Copy {
"eligibility_requests" : [
{
"eligibility_id" : "text" ,
"state" : "completed" ,
"card_id" : "text" ,
"eligibility_request" : {
"controlNumber" : "text" ,
"tradingPartnerServiceId" : "text" ,
"provider" : {
"firstName" : "text" ,
"lastName" : "text" ,
"npi" : "text"
} ,
"subscriber" : {
"firstName" : "text" ,
"lastName" : "text" ,
"dateOfBirth" : "text"
}
} ,
"eligibility_response" : {
"meta" : {
"senderId" : "text" ,
"submitterId" : "text" ,
"billerId" : "text" ,
"applicationMode" : "text" ,
"traceId" : "text" ,
"outboundTraceId" : "text"
} ,
"controlNumber" : "text" ,
"reassociationKey" : "text" ,
"tradingPartnerServiceId" : "text" ,
"provider" : {
"providerName" : "text" ,
"providerFirstName" : "text" ,
"providerOrgName" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"npi" : "text" ,
"providerCode" : "text" ,
"referenceIdentification" : "text" ,
"employersId" : "text" ,
"ssn" : "text" ,
"federalTaxpayersIdNumber" : "text" ,
"payorIdentification" : "text" ,
"pharmacyProcessorNumber" : "text" ,
"serviceProviderNumber" : "text" ,
"servicesPlanID" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
]
} ,
"subscriber" : {
"healthCareDiagnosisCodes" : [
{
"diagnosisTypeCode" : "text" ,
"diagnosisCode" : "text"
}
] ,
"memberId" : "text" ,
"firstName" : "text" ,
"lastName" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"gender" : "M" ,
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"uniqueHealthIdentifier" : "text" ,
"dateOfBirth" : "text" ,
"informationStatusCode" : "text" ,
"employmentStatusCode" : "text" ,
"governmentServiceAffiliationCode" : "text" ,
"description" : "text" ,
"militaryServiceRankCode" : "text" ,
"dateTimePeriodFormatQualifier" : "text" ,
"dateTimePeriod" : "text" ,
"endDateTimePeriod" : "text" ,
"startDateTimePeriod" : "text" ,
"ssn" : "text" ,
"groupNumber" : "text" ,
"planNumber" : "text" ,
"planNetworkIdNumber" : "text" ,
"relationToSubscriber" : "text" ,
"relationToSubscriberCode" : "text" ,
"insuredIndicator" : "text" ,
"maintenanceTypeCode" : "text" ,
"maintenanceReasonCode" : "text" ,
"birthSequenceNumber" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"responseProvider" : {
"providerName" : "text" ,
"providerFirstName" : "text" ,
"providerOrgName" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"npi" : "text" ,
"providerCode" : "text" ,
"referenceIdentification" : "text" ,
"employersId" : "text" ,
"ssn" : "text" ,
"federalTaxpayersIdNumber" : "text" ,
"payorIdentification" : "text" ,
"pharmacyProcessorNumber" : "text" ,
"serviceProviderNumber" : "text" ,
"servicesPlanID" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
]
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
]
} ,
"subscriberTraceNumbers" : [
{
"traceTypeCode" : "text" ,
"traceType" : "text" ,
"referenceIdentification" : "text" ,
"originatingCompanyIdentifier" : "text" ,
"secondaryReferenceIdentification" : "text"
}
] ,
"dependents" : [
{
"healthCareDiagnosisCodes" : [
{
"diagnosisTypeCode" : "text" ,
"diagnosisCode" : "text"
}
] ,
"memberId" : "text" ,
"firstName" : "text" ,
"lastName" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"gender" : "M" ,
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"uniqueHealthIdentifier" : "text" ,
"dateOfBirth" : "text" ,
"informationStatusCode" : "text" ,
"employmentStatusCode" : "text" ,
"governmentServiceAffiliationCode" : "text" ,
"description" : "text" ,
"militaryServiceRankCode" : "text" ,
"dateTimePeriodFormatQualifier" : "text" ,
"dateTimePeriod" : "text" ,
"endDateTimePeriod" : "text" ,
"startDateTimePeriod" : "text" ,
"ssn" : "text" ,
"groupNumber" : "text" ,
"planNumber" : "text" ,
"planNetworkIdNumber" : "text" ,
"relationToSubscriber" : "text" ,
"relationToSubscriberCode" : "text" ,
"insuredIndicator" : "text" ,
"maintenanceTypeCode" : "text" ,
