EligibilityRequest

An object representing the data for an eligibility request.

Medical BillingRevenue Cycle ManagementHealthcareClaimsEligibilityPrior AuthorizationRemittancePatient CollectionsCredentialingInsurance

Properties

Name	Type	Description
submitter_transaction_identifier	string	A unique identifier for the eligibility check within the batch. Candid returns this identifier in the response for the /batch/{batch_id} polling endpoint so you can correlate benefit responses with th
payer_id	string	Supported payer ID values can be found [here](https://www.stedi.com/healthcare/network).
provider	object
subscriber	object	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 undefined.
dependent	object	If a dependent has a unique member ID, include their information as subscriber and leave this field undefined.
encounter	object
get_existing_check_initiated_after	string	If not provided, this endpoint will run a fresh eligibility check. If provided, it will return an existing successful eligibility check if one exists that was initiated after provided date with the sa
source	string
portal_password	string	The password that the provider uses to log in to the payer's portal. This is not commonly used.
portal_username	string	The username that the provider uses to log in to the payer's portal. This is not commonly used.

View JSON Schema on GitHub

JSON Schema

{
  "type": "object",
  "properties": {
    "submitter_transaction_identifier": {
      "type": "string",
      "description": "A unique identifier for the eligibility check within the batch. Candid returns this identifier in the response for the\n/batch/{batch_id} polling endpoint so you can correlate benefit responses with the original eligibility check."
    },
    "payer_id": {
      "type": "string",
      "description": "Supported payer ID values can be found [here](https://www.stedi.com/healthcare/network)."
    },
    "provider": {
      "$ref": "#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Provider"
    },
    "subscriber": {
      "$ref": "#/components/schemas/type_pre-encounter/coverages/v1:MemberInfo",
      "description": "The primary policyholder for the insurance plan or a dependent with a unique member ID. <Note>If a dependent has a unique member ID, include their information here and leave dependent undefined.</Note>"
    },
    "dependent": {
      "$ref": "#/components/schemas/type_pre-encounter/coverages/v1:MemberInfo",
      "description": "<Note>If a dependent has a unique member ID, include their information as subscriber and leave this field undefined.</Note>"
    },
    "encounter": {
      "$ref": "#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Encounter"
    },
    "get_existing_check_initiated_after": {
      "type": "string",
      "format": "date-time",
      "description": "If not provided, this endpoint will run a fresh eligibility check. If provided, it will return an existing successful eligibility check if one exists that was initiated after provided date with the same parameters (Date of Service, Payer ID, Provider, Subscriber, Dependent, and Encounter)."
    },
    "source": {
      "type": "string"
    },
    "portal_password": {
      "type": "string",
      "description": "The password that the provider uses to log in to the payer's portal. This is not commonly used."
    },
    "portal_username": {
      "type": "string",
      "description": "The username that the provider uses to log in to the payer's portal. This is not commonly used."
    }
  },
  "required": [
    "payer_id",
    "provider",
    "subscriber"
  ],
  "description": "An object representing the data for an eligibility request.",
  "title": "EligibilityRequest",
  "$schema": "http://json-schema.org/draft-07/schema#",
  "$id": "https://api.joincandidhealth.com/schemas/eligibilityrequest"
}