UnitedHealthcare Benefit Check Request

Request for patient-specific benefit and cost-sharing check

Health InsuranceHealthcareFHIRClaimsEligibility

Properties

Name	Type	Description
memberId	string	Member ID
dateOfBirth	string	Date of birth
serviceCode	string	CPT/HCPCS service code
dateOfService	string	Date of service
npi	string	Provider NPI
providerTaxId	string	Provider tax ID
placeOfService	string	Place of service code

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-schema/provider-benefit-check-request-schema.json",
  "title": "UnitedHealthcare Benefit Check Request",
  "description": "Request for patient-specific benefit and cost-sharing check",
  "type": "object",
  "required": [
    "memberId",
    "dateOfBirth",
    "serviceCode",
    "dateOfService"
  ],
  "properties": {
    "memberId": {
      "type": "string",
      "description": "Member ID"
    },
    "dateOfBirth": {
      "type": "string",
      "format": "date",
      "description": "Date of birth"
    },
    "serviceCode": {
      "type": "string",
      "description": "CPT/HCPCS service code"
    },
    "dateOfService": {
      "type": "string",
      "format": "date",
      "description": "Date of service"
    },
    "npi": {
      "type": "string",
      "description": "Provider NPI"
    },
    "providerTaxId": {
      "type": "string",
      "description": "Provider tax ID"
    },
    "placeOfService": {
      "type": "string",
      "description": "Place of service code"
    }
  }
}