordinationOfBenefitsRequest: An object representing the data for a coordination of benefits request. - `trading_partner_service_id` string, required: The Payer ID. Each check must be for a participating health plan for which the patient has coverage. Medicare and Medicare Advantage plans are not supported. - `provider` PreEncounterEligibilityChecksV1CobProvider, required: Information about the entity requesting the COB check. Provide either organization_name (for organizations) or first_name and last_name (for individuals), plus npi. - `organization_name` string: The provider's business name. Required if the provider is an organization. - `first_name` string: The provider's first name. Required if the provider is an individual. - `last_name` string: The provider's last name. Required if the provider is an individual. - `npi` string, required: The provider's National Provider Identifier (NPI). - `subscriber` PreEncounterEligibilityChecksV1CobSubscriber, required: The primary policyholder for the insurance plan or a dependent with a unique member ID. You must provide at least one of member_id or ssn. - `first_name` string, required: The subscriber's first name. - `last_name` string, required: The subscriber's last name. - `date_of_birth` string, required: The subscriber's date of birth. - `member_id` string: The member ID for the subscriber's insurance policy. - `ssn` string: The subscriber's Social Security Number (SSN). - `dependent` PreEncounterEligibilityChecksV1CobDependent: A dependent for which you want to check coordination of benefits. If the dependent has their own member ID, include their information in the subscriber object instead. - `first_name` string, required: The dependent's first name. - `last_name` string, required: The dependent's last name. - `date_of_birth` string, required: The dependent's date of birth. - `ssn` string: The dependent's Social Security Number (SSN). - `encounter` PreEncounterEligibilityChecksV1CobEncounter, required: Information about the encounter for the COB check. Service dates must be within the past 2 years and must not be in the future. - `date_of_service` string: The date of service. Defaults to the current date if not specified. - `beginning_date_of_service` string: The beginning date of service. If included, end_date_of_service is also required. - `end_date_of_service` string: The end date of service. If included, beginning_date_of_service is also required. ## Response `200` Response with status 200 - PreEncounterEligibilityChecksV1CoordinationOfBenefitsResponse: An object representing the data for a coordination of benefits response. - `provider` PreEncounterEligibilityChecksV1CobResponseProvider: Information about the entity that submitted the original COB request. - `provider_name` string: The provider's last name. Applies to providers that are an individual. - `provider_first_name` string: The provider's first name. Applies to providers that are an individual. - `provider_org_name` string: The provider's organization name. - `npi` string: The provider's National Provider Identifier (NPI). - `aaa_errors` PreEncounterEligibilityChecksV1EligibilityCheckErrorDetails[]: AAA errors specifying reasons for rejection and recommended follow-up actions. - `field?` string - `description?` string - `location?` string - `possibleResolutions?` string - `code?` string - `followupAction?` string - `subscriber` PreEncounterEligibilityChecksV1CobResponseSubscriber: Information about the primary policyholder for the insurance plan listed in the COB request. - `member_id` string: The member ID for the subscriber's insurance policy. - `first_name` string - `last_name` string - `middle_name` string - `gender` string: The subscriber's gender. Typically `F` - Female, `M` - Male, or `U` - Unknown. - `date_of_birth` string - `ssn` string - `group_number` string: The group number associated with the subscriber's insurance policy. - `birth_sequence_number` string: Birth order when there are multiple births associated with the provided birth date. - `address` PreEncounterEligibilityChecksV1CobAddress: A patient's address as returned in a coordination of benefits response. - `address_1` string - `address_2` string - `city` string - `state` string: The US state or Canadian province code. Kept as a string rather than an enum because, per Stedi, payers may sometimes return non-compliant values. - `postal_code` string - `country_code` string - `country_sub_division_code` string - `aaa_errors` PreEncounterEligibilityChecksV1EligibilityCheckErrorDetails[]: AAA errors specifying reasons for rejection and recommended follow-up actions. - `field?