# Real-time eligibility checks
Source: https://www.stedi.com/docs/healthcare/send-eligibility-checks

***

title: Real-time eligibility checks
sidebarTitle: "Real-time eligibility checks"
--------------------------------------------

Real-time eligibility checks are ideal for in-person patient visits, telehealth appointments, and other scenarios where you need immediate information about a patient's coverage.

We recommend always starting with real-time checks when integrating with a new payer. This approach allows you to quickly test and refine your pipeline through fast feedback loops. Once you're comfortable with real-time checks, you may also want to start sending asynchronous batch checks to perform periodic refreshes for all or a subset of patients.

You can send real-time eligibility checks to payers manually through the Stedi portal or programmatically through the API. The synchronous response includes the patient's complete benefits information, such as coverage status, co-pays, and deductibles.

<Tip>
  Eligibility checks verify coverage with a specific payer. If you don't know
  the payer, you can perform an [insurance discovery
  check](/healthcare/insurance-discovery) instead to find a patient's coverage
  using their demographic data.
</Tip>

## Transaction enrollment

[Transaction enrollment](/healthcare/transaction-enrollment) is the process of registering a provider to exchange specific healthcare transactions with a payer.

Most payers don't require transaction enrollment for eligibility checks. Those that do, such as the Centers for Medicare & Medicaid Services (CMS), typically allow multiple enrollments with different clearinghouses. That means enrolling through Stedi shouldn't cancel or interfere with any existing enrollments you have through other clearinghouses.

Enrolling through Stedi for real-time eligibility checks also doesn't affect your existing enrollments for other transaction types. For example, enrolling with Stedi won't unenroll the provider from receiving transactions like Electronic Remittance Advices (ERAs) through other clearinghouses.

You can check whether a specific payer requires enrollment for eligibility checks in the [Payer Network](https://www.stedi.com/healthcare/network) or through the [Payers API](/healthcare/api-reference/get-payer).

To enroll, complete the following steps:

1. Create a provider record with the information required for enrollment. If you already have a record for the provider, you can skip this step. [Stedi portal](https://portal.stedi.com/app/healthcare/providers) | [API endpoint](/healthcare/api-reference/post-enrollment-create-provider)
2. Submit an enrollment request for real-time eligibility checks. [Stedi portal](https://portal.stedi.com/app/healthcare/enrollments) | [API endpoint](/healthcare/api-reference/post-enrollment-create-enrollment)

## Testing

The best way to test real-time eligibility checks is through mock requests. When you submit specific mock requests, Stedi returns mock benefits data from the specified payer. You can submit mock requests through the:

* **JSON endpoint:** Visit [Eligibility mock requests](/healthcare/api-reference/mock-requests-eligibility-checks) for a complete list.
* **Stedi portal:** Visit [Test mode](/healthcare/test-mode) to learn how to enable **Test mode** in your account and manually submit mock requests.

### Don't send fake data

Some payers, particularly CMS (HETS), prohibit sending test eligibility checks for fake patients or providers to their production systems. Payers may block your access if you send these types of test transactions.

You can send as many [mock requests](/healthcare/api-reference/mock-requests-eligibility-checks) to Stedi as you need, but if you need to send test data to payers in production, you must contact [Stedi support](https://www.stedi.com/contact) to coordinate with the payer and obtain approval. For example, some payers require that you use specific test credentials.

## Manual submission

Manual eligibility checks can be useful for testing and for situations when you need to do a one-time eligibility check.

Go to the [Create manual eligibility check](https://portal.stedi.com/app/healthcare/checks/create) page in the Stedi portal to submit manual eligibility checks and review the full JSON response. You can also sort and filter a more user-friendly response organized by coverage type and level.

## API submission

Call one of the following endpoints to send real-time 270/271 eligibility checks to payers:

* [Eligibility Check](/healthcare/api-reference/post-healthcare-eligibility) to send requests in JSON
* [Eligibility Check Raw X12](/healthcare/api-reference/post-healthcare-eligibility-raw-x12) to send requests in X12 EDI
* [Eligibility Check SOAP](/healthcare/api-reference/post-healthcare-eligibility-soap) to send SOAP requests using the CAQH CORE vC2.2.0 XML Schema. The XML document contains an eligibility check in X12 EDI format.

Stedi automatically applies various repairs to help your requests meet X12 HIPAA specifications, resulting in fewer payer rejections.

### Headers - required

JSON and Raw X12 endpoints:

* **`Authorization`:** [Generate an API key](/healthcare/api-reference#authentication) to use for authentication.
* **`Content-Type`:** Set to `application/json`.

SOAP endpoint:

* **`Content-Type`:** Set to `application/soap+xml`. You'll include authentication details in the XML document, so you don't need to set the `Authorization` header.

### Headers - situational

JSON, Raw X12, and SOAP endpoints:

* When sending eligibility checks to the Centers for Medicare & Medicaid Services (CMS), you may need to include the `X-Forwarded-For` header set to a comma-separated list of any upstream IP addresses. Visit [CMS traceability requirements](#cms-traceability-requirements) for details and examples.

### Body - JSON

The information you provide to the payer in an eligibility check can vary, depending on the circumstances. We recommend starting with a basic eligibility request.

