# Sample response interpretation

The following example COB response shows information for a dependent who is covered by multiple health plans through their parents' policies. The COB check was submitted to Aetna with a service type code of `30` and a date of service of `2024-11-27`.

The response indicates the following:

* **Active coverage:** The patient has active coverage with Aetna for medical care services, pharmacy services, and vision services. This is indicated by the three objects in the `benefitsInformation` array with the `code` set to `1`.
* **Coverage overlap:** The patient has overlapping coverage for medical care services between two health plans. This is indicated by the `benefitsInformation` object with the `code` set to `R`.
* **Primacy:** The other health plan is Cigna, listed in `benefitsInformation.benefitsRelatedEntities`. Cigna is the primary payer for medical care services. Note that the ID returned in this property is proprietary to our COB check product, so you can't use it as the Payer ID for eligibility checks or other API requests to Stedi. It likely doesn't match the Payer IDs listed in the [Payer Network](https://www.stedi.com/healthcare/network).
* **COB instance:** There is a COB instance for medical care services on the date of service provided in the request. This is indicated in the `coordinationOfBenefits` object.

Based on this response, you must send claims first to Cigna as the primary payer for medical care services. Once Cigna adjudicates the claim, you can send another one, if necessary, to Aetna as the secondary payer (subject to specific payer claims processing rules).

Before sending claims we'd also recommend sending a separate eligibility check to Aetna to verify coverage status.

{/* schema:CoordinationOfBenefitsResponseContent */}

```json
{
  "benefitsInformation": [
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": ["1"],
      "serviceTypes": ["Medical Care"],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": ["88"],
      "serviceTypes": ["Pharmacy"],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": ["AL"],
      "serviceTypes": ["Vision (Optometry)"],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "R",
      "name": "Other or Additional Payor",
      "serviceTypeCodes": ["1"],
      "serviceTypes": ["Medical Care"],
      "benefitsDateInformation": {
        "coordinationOfBenefits": "2024-07-01"
      },
      "benefitsRelatedEntities": [
        {
          "entityIdentifier": "Primary Payer",
          "entityName": "CIGNA",
          "entityIdentification": "PI",
          "entityIdentificationValue": "1006"
        },
        {
          "entityIdentifier": "Insured or Subscriber",
          "entityFirstname": "JOHN",
          "entityMiddlename": "X",
          "entityIdentification": "MI",
          "entityIdentificationValue": "00000000000",
          "entityLastname": "DOE"
        }
      ],
      "subscriber": {
        "dateOfBirth": "2002-12-31"
      }
    }
  ],
  "coordinationOfBenefits": {
    "classification": "CobInstanceExistsPrimacyDetermined",
    "instanceExists": true,
    "primacyDetermined": true,
    "coverageOverlap": true,
    "benefitOverlap": true
  },
  "dependent": {
    "firstName": "JORDAN",
    "lastName": "DOE",
    "gender": "M",
    "dateOfBirth": "2002-12-31",
    "relationToSubscriber": "Child",
    "relationToSubscriberCode": "19",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  },
  "errors": [],
  "meta": {
    "applicationMode": "production",
    "traceId": "01JDQFT4W3KTWZNTADEZ55BFFX",
    "outboundTraceId": "01JDQFT4W3KTWZNTADEZ55BFFX"
  },
  "payer": {
    "name": "Aetna",
    "payerIdentification": "AETNA-USH"
  },
  "provider": {
    "providerOrgName": "AETNA-USH",
    "npi": "1999999984"
  },
  "subscriber": {
    "memberId": "W000000000",
    "firstName": "JOHN",
    "lastName": "DOE",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  }
}
```

## Request and response examples

The following examples show request and response data for common COB scenarios.

### COB exists, primacy determined

In the following example, the COB check was submitted to Cigna with a service type code of `30` and a date of service of `2024-12-19`.

The response indicates that the patient has active coverage with Cigna for medical care services, and that there is overlapping coverage with Kaiser Foundation Health Plan of Massachusetts. COB is required for medical care services, and Kaiser is the primary payer.

<Accordion title="Request COB exists, primacy determined">
  {/* schema:CoordinationOfBenefitsRequestContent */}

  ```bash
  curl --request POST \
    --url https://healthcare.us.stedi.com/2024-04-01/coordination-of-benefits \
    --header 'Authorization: <api-key>' \
    --header 'Content-Type: application/json' \
    --data '{
    "test": false,
    "tradingPartnerServiceId": "62308",
    "provider": {
      "organizationName": "PPROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "X999999999",
      "firstName": "Goofy",
      "lastName": "Goof",
      "dateOfBirth": "1948-11-01"
    },
    "encounter": {
      "dateOfService": "2024-12-19",
      "serviceTypeCode": "30"
    }
  }'
  ```
</Accordion>