"maintenanceReasonCode" : "text" ,
"birthSequenceNumber" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"responseProvider" : {
"providerName" : "text" ,
"providerFirstName" : "text" ,
"providerOrgName" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"npi" : "text" ,
"providerCode" : "text" ,
"referenceIdentification" : "text" ,
"employersId" : "text" ,
"ssn" : "text" ,
"federalTaxpayersIdNumber" : "text" ,
"payorIdentification" : "text" ,
"pharmacyProcessorNumber" : "text" ,
"serviceProviderNumber" : "text" ,
"servicesPlanID" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
]
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
]
}
] ,
"payer" : {
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"firstName" : "text" ,
"lastName" : "text" ,
"name" : "text" ,
"middleName" : "text" ,
"suffix" : "text" ,
"employersId" : "text" ,
"federalTaxpayersIdNumber" : "text" ,
"naic" : "text" ,
"npi" : "text" ,
"centersForMedicareAndMedicaidPlanId" : "text" ,
"payorIdentification" : "text" ,
"contactInformation" : {
"name" : "text" ,
"contacts" : [
{
"communicationMode" : "text" ,
"communicationNumber" : "text"
}
]
} ,
"aaaErrors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
] ,
"etin" : "text"
} ,
"planInformation" : {
"stateLicenseNumber" : "text" ,
"medicareProviderNumber" : "text" ,
"medicaidProviderNumber" : "text" ,
"facilityIdNumber" : "text" ,
"personalIdentificationNumber" : "text" ,
"planNumber" : "text" ,
"planDescription" : "text" ,
"policyNumber" : "text" ,
"memberId" : "text" ,
"caseNumber" : "text" ,
"familyUnitNumber" : "text" ,
"groupNumber" : "text" ,
"groupDescription" : "text" ,
"referralNumber" : "text" ,
"alternativeListId" : "text" ,
"classOfContractCode" : "text" ,
"coverageListId" : "text" ,
"contractNumber" : "text" ,
"medicalRecordIdentificationNumber" : "text" ,
"electronicDevicePin" : "text" ,
"submitterIdentificationNumber" : "text" ,
"patientAccountNumber" : "text" ,
"hicNumber" : "text" ,
"drugFormularyNumber" : "text" ,
"priorAuthorizationNumber" : "text" ,
"idCardSerialNumber" : "text" ,
"idCardNumber" : "text" ,
"centersForMedicareAndMedicaidServicesNPI" : "text" ,
"issueNumber" : "text" ,
"insurancePolicyNumber" : "text" ,
"userIdentification" : "text" ,
"medicalAssistanceCategory" : "text" ,
"eligibilityCategory" : "text" ,
"planNetworkIdNumber" : "text" ,
"planNetworkIdDescription" : "text" ,
"facilityNetworkIdentificationNumber" : "text" ,
"medicaidRecipientIdNumber" : "text" ,
"priorIdNumber" : "text" ,
"socialSecurityNumber" : "text" ,
"federalTaxpayersIdentificationNumber" : "text" ,
"agencyClaimNumber" : "text"
} ,
"planDateInformation" : {
"discharge" : "text" ,
"issue" : "text" ,
"effectiveDateOfChange" : "text" ,
"periodStart" : "text" ,
"periodEnd" : "text" ,
"completion" : "text" ,
"coordinationOfBenefits" : "text" ,
"plan" : "text" ,
"benefit" : "text" ,
"primaryCareProvider" : "text" ,
"latestVisitOrConsultation" : "text" ,
"eligibility" : "text" ,
"added" : "text" ,
"cobraBegin" : "text" ,
"cobraEnd" : "text" ,
"premiumPaidToDateBegin" : "text" ,
"premiumPaidToDateEnd" : "text" ,
"planBegin" : "text" ,
"planEnd" : "text" ,
"benefitBegin" : "text" ,
"benefitEnd" : "text" ,
"eligibilityBegin" : "text" ,
"eligibilityEnd" : "text" ,
"enrollment" : "text" ,
"admission" : "text" ,
"dateOfDeath" : "text" ,
"certification" : "text" ,
"service" : "text" ,
"policyEffective" : "text" ,
"policyExpiration" : "text" ,
"dateOfLastUpdate" : "text" ,
"status" : "text"
} ,
"benefitsInformation" : [
{
"code" : "text" ,
"name" : "text" ,
"coverageLevelCode" : "text" ,
"coverageLevel" : "text" ,
"serviceTypeCodes" : [
"text"
] ,
"serviceTypes" : [
"text"
] ,
"insuranceTypeCode" : "text" ,
"insuranceType" : "text" ,
"planCoverage" : "text" ,
"timeQualifierCode" : "text" ,