#### Basic eligibility request

Each eligibility check must include at least the following information in the request body:

| Information                                    | Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| ---------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| `tradingPartnerServiceId`                      | <ul><li>This is the payer ID. You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record. If you don't already have payer IDs you use today, we recommend using the primary Payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list.</li><li> If you don't know the payer, try submitting an [insurance discovery check](/healthcare/insurance-discovery) instead.</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
| `provider` object, name and identifier         | <ul><li>You must include the provider's name - either the `firstName` and `lastName` of a specific provider within a practice or the `organizationName`.</li><li>You must include 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 `taxId` or `ssn`.</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| `subscriber` and/or `dependents` objects       | <ul><li>The `dependents` object is optional - refer to the scenarios when the [patient qualifies as a dependent](/healthcare/send-eligibility-checks#dependents).</li><li>At a minimum, our API requires that you supply at least one of these fields in the request: `memberId`, `dateOfBirth`, or `lastName`. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system.</li><li> When all four of `memberId`, `dateOfBirth`, `firstName`, and `lastName` are provided, payers are required to 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.</li><li> We recommend always including the patient's member ID when possible. Learn more about [patient information](/healthcare/send-eligibility-checks#patient-information).</li></ul> |
| `encounter` object, service dates              | <ul><li>You can specify either a single `dateOfService` or a `beginningDateOfService` and `endDateOfService`. The payer defaults to using the current date in their timezone if you don't include one.</li><li>When checking eligibility for today, omit the `dateOfService` property to ensure consistent behavior across payers.</li><li> 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.</li></ul>                                                                                                                                                       |
| `encounter` object, service or procedure codes | <ul><li>Specify `serviceTypeCodes` and/or a `procedureCode` and `productOrServiceIDQualifier` to request specific types of benefits information.</li><li>We recommend including no more than one service type code in each request.</li><li> If you don't include any service type code or procedure code information, Stedi defaults to using `30` (Plan coverage and general benefits) as the only `serviceTypeCodes` value.</li><li> Learn more about [STCs and procedure codes](/healthcare/eligibility-stc-procedure-codes).</li></ul>                                                                                                                                                                                                                                                                                                                                                                                  |

The following example shows the bare minimum request body for an eligibility check. Because the `dateOfService` is not specified, the payer will use the current date in their timezone (default) to retrieve benefits information.

{/* schema:EligibilityCheckRequestContent */}

```json
{
  "tradingPartnerServiceId": "AHS",
  "encounter": {
    "serviceTypeCodes": ["78"]
  },
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "memberId": "1234567890"
  }
}
```

#### Conditional requirements

Note that objects marked as **required** are required for all requests, while others are conditionally required depending on the circumstances. When you include a conditionally required object, you must include all of its required properties.

For example, you must always include the `provider` object in your request, but you only need to include the `dependents` object when you need to request benefits information for a dependent on the subscriber's insurance plan.

### Body - X12 EDI

When sending real-time eligibility checks through the Raw X12 or SOAP endpoints, you must send the eligibility check [270 X12 EDI format](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-inquiry-x279a1/01GRYB6GTDJ4MEP5Z16CGMQWT6?__hstc=181257784.360aac417a3f93a63ca63bf29197fe1f.1727971380232.1752174670420.1752250096430.449&__hssc=181257784.244.1752250096430&__hsfp=1923652471). The information you send can vary, depending on the circumstances. We recommend starting with a basic eligibility request.

#### Basic eligibility request

Each eligibility check must also include at least the following information:

| Information                                                      | Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| ---------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| `BHT03` (Submitter Transaction Identifier)                       | <ul><li>This identifier must be 1-50 characters long and different from the value you choose for `ST02`.</li><li> We also strongly recommend using a unique value. [Learn more](/healthcare/send-eligibility-checks#submitter-transaction-identifier)</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
| `Loop 2100A` (Information Source)                                | <ul><li>This loop contains the payer's information. Notably, you must include the payer's name (`NM103`) and identifier (`NM109`).</li><li>The payer's identifier **must** be a payer ID or payer ID alias listed in the [Payer Network](https://www.stedi.com/healthcare/network). For example, you could use `60054`, `HPQRS`, `AETNA`, or any other listed payer ID alias for Aetna.</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
| `Loop 2000B` (Information Receiver)                              | <ul><li>This loop contains information about the provider requesting the benefits information.</li><li> You must include the provider's name (`NM103`) and an identifier (`NM109`). Most often this is the [National Provider Identifier (NPI)](/healthcare/national-provider-identifier).</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
| `Loop 2000C` (Subscriber) and `Loop 2000D` (Dependent)           | <ul><li>`Loop 2000D` is optional - refer to the scenarios when the [patient qualifies as a dependent](/healthcare/send-eligibility-checks#dependents). </li><li>At a minimum, you must supply at least one of these fields in the appropriate loop to identify the patient: `NM109` (member ID), `DMG02` (birth date), or `NM103` (last name). However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the patient in their system.</li><li>When all four of member ID, first name, last name, and date of birth are provided, payers are required to 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.</li><li>We recommend always including the patient's member ID when possible. Learn more about [patient information](/healthcare/send-eligibility-checks#patient-information).</li></ul> |
| `Loop 2110C` or `Loop 2100D DTP` (Eligibility/Benefit Date)      | <ul><li>You can specify either a single date of service or a range of service dates. The payer defaults to using the current date in their timezone if you don't include one.</li><li>When checking eligibility for today, omit the service date from the request to ensure consistent behavior across payers.</li><li> 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.</li></ul>                                                                                                                                                                                                  |
| `Loop 2110C` or `Loop 2100D EQ` (Eligibility or Benefit Inquiry) | <ul><li>You must specify a service type code and/or a procedure code and qualifier to request specific types of benefits information.</li><li>We recommend including no more than one service type code in each request. Learn more about [STCs and procedure codes](/healthcare/eligibility-stc-procedure-codes).</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |

#### Envelope and header

Stedi generates its own `ISA` and `GS` headers and `IEA` and `GE` trailers before sending your eligibility check to the payer. You can submit your check to Stedi with any values in these segments, as long as they conform to the X12 EDI specification.

