--- title: "POST /eligibility-check" method: POST path: "/eligibility-check" tags: ["Real-time eligibility check"] --- # POST /eligibility-check `POST /eligibility-check` ## Request - Base URL: `https://healthcare.us.stedi.com/2026-06-01` - URL: `https://healthcare.us.stedi.com/2026-06-01/eligibility-check` - Auth: API key in header `Authorization` Submit a real-time 270/271 eligibility check in JSON format ## Headers - `X-Forwarded-For` string: **(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request's point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS. When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States. Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples. ## Request body - CreateEligibilityCheckRequestContent: The eligibility check request payload. - `dependent` EligibilityCheckRequestDependent: A dependent for which you want to retrieve benefits information. - You can only submit one dependent per eligibility check. - Only include the patient's information here when they are listed as a dependent on the subscriber's insurance plan AND the payer cannot uniquely identify them through information outside the subscriber's policy. For example, if the dependent has their own member ID number, you should identify them in the `subscriber` object instead. This includes member IDs that differ only by a suffix, such as `01`, because the patient can still be uniquely identified. - Most Medicaid plans don't support dependents, with a [few exceptions](https://www.stedi.com/docs/healthcare/send-eligibility-checks#medicaid-dependents). Sending this information to payers that don't support dependents will either cause an error, or the payer may ignore the information and return results for the subscriber instead. - Each payer has different requirements, so you should supply the fields necessary for each payer to identify the dependent in their system. However, we **strongly recommend** including the dependent's date of birth in the request when available because many payers return errors without it. - Enter the patient's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures. - `additionalInformation` EligibilityCheckRequestDependentAdditionalInformation: Additional identification numbers for the dependent. - `agencyClaimNumber` string: The agency claim number associated with the dependent. - `contractNumber` string: The contract number associated with the dependent's insurance plan. - `eligibilityCategory` string: The eligibility category for the dependent. - `groupNumber` string: The group number for the dependent's insurance plan. - `groupOrPolicyNumber` string: The group or policy number. - `identificationCardSerialNumber` string: The identification card serial number, when it differs from the member ID. - `identityCardNumber` string: The dependent's identity card number. Include this when this number differs from the subscriber's member ID. - `insurancePolicyNumber` string: The dependent's insurance policy number. - `issueNumber` string: The issue number for the dependent's insurance policy. - `mbi` string: The dependent's Medicare Beneficiary Identifier (MBI). The 270 carries it as the Health Insurance Claim (HIC) number, which CMS retired in favor of the MBI. - `medicalRecordId` string: The medical record identification number for the dependent. - `memberId` string: The dependent's member ID. Only set this when checking eligibility with a Property and Casualty payer and the patient identifier is a member ID that would be used in an 837 claim. If the dependent has their own member ID for a health plan, identify them in the `subscriber` object instead. - `patientAccountNumber` string: The patient account number for the dependent. - `planNetworkId` string: The plan network identification number for the dependent. - `planNumber` string: The plan number for the dependent's insurance plan. - `ssn` string: The dependent's Social Security Number (SSN). Don't use this for Federally-administered programs, such as Medicare. - `address` EligibilityCheckRequestAddress: The address of the entity. - `addressLine1` string, required: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string, required: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `birthSequenceNumber` integer: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. Requires `relationToSubscriber`; the request is rejected when it is omitted. - `dateOfBirth` string: The dependent's date of birth (DOB). We **strongly recommend** including the DOB in your request. Many payers need this information to identify the patient in their system and may immediately return an error when it's not provided. - `gender` 'FEMALE' | 'MALE': Code indicating the patient's gender. - `name` EligibilityCheckRequestDependentName, required: The dependent's name. - `person` EligibilityCheckRequestDependentPersonName, required: The name of a dependent, who is always a person. - `firstName` string, required: The dependent's first name. - `lastName` string, required: The dependent's last name. **Don't** include the dependent's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `middleName` string: The dependent's middle name or middle initial. - `suffix` string: The dependent's name suffix, such as Jr. or III. Only include the dependent's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. - `provider` EligibilityCheckRequestEntityProvider: Information about a provider's role and taxonomy. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. - `reference` string: The provider's taxonomy code. - `relationToSubscriber` 'SPOUSE' | 'CHILD' | 'OTHER_ADULT': The dependent's relationship to the subscriber. - `eligibilitySearchId` string: An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-views). - `encounter` EligibilityCheckRequestEncounter: Details about the eligibility or benefit information you are requesting for the patient. - You can optionally include service type codes (STCs) or procedure codes to request benefits for specific services. - You can specify either a single service date or a date range using `dates.service`. The payer defaults to using the current date in their timezone if you don't include one. - When checking eligibility for today, omit the service date to ensure consistent behavior across payers. - We recommend submitting dates up to 12 months in the past or up to the end of the current month. Payers aren't required to support dates outside these ranges. However, some payers such as the Centers for Medicare and Medicaid Services (CMS) do support requests for dates further in the future - especially the next calendar month. Check the payer's documentation to determine their specific behavior. - `additionalInformation` EligibilityCheckRequestEncounterAdditionalInformation: Additional information about the encounter. - `priorAuthNumber` string: The prior authorization number for a particular benefit or procedure. - `referralNumber` string: The referral number for a particular benefit or procedure. - `dates` EligibilityCheckRequestEncounterDates: Dates of service for the eligibility inquiry. If you don't specify a service date, the payer defaults to using the current date in their timezone. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `placeOfService` EligibilityCheckRequestPlaceOfService: The type of facility where providers deliver the service. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99', required: Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `services` EligibilityCheckRequestService[]: One or more codes classifying the type of services for which you want to receive benefits information. - You can include service type codes (STCs) or procedure codes to request specific types of benefits information. For medical benefits, you'll almost always need an STC because most medical payers don't support procedure codes (CPT/HCPCS/CDT). For dental benefits, many payers support procedure codes. Visit [STCs and procedure codes](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes) for guidance on choosing the right codes. - We recommend including one service per request. Not all payers support all service type codes, not all payers support multiple codes in the same request, and payers aren't required to respond with exactly the same codes you sent. - If you don't specify any services, Stedi defaults to using service type code `30` (Health Benefit Plan Coverage). - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS', required: Identifies the external code list that the specified procedure or service code belongs to. - `value` string, required: The service or procedure code value. - `externalPatientId` string: A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests. - `payerId` string, required: The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list. - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record. - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`. - `payerName` string: The payer's name, such as Cigna or Aetna. - `provider` EligibilityCheckRequestProvider, required: Information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. - Provide the provider's name as either a person (with `name.person`) or an organization (with `name.organization`). If you leave it out, Stedi uses the name on the NPPES record for the provider's `npi`, or `PROVIDER` when there is no record. - You must also provide an identifier - this is typically the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier) (`npi`). If the provider doesn't have an NPI, you can supply an alternative, such as their `tin` or `ssn`. - Don't include additional properties, such as `tin` or `address`, unless they are specifically required or suggested by the payer. - `additionalInformation` EligibilityCheckRequestProviderAdditionalInformation: Additional identification numbers for the provider. Only include when specifically required by a payer. - `contractNumber` string: The provider's contract number. - `electronicDevicePin` string: The provider's electronic device PIN. - `facilityIdNumber` string: The ID number for the provider's facility. - `facilityNetworkId` string: The provider's facility network identification number. - `medicaidProviderNumber` string: The provider's Medicaid provider number. - `medicareProviderNumber` string: The provider's Medicare provider number. - `personalIdentificationNumber` string: The provider's personal identification number (PIN). For payers Medicaid California, AltaMed, and Kern Family Health Care, this property is **required** and should be the [password the provider uses to log in to the payer's portal](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#portal-credentials). Otherwise, this isn't commonly used. - `planNetworkId` string: The provider's plan network identification number. - `priorIdentifierNumber` string: The provider's prior identifier number. - `stateLicense` EligibilityCheckRequestStateLicense: The provider's state license information. - `number` string, required: The provider's state license number. - `state` string: The state or province code that issued the license. - `submitterId` string: The provider's submitter ID. - `userId` string: The provider's user ID. - `address` EligibilityCheckRequestAddress: The address of the entity. - `addressLine1` string, required: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string, required: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. Only include when the payer requires it. - `name` union: The provider's name, as either a person or an organization. - object - `person` EligibilityCheckRequestProviderPersonName, required: The name of a provider who is a person. - `firstName` string: The provider's first name. - `lastName` string: The provider's last name. - `middleName` string: The provider's middle name or middle initial. - `suffix` string: The provider's name suffix, such as Jr. or III. - object - `organization` string, required: An organization's business name. - `npi` string: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). All healthcare providers eligible for an NPI must provide this identifier. Some non-traditional providers such as transportation services, durable medical equipment (DME) suppliers, or alternative medicine practitioners can't receive an NPI. If the provider doesn't have an NPI, payers virtually never support requests with alternate IDs. In the rare circumstance that a payer has instructed you to use an alternate ID, the payer will typically require you to supply either their `tin` or `ssn` instead. - `pharmacyProcessorNumber` string: The provider's pharmacy processor number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. - `provider` EligibilityCheckRequestEntityProvider: Information about a provider's role and taxonomy. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. - `reference` string: The provider's taxonomy code. - `serviceProviderNumber` string: The provider's service provider number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. - `ssn` string: The provider's Social Security Number (SSN). - Only include when specifically instructed by a payer - for example, if the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. - If the payer has instructed you to send an EIN but the provider operates using their SSN, use `provider.tin` instead of this field. - Don't use this for Federally-administered programs, such as Medicare. - `tin` string: The provider's Federal Taxpayer Identification Number. This is typically the provider's EIN (Employer Identification Number), but you may use the provider's SSN if the provider doesn't have an EIN. Only include if the payer requires it. - `type` 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'HOSPITAL' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'PLAN_SPONSOR': The type of provider making the request. - `subscriber` EligibilityCheckRequestSubscriber, required: The primary policyholder for the insurance plan _or_ a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave `dependent` empty. - At a minimum, our API requires that you supply at least one of these fields in the request: `memberId`, `dateOfBirth`, or `name.person.lastName`. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. - When you provide all four of `memberId`, `dateOfBirth`, `name.person.firstName`, and `name.person.lastName`, payers must return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. - We recommend always including the patient's member ID when possible. - Enter the patient's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures. - `additionalInformation` EligibilityCheckRequestSubscriberAdditionalInformation: Additional identification numbers for the subscriber. Use this object when you need to provide an identification number other than or in addition to the subscriber's member ID. For example, you may provide the patient account number. Don't include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID. - `agencyClaimNumber` string: The agency claim number associated with the subscriber. - `caseNumber` string: The case number associated with the subscriber. - `contractNumber` string: The contract number associated with the subscriber's insurance plan. - `groupNumber` string: The group number associated with the subscriber's insurance policy. - `groupOrPolicyNumber` string: The group or policy number. - `identificationCardSerialNumber` string: The identification card serial number, when it differs from the member ID. - `identityCardNumber` string: The subscriber's identity card number. Include this property when this number differs from the subscriber's member ID. This is common in Medicaid. - `insurancePolicyNumber` string: The subscriber's insurance policy number. - `mbi` string: The subscriber's Medicare Beneficiary Identifier (MBI). The 270 carries it as the Health Insurance Claim (HIC) number, which CMS retired in favor of the MBI. Don't include it unless it differs from the member ID. - `medicaidRecipientId` string: The Medicaid Recipient Identification Number. You can provide this number to identify the subscriber when it is the primary number the payer knows a member by (such as for Medicare or Medicaid). Don't supply this value unless it differs from the `memberId`. - `medicalRecordId` string: The medical record identification number for the subscriber. - `patientAccountNumber` string: The patient account number for the subscriber. - `planNetworkId` string: The plan network identification number for the subscriber. - `planNumber` string: The plan number for the subscriber's insurance plan. - `ssn` string: The subscriber's Social Security Number (SSN). Many commercial and government payers ignore this property due to concerns about member privacy. However, some Medicaid programs support alternative searches using the patient's Social Security Number, instead of the member ID. - `address` EligibilityCheckRequestSubscriberAddress: The subscriber's address. When providing address information: - `addressLine1` and `city` are **required** for standard eligibility checks and MBI lookups with SSN. We also recommend including `state` for member identification. - When performing an [MBI lookup without SSN](https://www.stedi.com/docs/healthcare/mbi-lookup) (Payer ID: `MBILUNOSSN`), only `state` is required. You can omit `addressLine1` and `city`. - `addressLine1` string: The first line of the address. Required for all payers except payer ID `MBILUNOSSN`. - `addressLine2` string: The second line of the address. - `city` string: The city. Required for all payers except payer ID `MBILUNOSSN`. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code. Required for payer ID `MBILUNOSSN`. - `birthSequenceNumber` integer: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. - `dateOfBirth` string: The subscriber's date of birth. - `gender` 'FEMALE' | 'MALE': Code indicating the patient's gender. - `memberId` string: The member ID for the subscriber's insurance policy. - `name` union: The subscriber's name, as either a person or an organization. - object - `person` EligibilityCheckRequestSubscriberPersonName, required: The name of a subscriber who is a person. - `firstName` string: The subscriber's first name. - `lastName` string: The subscriber's last name. **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `middleName` string: The subscriber's middle name or middle initial. - `suffix` string: The subscriber's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. - object - `organization` string, required: An organization's business name. - `provider` EligibilityCheckRequestEntityProvider: Information about a provider's role and taxonomy. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. - `reference` string: The provider's taxonomy code. ## Response `200` CreateEligibilityCheck 200 response - CreateEligibilityCheckResponseContent: The eligibility check response payload. - `dependent` EligibilityCheckDependent: Information about the dependent from the eligibility check request. Note that the payer may return the dependent in the subscriber object instead. When present, this object will always include the dependent's name for identification, but many payers also include the date of birth and other identifying information. Some payers truncate names to fit their own technical limits, so the payer may not return the dependent's full legal name. - `additionalInformation` EligibilityCheckDependentAdditionalInformation: Additional identifying information about the dependent. - `agencyClaimNumber` string: The agency claim number, only used when the information source is a Property and Casualty payer. - `classOfContractCode` string: The class of contract code - used to identify the applicable class of contract for claims processing. - `contractNumber` string: The contract number of a contract between the payer and the provider that requested the eligibility check. - `eligibilityCategory` string: The eligibility category for the dependent. - `familyUnitNumber` string: The family unit number. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: The group or policy number. - `identificationCardSerialNumber` string: Used when the identification card has a number in addition to the member ID. - `identityCardNumber` string: The identity card number. Present when this number differs from the member ID. - `insurancePolicyNumber` string: The insurance policy number. - `issueNumber` string: The issue number. - `mbi` string: The patient's Medicare Beneficiary Identifier (MBI). If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalRecordId` string: The medical record identification number. - `memberId` string: The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer. - `patientAccountNumber` string: The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `planNetwork` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorIdentifierNumber` string: The prior identifier number. - `ssn` string: The patient's Social Security Number (SSN). - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `birthSequenceNumber` integer: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. - `dateOfBirth` string: The patient's date of birth as an ISO 8601 `YYYY-MM-DD` string. For example, `1985-03-15` represents March 15, 1985. - `dates` EligibilityCheckPatientAttributeDateRanges: Contains the dates associated with patient attributes, as ISO 8601 date ranges. These provide temporal context for patient-specific data and eligibility periods. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `certification` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `cobra` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfDeath` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `effectiveDateOfChange` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `enrollment` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `issue` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `policy` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `premiumPaidToDate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `gender` 'FEMALE' | 'MALE' | 'UNKNOWN': Code indicating the patient's gender. Payers may sometimes return other non-compliant values. - `maintenance` EligibilityCheckMaintenance: Information indicating whether the payer signaled that the patient's identifying information differs from what you submitted. - `indicator` 'NONE' | 'PAYER_INDICATED': Indicates whether the payer signaled that the patient's identifying information differs from what you submitted. - `name` EligibilityCheckQualifiedPersonName, required: A person's name. - `person` EligibilityCheckPersonName, required: A person's name. Maps to elements NM103 through NM107. - `firstName` string: The person's first name. - `lastName` string: The person's last name. - `middleName` string: The person's middle name or initial. - `suffix` string: The person's name suffix, such as Jr. or III. - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationToSubscriber` 'SPOUSE' | 'CHILD' | 'EMPLOYEE' | 'UNKNOWN' | 'ORGAN_DONOR' | 'CADAVER_DONOR' | 'LIFE_PARTNER' | 'OTHER_RELATIONSHIP': The dependent's relationship to the subscriber. Payers may sometimes return other non-compliant values. - `eligibilitySearchId` string: An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-views). This property is for use by Stedi tools only, such as Stedi's MCP server. - `errors` EligibilityCheckResponseError[]: `AAA` rejection errors from the payer. [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) specify the reasons for the rejection and any recommended follow-up actions. - `code` string, required: The AAA reject reason code. - `description` string, required: The human-readable description of the error. - `followupAction` string, required: The recommended follow-up action. - `location` 'ENVELOPE' | 'PAYER' | 'PROVIDER' | 'SUBSCRIBER' | 'SUBSCRIBER_BENEFITS' | 'DEPENDENT' | 'DEPENDENT_BENEFITS', required: The location in the 271 response where an error occurred. Payers may sometimes return other non-compliant values. - `possibleResolutions` string: Detailed guidance on possible ways to resolve the error. - `id` string, required: A globally unique identifier for this eligibility check across all Stedi accounts. It's formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal. - `meta` EligibilityCheckMeta: Metadata about the response. Stedi uses this data for tracking and troubleshooting. - `outboundTraceId` string: The transaction identifier Stedi assigns to the outbound request's `BHT03` element. Although this is a unique identifier, we recommend using `id` instead to identify and track eligibility