"timeQualifier" : "text" ,
"benefitAmount" : "text" ,
"benefitPercent" : "text" ,
"quantityQualifierCode" : "text" ,
"quantityQualifier" : "text" ,
"benefitQuantity" : "text" ,
"authOrCertIndicator" : "text" ,
"inPlanNetworkIndicatorCode" : "text" ,
"inPlanNetworkIndicator" : "text" ,
"headerLoopIdentifierCode" : "text" ,
"trailerLoopIdentifierCode" : "text" ,
"compositeMedicalProcedureIdentifier" : {
"productOrServiceIdQualifierCode" : "text" ,
"productOrServiceIdQualifier" : "text" ,
"procedureCode" : "text" ,
"procedureModifiers" : [
"text"
] ,
"productOrServiceID" : "text" ,
"diagnosisCodePointer" : [
"text"
]
} ,
"benefitsAdditionalInformation" : {
"stateLicenseNumber" : "text" ,
"medicareProviderNumber" : "text" ,
"medicaidProviderNumber" : "text" ,
"facilityIdNumber" : "text" ,
"personalIdentificationNumber" : "text" ,
"planNumber" : "text" ,
"policyNumber" : "text" ,
"memberId" : "text" ,
"caseNumber" : "text" ,
"familyUnitNumber" : "text" ,
"groupNumber" : "text" ,
"referralNumber" : "text" ,
"alternativeListId" : "text" ,
"classOfContractCode" : "text" ,
"coverageListId" : "text" ,
"contractNumber" : "text" ,
"medicalRecordIdentificationNumber" : "text" ,
"electronicDevicePin" : "text" ,
"submitterIdentificationNumber" : "text" ,
"patientAccountNumber" : "text" ,
"hicNumber" : "text" ,
"drugFormularyNumber" : "text" ,
"priorAuthorizationNumber" : "text" ,
"idCardSerialNumber" : "text" ,
"idCardNumber" : "text" ,
"centersForMedicareAndMedicaidServicesNPI" : "text" ,
"issueNumber" : "text" ,
"insurancePolicyNumber" : "text" ,
"userIdentification" : "text" ,
"medicalAssistanceCategory" : "text" ,
"eligibilityCategory" : "text" ,
"planNetworkIdNumber" : "text" ,
"facilityNetworkIdentificationNumber" : "text" ,
"medicaidRecepientIdNumber" : "text" ,
"priorIdNumber" : "text" ,
"socialSecurityNumber" : "text" ,
"federalTaxpayersIdentificationNumber" : "text" ,
"agencyClaimNumber" : "text"
} ,
"benefitsDateInformation" : {
"discharge" : "text" ,
"discharges" : [
{
"date" : "text" ,
"startDate" : "text" ,
"endDate" : "text"
}
] ,
"issue" : "text" ,
"effectiveDateOfChange" : "text" ,
"periodStart" : "text" ,
"periodEnd" : "text" ,
"completion" : "text" ,
"coordinationOfBenefits" : "text" ,
"plan" : "text" ,
"benefit" : "text" ,
"primaryCareProvider" : "text" ,
"latestVisitOrConsultation" : "text" ,
"eligibility" : "text" ,
"added" : "text" ,
"cobraBegin" : "text" ,
"cobraEnd" : "text" ,
"premiumPaidtoDateBegin" : "text" ,
"premiumPaidToDateEnd" : "text" ,
"planBegin" : "text" ,
"planEnd" : "text" ,
"benefitBegin" : "text" ,
"benefitEnd" : "text" ,
"eligibilityBegin" : "text" ,
"eligibilityEnd" : "text" ,
"enrollment" : "text" ,
"admission" : "text" ,
"admissions" : [
{
"date" : "text" ,
"startDate" : "text" ,
"endDate" : "text"
}
] ,
"dateOfDeath" : "text" ,
"certification" : "text" ,
"service" : "text" ,
"policyEffective" : "text" ,
"policyExpiration" : "text" ,
"dateOfLastUpdate" : "text" ,
"status" : "text"
} ,
"benefitsRelatedEntity" : {
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"entityName" : "text" ,
"entityFirstname" : "text" ,
"entityMiddlename" : "text" ,
"entitySuffix" : "text" ,
"entityIdentification" : "text" ,
"entityIdentificationValue" : "text" ,
"entityRelationship" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"contactInformation" : {
"name" : "text" ,
"contacts" : [
{
"communicationMode" : "text" ,
"communicationNumber" : "text"
}
]
} ,
"providerInformation" : {
"providerCode" : "text" ,
"referenceIdentification" : "text"
}
} ,
"benefitsRelatedEntities" : [
{
"entityIdentifier" : "text" ,
"entityType" : "text" ,
"entityName" : "text" ,
"entityFirstname" : "text" ,
"entityMiddlename" : "text" ,
"entitySuffix" : "text" ,
"entityIdentification" : "text" ,
"entityIdentificationValue" : "text" ,