However, you must set `ST03` (Implementation Convention Reference) to `005010X279A1`.

#### Submitter Transaction Identifier

The `BHT03` (Submitter Transaction Identifier) element is **required** when submitting real-time eligibility checks in X12 EDI. The identifier you choose must be:

* An alphanumeric string from 1-50 characters long.
* Different from the value you choose for `ST02` (Transaction Set Control Number).

We also **strongly recommend** using a unique value. This approach makes it easier for Stedi to troubleshoot eligibility checks in your account.

The payer returns the identifier in the `BHT03` element of the 271 eligibility response, and Stedi returns it in the `meta.traceId` JSON property.

If you don't include `BHT03` in the request, Stedi returns a `200` with the `status` property set to `ERROR` and the `implementationTransactionSetSyntaxError` property set to `5`. The response also includes a negative [999 Implementation Acknowledgment](https://www.stedi.com/edi/x12/transaction-set/999) in the `x12` property.

<Accordion title="Example error response due to missing BHT03">
  {/* schema:EligibilityCheckResponseContent */}

  ```json
  {
    "controlNumber": "138549672",
    "tradingPartnerServiceId": "STEDI",
    "errors": [
      {
        "description": "The payer or clearinghouse rejected the request with validation errors. The original edi response is returned in the x12 field, please contact Stedi Support if you need further help."
      }
    ],
    "status": "ERROR",
    "transactionSetAcknowledgement": "R",
    "implementationTransactionSetSyntaxError": "5",
    "x12": "ISA*00*          *00*          *ZZ*STEDI          *01*117151744      *250523*1304*^*00501*000000000*0*P*:~GS*FA*STEDI*117151744*20250523*1304*000000000*X*005010X231A1~ST*999*0001*005010X231A1~AK1*HS*9872*005010X279A1~AK2*270*0001*005010X279A1~IK3*BHT*2**8~IK4*3*127*2~CTX*SITUATIONAL TRIGGER*BHT*2**3~IK5*R*5~AK9*R*1*1*0~SE*9*0001~GE*1*000000000~IEA*1*000000000~"
  }
  ```
</Accordion>

#### Trace Number

You may want to include a trace number in your request to help you track eligibility checks. Stedi always generates a trace number for internal tracking, and you can optionally supply your own trace number of up to 50 characters in a `TRN` segment.

You can send the trace number in **one** of the following locations (not both):

* If the subscriber is the patient, send it in `Loop 2000C TRN02` (Trace Number).
* If the dependent is the patient, send it in `Loop 2000D TRN02` (Dependent Trace Number).

Stedi returns both its internal trace number and your trace number (if provided) in the [`subscriberTraceNumbers` array](/healthcare/api-reference/post-healthcare-eligibility-raw-x12#response.subscriberTraceNumbers).

### Character restrictions

Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP `400` errors.

<Accordion title="Basic character set">
  The X12 Basic character set includes uppercase letters, digits, space, and some special characters. Lowercase letters and special language characters like `ñ` are not included.

  The following special characters are included:

  ![Basic special characters](/images/basic-special-characters.png)
</Accordion>

<Accordion title="Extended character set">
  The Extended character set includes the characters listed in Basic, plus lowercase letters and additional special characters, such as `@`.

  The following additional special characters are included:
  ![Extended special characters](/images/extended-special-characters-healthcare.png)
</Accordion>

In addition, the following characters are reserved for delimiters in the final X12 EDI transaction to the payer: `~`, `*`, `:`, and `^`. X12 doesn’t support using escape sequences to represent delimiters or special characters. Stedi returns a `400` error if you use these restricted characters improperly.

* **JSON endpoint:** Don’t include delimiter characters anywhere in your request data.
* **Raw X12 endpoint:** You can use these characters as delimiters, but not in the body of the request data.

#### Autocorrection for backticks

Stedi automatically replaces backticks (`` ` ``), also known as backquotes or grave accents, with an apostrophe (`'`) in `subscriber` and `dependents` first and last names. These corrections prevent errors when submitting your request. Stedi returns a message in the response's `warnings` array when it makes this replacement.

### Sample request and response

The following request and response examples show a basic eligibility check for a patient named Jane Doe. The request uses the `MH` service type code to check for mental health benefits.

The response contains the patient's benefits information. Visit [Determine patient benefits](/healthcare/eligibility-active-coverage-benefits) for detailed explanations of how to determine the patient's active coverage, financial responsibility, whether referrals and authorizations are required, and more.

#### JSON endpoint

<Tabs items={["Request - JSON", "Response"]}>
  <Tab value="Request - JSON">
    {/* schema:EligibilityCheckRequestContent */}

    ```bash
    curl --request POST \
      --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3 \
      --header 'Authorization: <api-key>' \
      --header 'Content-Type: application/json' \
      --data '{
          "tradingPartnerServiceId": "ABDCE",
          "encounter": {
            "serviceTypeCodes": ["MH"]
          },
          "provider": {
            "organizationName": "ACME Health Services",
            "npi": "1999999984"
          },
          "subscriber": {
            "dateOfBirth": "19000101",
            "firstName": "Jane",
            "lastName": "Doe",
            "memberId": "1234567890"
          }
       }'
    ```
  </Tab>