checks. An eligibility check's `id` is guaranteed to be globally unique, and you can use it to deep link to the eligibility check's results within the Stedi portal. - `subscriberTraceNumbers` EligibilityCheckSubscriberTraceNumber[]: A unique identifier the payer may assign to the transaction. Stedi doesn't support setting a subscriber trace number in the eligibility check request because there is no need to include a trace number for real-time queries. - `originatingCompanyIdentifier` string: The identifier of the organization that assigned the trace number. - `referenceIdentification` string: The unique trace number assigned to the transaction. - `secondaryReferenceIdentification` string: Identifies a subdivision within the organization that assigned the trace number. - `type` 'CURRENT_TRANSACTION' | 'REFERENCED_TRANSACTION': Which transaction a trace number refers to. Payers may sometimes return other non-compliant values. - `traceId` string: The transaction identifier from the response's `BHT03` element. Matches the request's `BHT03` if provided, otherwise matches the Stedi-generated `outboundTraceId`. - `payer` EligibilityCheckPayer, required: Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer's tax ID. Most payers also include contact information. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `identification` string: Typically the identification the payer reported for itself in the 271 response (`NM109` with the `PI` qualifier). This value comes from the payer and may not match a [Stedi Payer Network](https://www.stedi.com/healthcare/network) ID; use the root-level `payerId` for the canonical payer ID. - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - `person` EligibilityCheckPersonName, required: A person's name. Maps to elements NM103 through NM107. - `firstName` string: The person's first name. - `lastName` string: The person's last name. - `middleName` string: The person's middle name or initial. - `suffix` string: The person's name suffix, such as Jr. or III. - object - `organization` string, required: An organization's name. Maps to element NM103. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'GATEWAY_PROVIDER' | 'PLAN_SPONSOR' | 'PAYER', required: The entity identifier code for the payer. Payers may sometimes return other non-compliant values. - `payerId` string: The primary payer ID from the [Stedi Payer Network](https://www.stedi.com/healthcare/network). This ID is consistent across eligibility and claims systems and matches the payer ID printed on the member's ID card. You can use it as the `payerId` in subsequent eligibility check requests. - `plans` EligibilityCheckPlan[]: The patient's insurance plans, grouped by plan name. Each plan contains the benefits that apply to the patient. - `benefits` EligibilityCheckBenefits, required: Benefit information from the payer, organized into categories like cost-sharing (co-insurance, deductibles, copayments), coverage details (exclusions, limitations), and eligibility statuses. - `benefitDescription` EligibilityCheckBenefitDescription[]: A list of free-text benefit descriptions from the payer. Payers sometimes use this type to communicate information that's difficult to capture elsewhere in the response. The description is included as free text in `messages` or identifiers in `additionalInformation`. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `benefitDisclaimer` EligibilityCheckBenefitDisclaimer[]: A list of disclaimers from the payer. A legal or advisory disclaimer attached to the benefit information. The X12 standard discourages use of this type, but many commercial payers still send disclaimers. When present, the disclaimer text arrives in `messages`, and there should be only one disclaimer per individual response. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `cannotProcess` EligibilityCheckCannotProcess[]: A list of entries indicating the payer couldn't process your request. Indicates that the payer couldn't process your request. A common cause is requesting benefits information for a service type or procedure code the payer doesn't support. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `cardReportedStolen` EligibilityCheckCardReportedStolen[]: A list of entries indicating the patient's card has been reported lost or stolen. This typically means that the payer has flagged the patient's member ID to prevent identity theft. The patient may still have active coverage, but you likely won't be able to run transactions with the patient's information until they resolve the issue. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `coInsurance` EligibilityCheckCoInsurance[]: A list of co-insurance benefit entries from the payer. The `percent` is the patient's share of costs, expressed as a decimal (such as `0.8` for 80%). The decimal precision reflects what the payer sent. A value of `0` indicates the payer reported no co-insurance responsibility. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string, required: The percentage value for this benefit, expressed as a decimal (e.g., 0.80 for 80%). - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `timePeriod` 'HOUR' | 'DAY' | '24_HOURS' | 'YEARS' | 'SERVICE_YEAR' | 'CALENDAR_YEAR' | 'YEAR_TO_DATE' | 'CONTRACT' | 'EPISODE' | 'VISIT' | 'OUTLIER' | 'REMAINING' | 'EXCEEDED' | 'NOT_EXCEEDED' | 'LIFETIME' | 'LIFETIME_REMAINING' | 'MONTH' | 'WEEK' | 'ADMISSION': Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values. - `coPayment` EligibilityCheckCoPayment[]: A list of copayment benefit entries from the payer. The `amount` is the fixed amount the patient pays for a service. The decimal precision reflects what the payer sent (for example, `25.0` or `40`). - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string, required: The monetary amount for this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `quantity` EligibilityCheckQuantity: A quantity value with a qualifier describing the unit of measure. For example, a value of `10` with a qualifier of `VISITS` means 10 visits. - `qualifier` 'MINIMUM' | 'QUANTITY_USED' | 'COVERED_ACTUAL' | 'COVERED_ESTIMATED' | 'NUMBER_OF_CO_INSURANCE_DAYS' | 'DEDUCTIBLE_BLOOD_UNITS' | 'DAYS' | 'HOURS' | 'LIFE_TIME_RESERVE_ACTUAL' | 'LIFE_TIME_RESERVE_ESTIMATED' | 'MAXIMUM' | 'MONTH' | 'NUMBER_OF_SERVICES_OR_PROCEDURES' | 'QUANTITY_APPROVED' | 'VISITS' | 'YEARS': Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values. - `value` string: The numeric quantity. For example, `10` when the `qualifier` is `VISITS`. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `timePeriod` 'HOUR' | 'DAY' | '24_HOURS' | 'YEARS' | 'SERVICE_YEAR' | 'CALENDAR_YEAR' | 'YEAR_TO_DATE' | 'CONTRACT' | 'EPISODE' | 'VISIT' | 'OUTLIER' | 'REMAINING' | 'EXCEEDED' | 'NOT_EXCEEDED' | 'LIFETIME' | 'LIFETIME_REMAINING' | 'MONTH' | 'WEEK' | 'ADMISSION': Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values. - `contactFollowingEntityForInformation` EligibilityCheckContactFollowingEntityForInformation[]: A list of entries directing you to contact another entity for benefit information. Indicates that the payer can't supply the information you requested and is directing you to another entity. The entity's information is listed in the `relatedEntities` array. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `costContainment` EligibilityCheckCostContainment[]: A list of cost containment benefit entries from the payer. Cost containment refers to rules a health plan may have in place to control the cost of care. This benefit is typically included when the patient has Medicaid coverage. The `amount` represents the total the patient pays out-of-pocket before benefits begin. The decimal precision reflects what the payer sent (for example, `500.0` or `500`). - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string, required: The monetary amount for this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `quantity` EligibilityCheckQuantity: A quantity value with a qualifier describing the unit of measure. For example, a value of `10` with a qualifier of `VISITS` means 10 visits. - `qualifier` 'MINIMUM' | 'QUANTITY_USED' | 'COVERED_ACTUAL' | 'COVERED_ESTIMATED' | 'NUMBER_OF_CO_INSURANCE_DAYS' | 'DEDUCTIBLE_BLOOD_UNITS' | 'DAYS' | 'HOURS' | 'LIFE_TIME_RESERVE_ACTUAL' | 'LIFE_TIME_RESERVE_ESTIMATED' | 'MAXIMUM' | 'MONTH' | 'NUMBER_OF_SERVICES_OR_PROCEDURES' | 'QUANTITY_APPROVED' | 'VISITS' | 'YEARS': Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values. - `value` string: The numeric quantity. For example, `10` when the `qualifier` is `VISITS`. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `timePeriod` 'HOUR' | 'DAY' | '24_HOURS' | 'YEARS' | 'SERVICE_YEAR' | 'CALENDAR_YEAR' | 'YEAR_TO_DATE' | 'CONTRACT' | 'EPISODE' | 'VISIT' | 'OUTLIER' | 'REMAINING' | 'EXCEEDED' | 'NOT_EXCEEDED' | 'LIFETIME' | 'LIFETIME_REMAINING' | 'MONTH' | 'WEEK' | 'ADMISSION': Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values. - `coverageBasis` EligibilityCheckCoverageBasis[]: A list of coverage basis entries from the payer. Describes the financial basis of the patient's health plan or eligibility for enrollment. For example, payers may use this type to indicate that a plan is fully insured, meaning the payer assumes full financial responsibility for medical claims. Payers may also use this type to indicate carve-out benefits, such as when the patient is enrolled in state-managed health programs, or to explain why a member was allowed to enroll in the plan (such as age range or having a disability). The detail is usually included as free text in `messages` or identifiers in `additionalInformation`. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `deductible` EligibilityCheckDeductible[]: A list of deductible benefit entries from the payer. The `amount` is what the patient must pay before the plan begins covering costs. The decimal precision reflects what the payer sent (for example, `1500.0` or `1000`). Check `timePeriod` to determine what the amount represents. A calendar-year deductible is the patient's total for the year, while a remaining deductible is the amount still owed before the plan pays. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string, required: The monetary amount for this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `quantity` EligibilityCheckQuantity: A quantity value with a qualifier describing the unit of measure. For example, a value of `10` with a qualifier of `VISITS` means 10 visits. - `qualifier` 'MINIMUM' | 'QUANTITY_USED' | 'COVERED_ACTUAL' | 'COVERED_ESTIMATED' | 'NUMBER_OF_CO_INSURANCE_DAYS' | 'DEDUCTIBLE_BLOOD_UNITS' | 'DAYS' | 'HOURS' | 'LIFE_TIME_RESERVE_ACTUAL' | 'LIFE_TIME_RESERVE_ESTIMATED' | 'MAXIMUM' | 'MONTH' | 'NUMBER_OF_SERVICES_OR_PROCEDURES' | 'QUANTITY_APPROVED' | 'VISITS' | 'YEARS': Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values. - `value` string: The numeric quantity. For example, `10` when the `qualifier` is `VISITS`. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - `provider` EligibilityCheckEntityProvider: Information about a provider associated with the related entity. - `code` 'ADMITTING' | 'ATTENDING' | 'BILLING' | 'CONSULTING' | 'COVERING' | 'HOSPITAL' | 'HOME_HEALTH_CARE' | 'LABORATORY' | 'OTHER_PHYSICIAN' | 'PHARMACIST' | 'PHARMACY' | 'PRIMARY_CARE_PHYSICIAN' | 'PERFORMING' | 'RURAL_HEALTH_CLINIC' | 'REFERRING' | 'SUBMITTING' | 'SKILLED_NURSING_FACILITY' | 'SUPERVISING': A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values. - `reference` string: The provider's taxonomy code. - `relationship` 'PARENT' | 'CHILD' | 'DOMESTIC_PARTNER' | 'SPOUSE' | 'EMPLOYEE' | 'OTHER' | 'UNKNOWN_RELATIONSHIP': Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values. - `serviceProviderNumber` string: Service Provider Number - `ssn` string: Social Security Number. - `tin` string: The Federal Taxpayer Identification Number. - `type` 'CONTRACTED_SERVICE_PROVIDER' | 'PREFERRED_PROVIDER_ORGANIZATION' | 'PROVIDER' | 'THIRD_PARTY_ADMINISTRATOR' | 'EMPLOYER' | 'OTHER_PHYSICIAN' | 'FACILITY' | 'GATEWAY_PROVIDER' | 'GROUP' | 'INDEPENDENT_PHYSICIANS_ASSOCIATION' | 'INSURED_OR_SUBSCRIBER' | 'LEGAL_REPRESENTATIVE' | 'ORIGIN_CARRIER' | 'PRIMARY_CARE_PROVIDER' | 'PRIOR_INSURANCE_CARRIER' | 'PLAN_SPONSOR' | 'PAYER' | 'PRIMARY_PAYER' | 'SECONDARY_PAYER' | 'TERTIARY_PAYER' | 