"entityRelationship" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"contactInformation" : {
"name" : "text" ,
"contacts" : [
{
"communicationMode" : "text" ,
"communicationNumber" : "text"
}
]
} ,
"providerInformation" : {
"providerCode" : "text" ,
"referenceIdentification" : "text"
}
}
] ,
"benefitsServiceDelivery" : [
{
"quantityQualifierCode" : "text" ,
"quantityQualifier" : "text" ,
"quantity" : "text" ,
"unitForMeasurementCode" : "text" ,
"sampleSelectionModulus" : "text" ,
"timePeriodQualifierCode" : "text" ,
"timePeriodQualifier" : "text" ,
"numOfPeriods" : "text" ,
"deliveryOrCalendarPatternCode" : "text" ,
"deliveryPatternTimeCode" : "text" ,
"unitForMeasurementQualifierCode" : "text" ,
"unitForMeasurementQualifier" : "text" ,
"deliveryOrCalendarPatternQualifierCode" : "text" ,
"deliveryOrCalendarPatternQualifier" : "text" ,
"deliveryPatternTimeQualifierCode" : "text" ,
"deliveryPatternTimeQualifier" : "text"
}
] ,
"additionalInformation" : [
{
"description" : "text"
}
] ,
"eligibilityAdditionalInformation" : {
"codeListQualifierCode" : "text" ,
"industryCode" : "text" ,
"codeCategory" : "text" ,
"injuredBodyPartName" : "text"
} ,
"eligibilityAdditionalInformationList" : [
{
"codeListQualifierCode" : "text" ,
"industryCode" : "text" ,
"codeCategory" : "text" ,
"injuredBodyPartName" : "text"
}
]
}
] ,
"errors" : [
{
"field" : "text" ,
"code" : "text" ,
"description" : "text" ,
"followupAction" : "text" ,
"location" : "text" ,
"possibleResolutions" : "text"
}
] ,
"status" : "text" ,
"transactionSetAcknowledgement" : "text" ,
"implementationTransactionSetSyntaxError" : "text" ,
"x12" : "text"
} ,
"eligibility_summarized_response" : {
"eligibility_request_id" : "123e4567-e89b-12d3-a456-426614174000" ,
"subscriber_details" : {
"member_id" : "text" ,
"firstname" : "text" ,
"lastname" : "text" ,
"middlename" : "text" ,
"gender" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
} ,
"dob" : "2024-04-25"
} ,
"payer_details" : {
"payer_name" : "text" ,
"address" : {
"address1" : "123 address1" ,
"address2" : "text" ,
"city" : "city1" ,
"state" : "wa" ,
"postalCode" : "981010000" ,
"countryCode" : "text" ,
"locationIdentifier" : "text" ,
"countrySubDivisionCode" : "text"
}
} ,
"plan_details" : {
"plan_number" : "text" ,
"group_name" : "text" ,
"group_number" : "text" ,
"plan_start_date" : "2024-04-25" ,
"plan_eligibility_start_date" : "2024-04-25" ,
"plan_name" : "text" ,
"plan_active" : false
} ,
"coverage_summary" : {
"individual_deductible_in_network" : {
"total_amount" : "text" ,
"remaining_amount" : "text"
} ,
"individual_oop_in_network" : {
"total_amount" : "text" ,
"remaining_amount" : "text"
} ,
"family_deductible_in_network" : {
"total_amount" : "text" ,
"remaining_amount" : "text"
} ,
"family_oop_in_network" : {
"total_amount" : "text" ,
"remaining_amount" : "text"
}
} ,
"chiropractic" : {
"co_insurance_in_network" : {
"amount" : "text"
} ,
"co_payment_in_network" : {
"amount" : "text"
} ,
"service_code" : "text"
} ,
"emergency_room" : {
"co_insurance_in_network" : {
"amount" : "text"
} ,
"co_payment_in_network" : {
"amount" : "text"
} ,
"service_code" : "text"
} ,
"office_visit" : {
"co_insurance_in_network" : {
"amount" : "text"
} ,
"co_payment_in_network" : {
"amount" : "text"
} ,
"service_code" : "text"
} ,
"urgent_care" : {
"co_insurance_in_network" : {
"amount" : "text"
} ,
"co_payment_in_network" : {
"amount" : "text"
} ,
"service_code" : "text"
} ,
"hospital_outpatient" : {
"co_insurance_in_network" : {
"amount" : "text"
} ,
"co_payment_in_network" : {
"amount" : "text"
} ,
"service_code" : "text"
}
} ,
"error" : {
"type" : "text" ,
"code" : "text" ,
"message" : "text"
} ,
"created_at" : "2024-04-25T23:34:43.433Z" ,
"update_at" : "2024-04-25T23:34:43.433Z"
}
] ,
"response_metadata" : {
"cursor" : "text"
}
} 