  <Tab value="Response">
    {/* schema:EligibilityCheckResponseContent */}

    ```json
    {
      "meta": {
        "senderId": "030240928",
        "submitterId": "117151744",
        "applicationMode": "production",
        "traceId": "01J2VZA127GH93JT74HJU",
        "outboundTraceId": "01J2VZA127GH93JT74HJU"
      },
      "controlNumber": "214976898",
      "id": "ec_01234567-89ab-cdef-0123-456789abcdef",
      "reassociationKey": "123456789",
      "tradingPartnerServiceId": "123456789",
      "provider": {
        "providerName": "ACME HEALTH SERVICES",
        "entityIdentifier": "Provider",
        "entityType": "Non-Person Entity",
        "npi": "1999999984"
      },
      "subscriber": {
        "memberId": "123456789",
        "firstName": "JANE",
        "lastName": "DOE",
        "middleName": "A",
        "gender": "F",
        "entityIdentifier": "Insured or Subscriber",
        "entityType": "Person",
        "dateOfBirth": "19000101",
        "groupNumber": "123456789",
        "address": {
          "address1": "1234 FIRST ST",
          "city": "NEW YORK",
          "state": "WV",
          "postalCode": "123451111"
        }
      },
      "payer": {
        "entityIdentifier": "Payer",
        "entityType": "Non-Person Entity",
        "name": "ABCDE",
        "federalTaxpayersIdNumber": "123412345",
        "contactInformation": {
          "contacts": [
            {
              "communicationMode": "Telephone",
              "communicationNumber": "1234567890"
            },
            {
              "communicationMode": "Uniform Resource Locator (URL)",
              "communicationNumber": "website.company.com"
            }
          ]
        }
      },
      "planInformation": {
        "groupNumber": "12341234",
        "groupDescription": "ABCDE",
        "priorIdNumber": "1234567890"
      },
      "planDateInformation": {
        "planBegin": "20240101",
        "planEnd": "20241231",
        "eligibilityBegin": "20220102"
      },
      "planStatus": [
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "planDetails": "Open Access Plus",
          "serviceTypeCodes": ["30"]
        },
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "serviceTypeCodes": [
            "A7",
            "BC",
            "A8",
            "A4",
            "A5",
            "A6",
            "7",
            "4",
            "BB",
            "22"
          ]
        },
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "serviceTypeCodes": ["MH"]
        }
      ],
      "benefitsInformation": [
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "planCoverage": "Open Access Plus",
          "additionalInformation": [
            {
              "description": "Complete Care Management"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "6000",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "500",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "3000",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "250",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "30000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "benefitPercent": "0.1",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "7500",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
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          "timeQualifier": "Calendar Year",
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            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
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            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
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          ]
        },
        {
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          "name": "Co-Insurance",
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            {
              "description": "Includes services provided by Client Specific Network"
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              "description": "Includes services provided by Client Specific Network"
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          ],
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          "timeQualifier": "Visit",
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          "inPlanNetworkIndicator": "Yes",
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        },
        {
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        {
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          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
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              "description": "Services rendered thru Client Specific Network"
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              "description": "Services rendered thru Client Specific Network"
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          ],
          "eligibilityAdditionalInformation": {
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            "codeListQualifier": "Mutually Defined",
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          "eligibilityAdditionalInformationList": [
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          ]
        },
        {
          "code": "A",
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              "description": "Services rendered thru Client Specific Network"
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          "eligibilityAdditionalInformation": {
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          "eligibilityAdditionalInformationList": [
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              "codeListQualifierCode": "ZZ",
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        },
        {
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          "inPlanNetworkIndicator": "Yes"
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          "eligibilityAdditionalInformation": {
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          "eligibilityAdditionalInformationList": [
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              "codeListQualifierCode": "ZZ",
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        },
        {
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          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
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          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
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          "serviceTypes": ["Diagnostic X-Ray"],
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            "codeListQualifier": "Mutually Defined",
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            "industry": "Outpatient Hospital"
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          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
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              "industry": "Outpatient Hospital"
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          ]
        },
        {
          "code": "A",
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          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
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          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
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          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
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              "industry": "Outpatient Hospital"
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          ]
        },
        {
          "code": "C",
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          "serviceTypes": ["Partial Hospitalization (Psychiatric)"],
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          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
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          ]
        },
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": ["MH"],
          "serviceTypes": ["Mental Health"],
          "additionalInformation": [
            {
              "description": " Provider is out of network based on NPI ID provided in request."
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          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "5760",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "500",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
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          "serviceTypes": ["Health Benefit Plan Coverage"],
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          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
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          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
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          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
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          ]
        },
        {
          "code": "C",
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          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
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          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "30000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
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          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "7500",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
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          "coverageLevel": "Individual",
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          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            }
          ]
        }
      ],
      "errors": [],
      "x12": "ISA*00*          *00*          *ZZ*STEDI          *01*117151744      *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~"
    }
    ```
  </Tab>
</Tabs>

#### Raw X12 endpoint

<Tabs items={["Request - X12 EDI", "Response"]}>
  <Tab value="Request - X12 EDI">
    ```bash
    curl --request POST \
      --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3/raw-x12 \
      --header 'Authorization: <api-key>' \
      --header 'Content-Type: application/json' \
      --data '{
      "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*123456789*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~HL*3*2*22*0~TRN*1*11122-12345*1234567890~NM1*IL*1*JANE*DOE****MI*1234567890~DMG*D8*19000101~DTP*291*D8*20240108~EQ*MH~SE*13*123456789~GE*1*000000001~IEA*1*000000001~"
    }'
    ```
  </Tab>