'PARTY_PERFORMING_VERIFICATION' | 'VENDOR' | 'ORGANIZATION_COMPLETING_CONFIGURATION_CHANGE' | 'UTILIZATION_MANAGEMENT_ORGANIZATION' | 'MANAGED_CARE_ORGANIZATION', required: The entity identifier code for the benefit related entity. Payers may sometimes return other non-compliant values. - `service` EligibilityCheckServiceOrProcedure: The service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC. - `definition` string: The human-readable definition of the code. - `range` EligibilityCheckServiceCodeRange: A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215. - `end` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `start` EligibilityCheckServiceCode, required: A single service or procedure code with its definition. - … - `system` 'STC' | 'CDT' | 'CPT' | 'NDC' | 'HCPCS' | 'ICD-10-PCS': Identifies the external code list used to provide the specified procedure or service codes. Payers may sometimes return other non-compliant values. - `value` string: The service or procedure code value. - `serviceLimits` EligibilityCheckServiceLimit[]: Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules. - union: A service limit specified as an age boundary or a delivery restriction. For example, minimum age 18, or 10 visits per year on weekdays. - object - … - object - … - object - … - `timePeriod` 'HOUR' | 'DAY' | '24_HOURS' | 'YEARS' | 'SERVICE_YEAR' | 'CALENDAR_YEAR' | 'YEAR_TO_DATE' | 'CONTRACT' | 'EPISODE' | 'VISIT' | 'OUTLIER' | 'REMAINING' | 'EXCEEDED' | 'NOT_EXCEEDED' | 'LIFETIME' | 'LIFETIME_REMAINING' | 'MONTH' | 'WEEK' | 'ADMISSION': Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values. - `exclusions` EligibilityCheckExclusion[]: A list of services or conditions the plan excludes from coverage. An exclusion is a service or condition the plan doesn't cover for any patient. This is different from a `nonCovered` entry, which reports that this patient doesn't have coverage for a specific service you submitted in the request. - `additionalInformation` EligibilityCheckEligibilityAndBenefitAdditionalInformation: Additional plan, group, and policy identification numbers for this benefit entry. - `alternativeListId` string: The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient. - `coverageListId` string: The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient. - `drugFormularyNumber` string: The drug formulary number. - `familyUnitNumber` string: The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID. - `group` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `groupOrPolicyNumber` string: A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation. - `insurancePolicyNumber` string: The insurance policy number. - `mbi` string: The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis) for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid. - `medicaidRecipientId` string: The Medicaid recipient identification number. - `medicalAssistanceCategory` string: The medical assistance category. - `memberId` string: The patient's member ID. - `plan` EligibilityCheckAdditionalInformationWithName: Additional information with description. - `name` string: The name or description associated with `number`. - `number` string, required: The identification number. - `priorAuthNumber` string: The prior authorization number. - `referralNumber` string: The referral number. - `amount` string: The monetary amount associated with this benefit. - `coverageLevel` 'CHILDREN_ONLY' | 'DEPENDENTS_ONLY' | 'EMPLOYEE_AND_CHILDREN' | 'EMPLOYEE_ONLY' | 'EMPLOYEE_AND_SPOUSE' | 'FAMILY' | 'INDIVIDUAL' | 'SPOUSE_AND_CHILDREN' | 'SPOUSE_ONLY', required: Code indicating the level of coverage for the patient. Payers may sometimes return other non-compliant values. - `dates` EligibilityCheckEligibilityAndBenefitDateRanges: Contains the dates associated with specific benefits, as ISO 8601 date ranges. These dates determine eligibility for individual benefits, separate from overall plan eligibility dates. - `added` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `admission` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `benefit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `completion` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `coordinationOfBenefits` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `dateOfLastUpdate` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `discharge` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `eligibility` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `latestVisit` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `period` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `plan` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `primaryCareProvider` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `service` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `status` EligibilityCheckDateRange: A calendar date range. Both bounds are optional and at least one is always present; `end` is inclusive. A point-in-time date is carried in `start`. - `end` string: The inclusive end of the range. - `start` string: The start of the range, or a single point-in-time date. - `diagnosis` EligibilityCheckDiagnosis: A diagnosis associated with this benefit entry. Includes a code system and one or more diagnosis codes. - `codeSystem` 'ICD-10-CM', required: The code system for diagnosis codes. Only supports ICD-10-CM. - `codes` EligibilityCheckDiagnosisCode[], required: Diagnosis codes associated with this benefit entry. - `definition` string: The human-readable definition of the diagnosis code. - `value` string, required: The diagnosis code value. - `insuranceType` 'DISABILITY' | 'MEDICARE_POINT_OF_SERVICE_POS' | 'MULTIPLE_OPTIONS_HEALTH_PLAN' | 'MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN' | 'MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY' | 'MEDICARE_SECONDARY_WORKERS_COMPENSATION' | 'MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY' | 'MEDICARE_SECONDARY_BLACK_LUNG' | 'MEDICARE_SECONDARY_VETERANS_ADMINISTRATION' | 'MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP' | 'MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY' | 'AUTO_INSURANCE_POLICY' | 'COMMERCIAL' | 