UnitedHealthcare Eligibility Response

Real-time eligibility verification response with coverage details

Health InsuranceHealthcareFHIRClaimsEligibility

Properties

Name	Type	Description
memberId	string	UnitedHealthcare member ID
memberName	string	Member full name
coverageStatus	string	Coverage status
planName	string	Insurance plan name
groupNumber	string	Group number
effectiveDate	string	Coverage effective date
terminationDate	string	Coverage termination date
deductible	number	Annual deductible amount
deductibleMet	number	YTD deductible met
outOfPocketMax	number	Annual out-of-pocket maximum
outOfPocketMet	number	YTD out-of-pocket met
copay	number	Copay amount
coinsurance	number	Coinsurance percentage
networkStatus	string	Network status

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-eligibility-response-schema.json",
  "title": "UnitedHealthcare Eligibility Response",
  "description": "Real-time eligibility verification response with coverage details",
  "type": "object",
  "properties": {
    "memberId": {
      "type": "string",
      "description": "UnitedHealthcare member ID"
    },
    "memberName": {
      "type": "string",
      "description": "Member full name"
    },
    "coverageStatus": {
      "type": "string",
      "enum": [
        "ACTIVE",
        "INACTIVE",
        "TERMED"
      ],
      "description": "Coverage status"
    },
    "planName": {
      "type": "string",
      "description": "Insurance plan name"
    },
    "groupNumber": {
      "type": "string",
      "description": "Group number"
    },
    "effectiveDate": {
      "type": "string",
      "format": "date",
      "description": "Coverage effective date"
    },
    "terminationDate": {
      "type": "string",
      "format": "date",
      "description": "Coverage termination date"
    },
    "deductible": {
      "type": "number",
      "description": "Annual deductible amount"
    },
    "deductibleMet": {
      "type": "number",
      "description": "YTD deductible met"
    },
    "outOfPocketMax": {
      "type": "number",
      "description": "Annual out-of-pocket maximum"
    },
    "outOfPocketMet": {
      "type": "number",
      "description": "YTD out-of-pocket met"
    },
    "copay": {
      "type": "number",
      "description": "Copay amount"
    },
    "coinsurance": {
      "type": "number",
      "description": "Coinsurance percentage"
    },
    "networkStatus": {
      "type": "string",
      "enum": [
        "IN_NETWORK",
        "OUT_OF_NETWORK",
        "UNKNOWN"
      ],
      "description": "Network status"
    }
  }
}