  <Tab value="Response">
    {/* schema:EligibilityCheckResponseContent */}

    ```json
    {
      "meta": {
        "senderId": "030240928",
        "submitterId": "117151744",
        "applicationMode": "production",
        "traceId": "01J2VZA127GH93JT74HJU",
        "outboundTraceId": "01J2VZA127GH93JT74HJU"
      },
      "controlNumber": "214976898",
      "id": "ec_01234567-89ab-cdef-0123-456789abcdef",
      "reassociationKey": "123456789",
      "tradingPartnerServiceId": "123456789",
      "provider": {
        "providerName": "ACME HEALTH SERVICES",
        "entityIdentifier": "Provider",
        "entityType": "Non-Person Entity",
        "npi": "1999999984"
      },
      "subscriber": {
        "memberId": "123456789",
        "firstName": "JANE",
        "lastName": "DOE",
        "middleName": "A",
        "gender": "F",
        "entityIdentifier": "Insured or Subscriber",
        "entityType": "Person",
        "dateOfBirth": "19000101",
        "groupNumber": "123456789",
        "address": {
          "address1": "1234 FIRST ST",
          "city": "NEW YORK",
          "state": "WV",
          "postalCode": "123451111"
        }
      },
      "payer": {
        "entityIdentifier": "Payer",
        "entityType": "Non-Person Entity",
        "name": "ABCDE",
        "federalTaxpayersIdNumber": "123412345",
        "contactInformation": {
          "contacts": [
            {
              "communicationMode": "Telephone",
              "communicationNumber": "1234567890"
            },
            {
              "communicationMode": "Uniform Resource Locator (URL)",
              "communicationNumber": "website.company.com"
            }
          ]
        }
      },
      "planInformation": {
        "groupNumber": "12341234",
        "groupDescription": "ABCDE",
        "priorIdNumber": "1234567890"
      },
      "planDateInformation": {
        "planBegin": "20240101",
        "planEnd": "20241231",
        "eligibilityBegin": "20220102"
      },
      "planStatus": [
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "planDetails": "Open Access Plus",
          "serviceTypeCodes": ["30"]
        },
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "serviceTypeCodes": [
            "A7",
            "BC",
            "A8",
            "A4",
            "A5",
            "A6",
            "7",
            "4",
            "BB",
            "22"
          ]
        },
        {
          "statusCode": "1",
          "status": "Active Coverage",
          "serviceTypeCodes": ["MH"]
        }
      ],
      "benefitsInformation": [
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "planCoverage": "Open Access Plus",
          "additionalInformation": [
            {
              "description": "Complete Care Management"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "6000",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "500",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "3000",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "250",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "30000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "benefitPercent": "0.1",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "7500",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "23",
          "timeQualifier": "Calendar Year",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "benefitPercent": "0.5",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "A7",
            "BC",
            "A8",
            "A4",
            "A5",
            "A6",
            "7",
            "4",
            "BB",
            "22"
          ],
          "serviceTypes": [
            "Psychiatric - Inpatient",
            "Day Care (Psychiatric)",
            "Psychiatric - Outpatient",
            "Psychiatric",
            "Psychiatric - Room and Board",
            "Psychotherapy",
            "Anesthesia",
            "Diagnostic X-Ray",
            "Partial Hospitalization (Psychiatric)",
            "Social Work"
          ],
          "inPlanNetworkIndicatorCode": "W",
          "inPlanNetworkIndicator": "Not Applicable"
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["BC", "A4", "A6", "4", "22"],
          "serviceTypes": [
            "Day Care (Psychiatric)",
            "Psychiatric",
            "Psychotherapy",
            "Diagnostic X-Ray",
            "Social Work"
          ],
          "benefitAmount": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "22",
              "industry": "Outpatient Hospital"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A8"],
          "serviceTypes": ["Psychiatric - Outpatient"],
          "benefitAmount": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "4", "22"],
          "serviceTypes": [
            "Psychiatric",
            "Psychotherapy",
            "Diagnostic X-Ray",
            "Social Work"
          ],
          "benefitAmount": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "benefitAmount": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "02",
            "industry": "Telehealth Provided Other than in Patient’s Home"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "02",
              "industry": "Telehealth Provided Other than in Patient’s Home"
            }
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "benefitAmount": "20",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "4", "22"],
          "serviceTypes": [
            "Psychiatric",
            "Psychotherapy",
            "Diagnostic X-Ray",
            "Social Work"
          ],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "benefitAmount": "20",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Included For Specific Services"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "02",
            "industry": "Telehealth Provided Other than in Patient’s Home"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "02",
              "industry": "Telehealth Provided Other than in Patient’s Home"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Included For Specific Services"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "02",
            "industry": "Telehealth Provided Other than in Patient’s Home"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "02",
              "industry": "Telehealth Provided Other than in Patient’s Home"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "02",
            "industry": "Telehealth Provided Other than in Patient’s Home"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "02",
              "industry": "Telehealth Provided Other than in Patient’s Home"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "4", "22"],
          "serviceTypes": [
            "Psychiatric",
            "Psychotherapy",
            "Diagnostic X-Ray",
            "Social Work"
          ],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "benefitAmount": "20",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "02",
            "industry": "Telehealth Provided Other than in Patient’s Home"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "02",
              "industry": "Telehealth Provided Other than in Patient’s Home"
            }
          ]
        },
        {
          "code": "B",
          "name": "Co-Payment",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["A4", "A6", "22"],
          "serviceTypes": ["Psychiatric", "Psychotherapy", "Social Work"],
          "timeQualifierCode": "27",
          "timeQualifier": "Visit",
          "benefitAmount": "20",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["7"],
          "serviceTypes": ["Anesthesia"],
          "benefitPercent": "0",
          "authOrCertIndicator": "Y",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "CB",
          "name": "Coverage Basis",
          "serviceTypeCodes": ["7", "BB"],
          "serviceTypes": ["Anesthesia", "Partial Hospitalization (Psychiatric)"],
          "authOrCertIndicator": "Y",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes"
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["7"],
          "serviceTypes": ["Anesthesia"],
          "benefitAmount": "0",
          "authOrCertIndicator": "Y",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["7"],
          "serviceTypes": ["Anesthesia"],
          "benefitPercent": "0",
          "authOrCertIndicator": "Y",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "11",
            "industry": "Office"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "11",
              "industry": "Office"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["4"],
          "serviceTypes": ["Diagnostic X-Ray"],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "22",
              "industry": "Outpatient Hospital"
            }
          ]
        },
        {
          "code": "A",
          "name": "Co-Insurance",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["4"],
          "serviceTypes": ["Diagnostic X-Ray"],
          "benefitPercent": "0",
          "authOrCertIndicator": "N",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Services rendered thru Client Specific Network"
            }
          ],
          "eligibilityAdditionalInformation": {
            "codeListQualifierCode": "ZZ",
            "codeListQualifier": "Mutually Defined",
            "industryCode": "22",
            "industry": "Outpatient Hospital"
          },
          "eligibilityAdditionalInformationList": [
            {
              "codeListQualifierCode": "ZZ",
              "codeListQualifier": "Mutually Defined",
              "industryCode": "22",
              "industry": "Outpatient Hospital"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["BB"],
          "serviceTypes": ["Partial Hospitalization (Psychiatric)"],
          "benefitAmount": "0",
          "authOrCertIndicator": "Y",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": ["MH"],
          "serviceTypes": ["Mental Health"],
          "additionalInformation": [
            {
              "description": " Provider is out of network based on NPI ID provided in request."
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "5760",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "500",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "2760",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            },
            {
              "description": "Copay does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "250",
          "inPlanNetworkIndicatorCode": "Y",
          "inPlanNetworkIndicator": "Yes",
          "additionalInformation": [
            {
              "description": "Includes services provided by Client Specific Network"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "FAM",
          "coverageLevel": "Family",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "30000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            }
          ]
        },
        {
          "code": "C",
          "name": "Deductible",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "7500",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No"
        },
        {
          "code": "G",
          "name": "Out of Pocket (Stop Loss)",
          "coverageLevelCode": "IND",
          "coverageLevel": "Individual",
          "serviceTypeCodes": ["30"],
          "serviceTypes": ["Health Benefit Plan Coverage"],
          "timeQualifierCode": "29",
          "timeQualifier": "Remaining",
          "benefitAmount": "15000",
          "inPlanNetworkIndicatorCode": "N",
          "inPlanNetworkIndicator": "No",
          "additionalInformation": [
            {
              "description": "Deductible does apply to member's out-of-pocket maximum"
            },
            {
              "description": "Coinsurance does apply to member's out-of-pocket maximum"
            }
          ]
        }
      ],
      "errors": [],
      "x12": "ISA*00*          *00*          *ZZ*STEDI          *01*117151744      *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~"
    }
    ```
  </Tab>
</Tabs>