'CONSOLIDATED_OMNIBUS_BUDGET_RECONCILIATION_ACT_COBRA' | 'MEDICARE_CONDITIONALLY_PRIMARY' | 'DISABILITY_BENEFITS' | 'EXCLUSIVE_PROVIDER_ORGANIZATION' | 'FAMILY_OR_FRIENDS' | 'GROUP_POLICY' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO' | 'HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK' | 'SPECIAL_LOW_INCOME_MEDICARE_BENEFICIARY' | 'INDEMNITY' | 'INDIVIDUAL_POLICY' | 'LONG_TERM_CARE' | 'LONG_TERM_POLICY' | 'LIFE_INSURANCE' | 'LITIGATION' | 'MEDICARE_PART_A' | 'MEDICARE_PART_B' | 'MEDICAID' | 'MEDIGAP_PART_A' | 'MEDIGAP_PART_B' | 'MEDICARE_PRIMARY' | 'OTHER' | 'PROPERTY_INSURANCE_PERSONAL' | 'PERSONAL' | 'PERSONAL_PAYMENT_CASH_NO_INSURANCE' | 'PREFERRED_PROVIDER_ORGANIZATION_PPO' | 'POINT_OF_SERVICE_POS' | 'QUALIFIED_MEDICARE_BENEFICIARY' | 'PROPERTY_INSURANCE_REAL' | 'SUPPLEMENTAL_POLICY' | 'TAX_EQUITY_FISCAL_RESPONSIBILITY_ACT_TEFRA' | 'WORKERS_COMPENSATION' | 'WRAP_UP_POLICY': Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values. - `messages` string[]: Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer. - `network` EligibilityCheckNetwork: Network information for a benefit, including the in-plan network indicator and plan network identification. - `description` string: The plan, group, or plan network name. - `id` string: The plan network identification number. - `indicator` 'IN_NETWORK' | 'OUT_OF_NETWORK' | 'IN_AND_OUT_OF_NETWORK': Code indicating whether the benefit is in-network or out-of-network. Note that this property **doesn't indicate** whether the provider is in or out-of-network for the patient. To determine that, you must check with the payer directly. Payers may sometimes return other non-compliant values. - `percent` string: The percentage associated with this benefit. - `placesOfService` EligibilityCheckPlaceOfService[]: The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details. - `code` '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' | '27' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '66' | '71' | '72' | '81' | '99': Standardized code identifying the type of healthcare facility where providers may deliver services. Payers may sometimes return other non-compliant values. - `name` string: The human-readable name of the place of service. - `planCoverageDescription` string: The plan coverage description the payer sent for this benefit entry. Payers typically send the plan name, but some send benefit-level information instead. Stedi omits this property when it matches the plan's `name`. When the plan has no `name`, check this property for the payer's plan information. - `priorAuthIndicator` 'REQUIRED' | 'NOT_REQUIRED': Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values. - `relatedEntities` EligibilityCheckRelatedEntity[]: Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. - `address` EligibilityCheckAddress: The address of the entity. - `addressLine1` string: The first line of the address. - `addressLine2` string: The second line of the address. - `city` string: The city. - `country` string: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). - `countrySubdivision` string: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). - `postalCode` string: The United States or Canadian postal code, excluding punctuation and blanks. - `state` string: The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. - `contacts` EligibilityCheckContact[]: The entity's contact information. - `ediNumbers` string[]: The contact's EDI numbers. - `emails` string[]: The contact's email addresses. - `faxNumbers` string[]: The contact's fax numbers. - `name` string: The name of the contact person. - `phoneNumbers` string[]: The contact's phone numbers. - `urls` string[]: The contact's URLs. - `ein` string: The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in `tin`. - `etin` string: Electronic Transmitter Identification Number. - `facilityId` string: Facility Identification. - `memberId` string: Member Identification Number - `naicId` string: National Association of Insurance Commissioners Identification - `name` union: A name that is either a person or an organization. - object - … - object - … - `npi` string: Centers for Medicare and Medicaid Services National Provider Identifier - `payerId` string: Payer Identification - `pharmacyProcessorNumber` string: Pharmacy Processor Number - … truncated; see the full OpenAPI document linked below ## Other responses - `400`: CreateEligibilityCheck400Error 400 response - `401`: AuthenticationFailedException 401 response - `403`: CreateEligibilityCheck403Error 403 response - `404`: ResourceNotFoundException 404 response - `413`: ContentTooLargeException 413 response - `429`: CreateEligibilityCheck429Error 429 response - `451`: EligibilityCheckNonUsOriginException 451 response - `500`: CreateEligibilityCheck500Error 500 response - `503`: ServiceUnavailableException 503 response - `504`: GatewayTimeoutException 504 response ## Changes - **2026-10-27** `12bd127181aa`: 2 info - the request property `provider/name` became optional - the request property `provider/name/oneOf[subschema #1: person]/person/lastName` became optional - **2026-10-22** `780b178dd68e`: 1 info - the `payerName` request property's maxLength was increased from `60` to `120` - **2026-09-23** `7c1772192045`: 2 info - added the new optional request property `dependent/birthSequenceNumber` - added the new optional request property `subscriber/birthSequenceNumber` - **2026-09-23** `20e42421b074`: 1 breaking - added `#/components/schemas/EligibilityCheckInvalidParticipantException` to the response body `oneOf` list for the response status `400` - **2026-09-17** `67e4912a2de4`: 1 breaking, 1 info - added `#/components/schemas/EligibilityCheckThrottledException` to the response body `oneOf` list for the response status `429` - added the non-success response with the status `451` [Operation history](https://skmtc.dev/stedi/apis/stedi-healthcare/changes/eligibility-check/post.md) --- [API](https://skmtc.dev/stedi/apis/stedi-healthcare.md) - [All operations](https://skmtc.dev/stedi/apis/stedi-healthcare/llms.txt) - [OpenAPI document](https://skmtc.dev/stedi/apis/stedi-healthcare/revisions/12bd127181aa?raw)