` string - `description?` string - `location?` string - `possibleResolutions?` string - `code?` string - `followupAction?` string - `dependent` PreEncounterEligibilityChecksV1CobResponseDependent: Information about the dependent listed in the original COB request. - `member_id` string: The member ID for the subscriber's insurance policy. - `first_name` string - `last_name` string - `middle_name` string - `gender` string: The dependent's gender. Typically `F` - Female, `M` - Male, or `U` - Unknown. - `date_of_birth` string - `ssn` string - `group_number` string: The group number associated with the subscriber's insurance policy. - `relation_to_subscriber` string: The name of the relation_to_subscriber_code. For example, `Child` when the code is `19`. - `relation_to_subscriber_code` string: The dependent's relationship to the subscriber. For example `01` - Spouse, `19` - Child, `20` - Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. - `birth_sequence_number` string: Birth order when there are multiple births associated with the provided birth date. - `address` PreEncounterEligibilityChecksV1CobAddress: A patient's address as returned in a coordination of benefits response. - `address_1` string - `address_2` string - `city` string - `state` string: The US state or Canadian province code. Kept as a string rather than an enum because, per Stedi, payers may sometimes return non-compliant values. - `postal_code` string - `country_code` string - `country_sub_division_code` string - `aaa_errors` PreEncounterEligibilityChecksV1EligibilityCheckErrorDetails[]: AAA errors specifying reasons for rejection and recommended follow-up actions. - `field?` string - `description?` string - `location?` string - `possibleResolutions?` string - `code?` string - `followupAction?` string - `payer` PreEncounterEligibilityChecksV1CobPayer: Information about the payer listed in the COB request. - `name` string: The payer's name, such as `CIGNA`. - `payer_identification` string: The trading_partner_service_id (Payer ID) used to identify the payer in the COB request. - `plan_date_information` PreEncounterEligibilityChecksV1CobPlanDateInformation: Dates associated with the patient's health plan coverage. - `plan_begin` string: When the patient's health plan coverage begins. - `plan_end` string: When the patient's health plan coverage ends. - `benefits_information` unknown[]: Raw passthrough of Stedi's benefits information (coverage, service types, related entities, etc.). - unknown - `errors` PreEncounterEligibilityChecksV1EligibilityCheckErrorDetails[] - `field?` string - `description?` string - `location?` string - `possibleResolutions?` string - `code?` string - `followupAction?` string - `coordination_of_benefits` PreEncounterEligibilityChecksV1Cob: An overview of the COB response. Indicates whether there is a coverage overlap, whether that overlap creates a coordination of benefits instance, and whether Stedi was able to identify payer primacy (when a COB instance exists). - `classification` string: The classification for the discovered benefits. One of: `CobInstanceExistsPrimacyDetermined`, `CobInstanceExistsPrimacyUndetermined`, `CoverageOverlapNoBenefitOverlap`, `CoverageOverlapExistsNotSubjectToCob`, or `MemberFoundNoCob`. - `instance_exists` boolean: If true, the COB response contains at least one coordination of benefits instance. - `primacy_determined` boolean: If true, Stedi was able to determine the primary payer for the patient. - `coverage_overlap` boolean: If true, the patient has active coverage with two or more payers during the service date. - `benefit_overlap` boolean: If true, the patient has active coverage from two or more payers for the same service type code. ## Changes - **2026-09-17** `24b2d80d577a`: 6 breaking, 1 warning, 10 info - added the new required request property `encounter` - added the new required request property `provider` - added the new required request property `subscriber` - added the new required request property `trading_partner_service_id` - …13 more - **2026-09-12** `3a81ee81d4ed`: 1 info - api operation id `coordination-of-benefits` removed and replaced with `v1_coordination-of-benefits` [Operation history](https://skmtc.dev/joincandidhealth/apis/api-reference/changes/eligibility-checks/v1/coordination-of-benefits/post.md) --- [API](https://skmtc.dev/joincandidhealth/apis/api-reference.md) - [All operations](https://skmtc.dev/joincandidhealth/apis/api-reference/llms.txt) - [OpenAPI document](https://skmtc.dev/joincandidhealth/apis/api-reference/revisions/d8b0a61873e2?raw)