#### SOAP endpoint

Note that the HTTP response must also include two additional headers:

* `stedi-id`: The Stedi-assigned unique identifier for the eligibility check, formatted as `ec_<UUID>`. For example: `id: ec_f81d4fae-7dec-11d0-a765-00a0c91e6b12`.
* `stedi-eligibility-search-id`: A Stedi-assigned identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](/healthcare/eligibility-searches-view). For example: `stedi-eligibility-search-id: 01997873-bebb-7b33-81ef-f408866dfb2cb`.

The response body is a SOAP message, and its structure is similar to the request.

<Tabs items={["Request - SOAP", "Response"]}>
  <Tab value="Request - SOAP">
    ```bash
    curl --request POST \
    --url "https://healthcare.us.stedi.com/2025-06-01/protocols/caqh-core" \
    --header "Content-Type: application/soap+xml" \
    --data '<soapenv:Envelope xmlns:soapenv="http://www.w3.org/2003/05/soap-envelope" xmlns:cor="http://www.caqh.org/SOAP/WSDL/CORERule2.2.0.xsd">
    <soapenv:Header>
      <wsse:Security soapenv:mustUnderstand="true" xmlns:wsse="http://docs.oasis-open.org/wss/2004/01/oasis-200401-wss-wssecurity-secext-1.0.xsd" xmlns:wsu="http://docs.oasis-open.org/wss/2004/01/oasis-200401-wss-wssecurity-utility-1.0.xsd">
        <wsse:UsernameToken>
          <wsse:Username>STEDI-ACCOUNT-ID</wsse:Username>
          <wsse:Password>STEDI-API-KEY</wsse:Password>
        </wsse:UsernameToken>
      </wsse:Security>
    </soapenv:Header>
    <soapenv:Body>
      <cor:COREEnvelopeRealTimeRequest>
        <PayloadType>X12_270_Request_005010X279A1</PayloadType>
        <ProcessingMode>RealTime</ProcessingMode>
        <PayloadID>YOUR-PAYLOAD-ID</PayloadID>
        <TimeStamp>2024-07-29T12:00:00Z</TimeStamp>
        <SenderID>SENDER-ID</SenderID>
        <ReceiverID>RECEIVER-ID</ReceiverID>
        <CORERuleVersion>2.2.0</CORERuleVersion>
        <Payload><![CDATA[ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~HL*3*2*22*0~TRN*1*11122-12345*1234567890~NM1*IL*1*JANE*DOE****MI*123456789~DMG*D8*19000101~DTP*291*D8*20240108~EQ*MH~SE*13*1234~GE*1*000000001~IEA*1*000000001~]]></Payload>
      </cor:COREEnvelopeRealTimeRequest>
    </soapenv:Body>
    </soapenv:Envelope>'
    ```
  </Tab>