<Accordion title="Response COB exists, primacy determined">
  {/* schema:CoordinationOfBenefitsResponseContent */}

  ```json
  {
    "benefitsInformation": [
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": ["1"],
        "serviceTypes": ["Medical Care"],
        "benefitsDateInformation": {
          "benefitBegin": "2024-01-01"
        },
        "subscriber": {
          "dateOfBirth": "1948-11-01"
        }
      },
      {
        "code": "R",
        "name": "Other or Additional Payor",
        "serviceTypeCodes": ["1"],
        "serviceTypes": ["Medical Care"],
        "benefitsDateInformation": {
          "coordinationOfBenefits": "2024-01-01"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Primary Payer",
            "entityName": "KAISER FOUNDATION HEALTH PLAN OF MAS",
            "entityIdentification": "PI",
            "entityIdentificationValue": "1009"
          },
          {
            "entityIdentifier": "Insured or Subscriber",
            "entityFirstname": "GOOFY",
            "entityMiddlename": "X",
            "entityIdentification": "MI",
            "entityIdentificationValue": "999999999",
            "entityLastname": "GOOF"
          }
        ],
        "subscriber": {
          "dateOfBirth": "1948-11-01"
        }
      }
    ],
    "coordinationOfBenefits": {
      "classification": "CobInstanceExistsPrimacyDetermined",
      "instanceExists": true,
      "primacyDetermined": true,
      "coverageOverlap": true,
      "benefitOverlap": true
    },
    "dependent": {
      "firstName": "GOOFY",
      "lastName": "GOOF",
      "gender": "M",
      "dateOfBirth": "1948-11-01",
      "relationToSubscriber": "Spouse",
      "relationToSubscriberCode": "01",
      "address": {
        "address1": "3 DISNEY RD",
        "city": "ORLANDO",
        "state": "FL",
        "postalCode": "32801"
      }
    },
    "errors": [],
    "meta": {
      "applicationMode": "production",
      "traceId": "01JJQRFYSXPKNYQ96EVM7XDXC4",
      "outboundTraceId": "01JJQRFYSXPKNYQ96EVM7XDXC4"
    },
    "payer": {
      "name": "CIGNA",
      "payerIdentification": "CIGNA-HCIN"
    },
    "provider": {
      "providerOrgName": "PROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "X99999999",
      "firstName": "MRS",
      "lastName": "GOOF",
      "groupNumber": "12345678",
      "address": {
        "address1": "3 DISNEY RD",
        "city": "ORLANDO",
        "state": "FL",
        "postalCode": "32801"
      }
    }
  }
  ```
</Accordion>

### Coverage overlap, no benefit overlap

In the following example, the COB check was submitted to Cigna with a service type code of `30` and a date of service of `2025-01-01`.

The response indicates that the patient has active coverage with Cigna for medical care services, and that there is overlapping coverage with Aetna for dental care services. There is no benefit overlap between the two health plans because dental and medical benefits have two different service type codes. COB is not required.

<Accordion title="Request Coverage overlap, no benefit overlap">
  {/* schema:CoordinationOfBenefitsRequestContent */}

  ```bash
  curl --request POST \
    --url https://healthcare.us.stedi.com/2024-04-01/coordination-of-benefits \
    --header 'Authorization: <api-key>' \
    --header 'Content-Type: application/json' \
    --data '{
    "test": false,
    "tradingPartnerServiceId": "62308",
    "provider": {
      "organizationName": "PROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "X999999999",
      "firstName": "MICKEY",
      "lastName": "MOUSE",
      "dateOfBirth": "1928-11-28"
    },
    "encounter": {
      "dateOfService": "2025-01-01",
      "serviceTypeCode": "30"
    }
  }'
  ```
</Accordion>