  <Tab value="Response">
    ```xml
    <soapenv:Envelope xmlns:soapenv="http://www.w3.org/2003/05/soap-envelope"
                 xmlns:cor="http://www.caqh.org/SOAP/WSDL/CORERule2.2.0.xsd">
    <soapenv:Header/>
    <soapenv:Body>
      <cor:COREEnvelopeRealTimeResponse>
        <PayloadType>X12_271_Response_005010X279A1</PayloadType>
        <ProcessingMode>RealTime</ProcessingMode>
        <PayloadID>f81d4fae-7dec-11d0-a765-00a0c91e6b12</PayloadID>
        <TimeStamp>2024-07-28T12:01:22.000Z</TimeStamp>
        <SenderID>RECEIVER_ID</SenderID>
        <ReceiverID>STEDI</ReceiverID>
        <CORERuleVersion>2.2.0</CORERuleVersion>
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        <ErrorCode>Success</ErrorCode>
        <ErrorMessage></ErrorMessage>
      </cor:COREEnvelopeRealTimeResponse>
    </soapenv:Body>
    </soapenv:Envelope>
    ```
  </Tab>
</Tabs>

### Retries

Implementing the right retry strategy for eligibility check failures saves a lot of time and money.

At a minimum, we **strongly recommend** automatically retrying every request that fails due to payer connectivity issues. Automatic retries resolve a significant portion of these types of failures without manual intervention. Visit [Retry strategy](/healthcare/eligibility-troubleshooting#retry-strategy) for details.

### Timeout

Insurance payers may take up to 60 seconds to respond to a request, but Stedi holds real-time eligibility check requests open for up to 120 seconds before timing out. During this period, Stedi attempts multiple retries to payers in an effort to complete your request.

Canceling and retrying requests before Stedi's automatic retry period ends may create multiple ongoing requests to payers and increase your concurrency usage.

#### Request hedging

When eligibility responses are taking too long, you can use request hedging to try to get results faster. To implement request hedging, send a second request at some internal duration cutoff (for example, 30 seconds) without cancelling the first request. Then, you can use whichever result comes back first. If one of the requests fails, you can wait for the second request to see if it's successful.

### Concurrency limit

Our real-time eligibility check endpoints share a concurrency pool with other real-time healthcare APIs. For more information, visit [Concurrency Limits](/healthcare/api-reference#concurrency-limits).

### Recommended API clients

You may want to use an API client to make testing and debugging easier.

We **don't recommend** using Postman for requests containing Protected Health Information (PHI) because Postman defaults to storing request history - including full request payloads - on its cloud servers. You can’t turn this feature off without impractical workarounds.

Visit [API clients](/healthcare/api-reference#api-clients) for a list of recommended clients you can use instead.

## Eligibility check ID

Stedi assigns a globally unique identifier to each eligibility check, formatted as `ec_<UUID>`. For example: `ec_f81d4fae-7dec-11d0-a765-00a0c91e6b12`.

The unique eligibility check ID is returned in the following locations:

* **SOAP:** `stedi-id` header in the HTTP response
* **JSON and Raw X12:** `id` property in the JSON response

You can use this eligibility check ID to debug failures, correlate retries, and link directly to an eligibility check's results in the Stedi portal. The format for direct portal links is: `https://portal.stedi.com/app/healthcare/eligibility/{search-id}/inspect/{check-id}`, where `{search-id}` is the [eligibility search ID](/healthcare/api-reference/post-healthcare-eligibility#response.eligibilitySearchId) and `{check-id}` is the unique Stedi-assigned eligibility check ID.

You can find the eligibility search ID at the top of an eligibility search's details page in the portal. Visit [Eligibility searches](https://portal.stedi.com/app/healthcare/eligibility) to review a list of your eligibility searches.

## Patient information

All payers are required to be able to search for patients using the following "bare minimum" subsets of information. They will return benefits information as long as they can find a unique match for the patient within their system.

For a subscriber:

* Member ID, first name, last name, date of birth
* Member ID, last name, date of birth
* Member ID, first name, last name

For a dependent:

* Subscriber member ID (in the `subscriber` object), first name, last name, date of birth
* Subscriber member ID, last name, date of birth
* Subscriber member ID, first name, last name

Of course, not all of this patient information is always available. For example, a patient may forget their ID card. In these instances, some payers may still be able to search with even less information, such as the patient's first name, last name, and date of birth. Contact us if you have questions about alternative search options for a particular payer.

### Dependents

The patient qualifies as a dependent for eligibility checks when:

1. The patient is listed as a dependent on the subscriber's insurance plan.
2. The payer cannot uniquely identify the patient through information outside the subscriber's policy.

When the patient meets these criteria, you should submit their information in the `dependents` array (JSON) or `Loop 2000D` (X12 EDI). Otherwise, you must submit their information in the `subscriber` object (JSON) or `Loop 2000C` (X12 EDI) instead.

For example, if the dependent has their own member ID number in the payer's database, you must identify them as a subscriber. This includes member IDs that differ only by a suffix, such as `01`, because the patient can still be uniquely identified.

#### Medicaid dependents

Most Medicaid plans don't support dependents. However, some state Medicaid plans support eligibility inquiries for newborn children under 12 months old.

Children typically must be enrolled in Medicaid as a separate subscriber with their own unique member ID, even if they are legally the dependent of a parent who is a Medicaid plan member. Therefore, you'll almost always need to submit the child as a subscriber in the `subscriber` object (JSON) or `Loop 2000C` (X12 EDI).

Sending the `dependents` array (JSON) or `Loop 2000D` (X12 EDI) 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.

### Patient names

Note the following information and best practices when entering patient names:

* Enter the name exactly as written on the patient's insurance ID card (if available), including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. If the patient's insurance ID card isn't available, enter the name exactly as written on a government-issued ID card. If a government ID card isn't available, enter the name exactly as given by the patient.
* Don't include a name prefix, title, rank, honorific, or academic degree in any property. These include Mrs., Dr., Hon., and PhD.
* Don't include a suffix or generation such as Jr. or III in the `firstName` or `lastName` property. Put it in the separate `suffix` property instead. Payers are supposed to automatically parse suffixes out of the last name, but Stedi can't guarantee that all payers will do this correctly.
* You can populate a middle name (or names) or initial in the `middleName` property, but most payers ignore it when searching for the patient.
* Case doesn't matter. For example, JANE is equivalent to Jane.

The following are supported for patient names:

* Compound last and first names separated by spaces or hyphens such as Jean‐Claude or Smith Jones
* Apostrophized or elided names such as O’Connor or D’Amore
* Numbers like 3, however this typically indicates a data entry error

Some payers may have more specific requirements or restrictions that we don't cover in our docs. If you're receiving errors for a specific payer, we recommend consulting that payer's documentation for eligibility checks for additional guidance.

### MBI for CMS checks

A Medicare Beneficiary Identifier (MBI) is a unique, randomly-generated identifier assigned to individuals enrolled in Medicare. You must include the patient's MBI in every eligibility check to the Centers for Medicare and Medicaid Services (payer ID: CMS).

Some payers return the patient's MBI in one of the following properties of the standard eligibility response:

* [`benefitsInformation.benefitsAdditionalInformation.hicNumber`](/healthcare/api-reference/post-healthcare-eligibility#response.benefitsInformation.benefitsAdditionalInformation.hicNumber)
* [`planInformation.hicNumber`](/healthcare/api-reference/post-healthcare-eligibility#response.planInformation.hicNumber)

If the value in either of these properties matches the format specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis), the number is likely an MBI, and we recommend sending a follow-up eligibility check to CMS for additional benefits data. You're most likely to receive an MBI in eligibility check responses from commercial Medicare Advantage plans, but they can also be present in responses from Medicaid plans for dual-eligible patients.

When you don't know a patient's MBI, you can use Stedi's eligibility check APIs to perform an MBI lookup instead of a standard eligibility check. Stedi returns a complete benefits response from CMS with the patient's MBI in the `subscriber` object for future reference. Visit [Medicare Beneficiary Identifier (MBI) lookup](/healthcare/mbi-lookup) for complete details.

<Tip>
  **Don't** submit eligibility checks for Medicare Advantage plans to CMS (HETS)
  – you should submit them to the actual Medicare Advantage plan payer
  instead.
</Tip>

## CMS traceability requirements

Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include the entire chain of network hops for every eligibility request sent to CMS's eligibility system, HETS.

Specifically, requests must include a standard `X-Forwarded-For` HTTP header containing the network IP addresses from the point of origin through receipt by the HETS system. CMS expects `X-Forwarded-For` to list each IP, comma-separated, starting with the originating system and continuing through every intermediary.

To comply with this requirement:

* You must collect all IP addresses for upstream requests and pass them in the standard `X-Forwarded-For` header when calling Stedi's API. If you are yourself an intermediary – for example, an RCM, EHR, or PMS system – you'll need to coordinate with your providers and any third-party organizations to ensure they include the Network IP details as part of the `X-Forwarded-For` header. This enables CMS to receive a complete list of all IPs, including the original initiator of the request (typically, the provider).
* Stedi records the IP address you use when you call our API, as well as all the IP addresses listed in the `X-Forwarded-For` header. We include these IP addresses in the list submitted to CMS.

You only need to include the `X-Forwarded-For` header in eligibility requests when there are upstream IP addresses.

The following examples illustrate when and how to include the header:

\| Scenario                                                                                                                                                                   | `X-Forwarded-For` required?                                                                                                                      | Result                                                                |
\| -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------ | --------------------------------------------------------------------- |
\| A provider (IP `2.2.2.2`) connects directly to Stedi without intermediaries.                                                                                               | No.                                                                                                                                              | CMS ultimately receives `X-Forwarded-For: 2.2.2.2`                    |
\| A provider (IP `2.2.2.2`) routes through an RCM platform's transactional system (IP `3.3.3.3`) that calls Stedi's API using a separate integration backend (IP `4.4.4.4`). | Yes. The RCM platform sets `X-Forwarded-For: 2.2.2.2, 3.3.3.3`. Stedi records the IP address of the API caller (`4.4.4.4` ) and sends it to CMS. | CMS ultimately receives `X-Forwarded-For: 2.2.2.2, 3.3.3.3, 4.4.4.4`. |
\| A provider network (IP `2.2.2.2`) passes through an office firewall (IP `4.4.4.4`) and then an RCM platform (IP `3.3.3.3`), which calls Stedi's API.                       | Yes. The RCM platform sets `X-Forwarded-For: 2.2.2.2, 4.4.4.4`. Stedi records the IP address of the API caller (`3.3.3.3`) and sends it to CMS.  | CMS ultimately receives `X-Forwarded-For: 2.2.2.2, 4.4.4.4, 3.3.3.3`. |