<Accordion title="Response Coverage overlap, no benefit overlap">
  ```json
  {
    "benefitsInformation": [
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": ["1"],
        "serviceTypes": ["Medical Care"],
        "benefitsDateInformation": {
          "benefitBegin": "2024-10-03"
        },
        "subscriber": {
          "dateOfBirth": "1925-11-28"
        },
        "dependent": {
          "firstName": "MICKEY",
          "lastName": "MOUSE",
          "memberId": "X999999999",
          "dateOfBirth": "1928-11-28",
          "familySeqNum": "0003",
          "relationToSubscriber": "Spouse",
          "relationToSubscriberCode": "01"
        }
      },
      {
        "code": "R",
        "name": "Other or Additional Payor",
        "serviceTypeCodes": ["35"],
        "serviceTypes": ["Dental Care"],
        "benefitsDateInformation": {
          "periodStart": "2024-10-03"
        },
        "benefitsRelatedEntities": [
          {
            "entityIdentifier": "Payer",
            "entityName": "AETNA",
            "entityIdentification": "PI",
            "entityIdentificationValue": "1000"
          },
          {
            "entityIdentifier": "Insured or Subscriber",
            "entityFirstname": "MINNIE",
            "entityMiddlename": "X",
            "entityIdentification": "MI",
            "entityIdentificationValue": "X999999999",
            "entityLastname": "MOUSE"
          }
        ],
        "subscriber": {
          "dateOfBirth": "1925-11-28"
        },
        "dependent": {
          "firstName": "MICKEY",
          "lastName": "MOUSE",
          "memberId": "X999999999",
          "dateOfBirth": "1928-11-28",
          "familySeqNum": "0003",
          "relationToSubscriber": "Spouse",
          "relationToSubscriberCode": "01"
        }
      }
    ],
    "coordinationOfBenefits": {
      "classification": "CoverageOverlapNoBenefitOverlap",
      "instanceExists": true,
      "coverageOverlap": true,
      "benefitOverlap": false,
      "primacyDetermined": false
    },
    "dependent": {
      "firstName": "MICKEY",
      "lastName": "MOUSE",
      "gender": "M",
      "dateOfBirth": "1928-11-28",
      "relationToSubscriber": "Spouse",
      "relationToSubscriberCode": "01",
      "address": {
        "address1": "3 DISNEY RD",
        "city": "ORLANDO",
        "state": "FL",
        "postalCode": "32801"
      }
    },
    "errors": [],
    "meta": {
      "applicationMode": "production",
      "traceId": "01JJVW6QJWXESXYAAAE4H996HR",
      "outboundTraceId": "01JJVW6QJWXESXYAAAE4H996HR"
    },
    "payer": {
      "name": "CIGNA",
      "payerIdentification": "CIGNA-HCIN"
    },
    "provider": {
      "providerOrgName": "PROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "X99999999",
      "firstName": "MINNIE",
      "lastName": "MOUSE",
      "middleName": "X",
      "groupNumber": "3340181",
      "address": {
        "address1": "3 DISNEY RD",
        "city": "ORLANDO",
        "state": "FL",
        "postalCode": "32801"
      }
    }
  }
  ```
</Accordion>

### Member found, no COB

In the following example, the COB check was submitted to UnitedHealthcare with a service type code of `30` and a date of service of `2023-01-10`.

The response indicates that the patient has active coverage with UnitedHealthcare for medical care services, but there is no overlapping coverage with any other health plan.

<Accordion title="Request Member found, no COB">
  {/* schema:CoordinationOfBenefitsRequestContent */}

  ```bash
  curl --request POST \
    --url https://healthcare.us.stedi.com/2024-04-01/coordination-of-benefits \
    --header 'Authorization: <api-key>' \
    --header 'Content-Type: application/json' \
    --data '{
    "test": false,
    "tradingPartnerServiceId": "87726",
    "provider": {
      "organizationName": "PROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "999999999",
      "firstName": "Donald",
      "lastName": "Duck",
      "dateOfBirth": "1960-01-01"
    },
    "dependent": {
      "firstName": "Huey",
      "lastName": "Duck",
      "dateOfBirth": "1990-01-01"
    },
    "encounter": {
      "dateOfService": "2023-01-10",
      "serviceTypeCode": "30"
    }
  }'
  ```
</Accordion>

<Accordion title="Response Member found, no COB">
  {/* schema:CoordinationOfBenefitsResponseContent */}

  ```json
  {
    "benefitsInformation": [
      {
        "code": "1",
        "name": "Active Coverage",
        "serviceTypeCodes": ["1"],
        "serviceTypes": ["Medical Care"],
        "benefitsDateInformation": {
          "benefitBegin": "2024-01-01"
        }
      }
    ],
    "coordinationOfBenefits": {
      "classification": "MemberFoundNoCob",
      "instanceExists": false,
      "coverageOverlap": false,
      "benefitOverlap": false,
      "primacyDetermined": false
    },
    "dependent": {
      "firstName": "HUEY",
      "lastName": "DUCK",
      "middleName": "M",
      "gender": "F",
      "dateOfBirth": "1990-01-01",
      "relationToSubscriber": "Child",
      "relationToSubscriberCode": "19",
      "address": {
        "address1": "25 THE ROAD",
        "city": "READING",
        "state": "MA",
        "postalCode": "01867"
      }
    },
    "errors": [],
    "meta": {
      "applicationMode": "production",
      "traceId": "09JJSWD8RBGZMVCCYGQZS3P1F7",
      "outboundTraceId": "09JJSWD8RBGZMVCCYGQZS3P1F7"
    },
    "payer": {
      "name": "UnitedHealthcare",
      "payerIdentification": "UHC"
    },
    "provider": {
      "providerOrgName": "PROVIDER",
      "npi": "1999999984"
    },
    "subscriber": {
      "memberId": "999999999",
      "firstName": "DONALD",
      "lastName": "DUCK",
      "middleName": "X",
      "address": {
        "address1": "25 THE ROAD",
        "city": "READING",
        "state": "MA",
        "postalCode": "01867"
      }
    }
  }
  ```
</Accordion>

## Follow up with eligibility checks

Our COB data is updated weekly, and the response doesn't contain complete details about the patient's coverage with each health plan.

When Stedi finds overlapping coverage, we strongly recommend conducting follow-up [eligibility checks](/healthcare/send-eligibility-checks) with each payer to verify coverage status and retrieve the patient's complete, up-to-date benefits information.