# How to map a Medicare 271 eligibility response to a CWF
> Medicare now returns 271s, but many providers still want to see eligibility data in a CWF format. Here's how to bridge the gap.
Published Jun 2, 2025
Updated Nov 10, 2026
Category: Guide
Stedi’s [Eligibility Check APIs](https://www.stedi.com/docs/healthcare/send-eligibility-checks) let you get Medicare 271 eligibility responses as JSON. But your system – or one downstream – might need to display that JSON data in Common Working File (CWF) fields. Many providers still expect a CWF-style layout.
This guide shows how to map Stedi’s JSON 271 eligibility responses to CWF fields. It also covers what the CWF was, how Medicare eligibility checks work today, and why the CWF format still persists.
## What Is the Common Working File (CWF)?
The Centers for Medicare & Medicaid Services (CMS) built the CWF in the 1980s to centrally manage Medicare eligibility. It was the source of truth for who was covered, when, and under which Medicare part.
The system produced fixed-format text files – also called “CWFs” – for mainframe terminals and printed reports. Each file had a set layout, with fields like member ID, coverage type, and benefit dates. For example:
Example of a CWF-like layout with fixed fields
## How Medicare eligibility checks work today
CMS replaced the CWF in 2019 with the HIPAA Eligibility Transaction System (HETS). HETS returns standard 271 eligibility responses, the same as commercial insurers. Medicare 271s include a lot of Medicare-specific info, including:
- Medicare Part A and Part B entitlements and dates
- Part C (Medicare Advantage) and Part D (Prescription Drug) plan info
- Deductibles, copays, and benefit limits
- Remaining Skilled Nursing Facility (SNF) days
- ESRD transplant or dialysis dates
- Smoking cessation visits and therapy caps
- Qualified Medicare Beneficiary (QMB), secondary payers, Medicaid crossover, and other coordination of benefits information.
In a response from our [Real-Time Eligibility Check JSON](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check) endpoint, that data lives in the [`plans`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans) array. Each plan’s [`benefits`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits) object groups it into arrays by benefit type, such as [`coPayment`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment). Each entry describes a specific coverage, limit, or service type. For example:
```jsonc
{
"plans": [
{
"benefits": {
"coPayment": [
{
"amount": "408",
"dates": {
"admission": {
"end": "2024-12-31",
"start": "2024-01-01"
}
},
"insuranceType": "MEDICARE_PART_A",
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
},
"service": {
"definition": "Health Benefit Plan Coverage",
"system": "STC",
"value": "30"
},
"serviceLimits": [
{
"delivery": {
"frequency": {
"qualifier": "DAYS"
},
"period": {
"qualifier": "EXCEEDED",
"value": 60
}
}
},
{
"delivery": {
"frequency": {
"qualifier": "DAYS"
},
"period": {
"qualifier": "NOT_EXCEEDED",
"value": 90
}
}
},
{
"delivery": {
"period": {
"qualifier": "EPISODE",
"value": 1
}
}
}
],
"timePeriod": "DAY"
}
]
}
}
],
"subscriber": {
"memberId": "123456789",
"name": {
"person": {
"firstName": "JANE",
"lastName": "DOE"
}
},
...
},
...
}
```
## How to use this guide
Stedi’s JSON 271 eligibility response is easier to use in modern applications. But if your customers need the old CWF layout, you’ll need to map each field from JSON.
This guide isn’t an official spec. It’s a practical reference. Each section shows a CWF-style layout, a table of field mappings, and notes on when to use each field. For details on our JSON 271 eligibility responses, see our [API documentation](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check).
## Provider information
Provider information in a CWF-like format
| **CWF field** | **JSON 271 eligibility response property** |
| ----------------- | ---------------------------------------------------------------------------------------------------------------------------------------------- |
| Organization Name | `[provider.name.organization](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.provider.name.organization)` |
| NPI ID | `[provider.npi](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.provider.npi)` |
## Patient Demographics
The following table includes patient demographics from the **SUBMITTED TO PAYER** and **RETURNED BY PAYER** sections of the sample CWF.
Patient demographics section in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ---------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **SUBMITTED TO PAYER** |
|
|
| First Name | `[subscriber.name.person.firstName](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.name.person.firstName)` |
|
| Last Name | `[subscriber.name.person.lastName](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.name.person.lastName)` |
|
| Member ID (MBI) | `[subscriber.memberId](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.memberId)` |
|
| D.O.B. | `[subscriber.dateOfBirth](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.dateOfBirth)` |
|
| Eligibility Date(From) | `[subscriber.dates.eligibility.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.dates.eligibility.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Eligibility Date(To) | `[subscriber.dates.eligibility.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.dates.eligibility.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Service Types(s) | `[service.value](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.service.value)` `[service.system](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.service.system)` | Check the `[service](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.service)` on each benefit entry. `system` is `STC` for a Service Type Code, or a procedure code system such as `HCPCS`. |
| **RETURNED TO PAYER** |
|
|
| First Name | `subscriber.name.person.firstName` |
|
| Middle Name | `[subscriber.name.person.middleName](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.name.person.middleName)` |
|
| Last Name | `subscriber.name.person.lastName` |
|
| Suffix | `[subscriber.name.person.suffix](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.name.person.suffix)` |
|
| Member ID (MBI) | `subscriber.memberId` |
|
| D.O.B. | `subscriber.dateOfBirth` |
|
| Gender | `[subscriber.gender](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.gender)` |
|
| Address Line 1 | `[subscriber.address.addressLine1](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.address.addressLine1)` |
|
| Address Line 2 | `[subscriber.address.addressLine2](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.address.addressLine2)` |
|
| City | `[subscriber.address.city](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.address.city)` |
|
| State | `[subscriber.address.state](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.address.state)` |
|
| Zip Code | `[subscriber.address.postalCode](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.address.postalCode)` |
|
## Benefit Information
In the JSON 271 eligibility response, each plan’s `benefits` object contains most of the benefits information, grouped into arrays by benefit type.
The [`insuranceType`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.insuranceType) property on each benefit entry indicates the type of insurance policy within a program, such as Medicare. A value of `MEDICARE_PART_A` indicates Medicare Part A. A value of `MEDICARE_PART_B` indicates Medicare Part B. For a complete list of values, see the [API reference](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.insuranceType).
The `service` object on each benefit entry identifies the type of healthcare services the benefits information relates to. Its `service.value` is the Service Type Code (STC). An STC of `30` relates to general benefits information. For a complete list of STCs, see [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks) in our docs.
Benefit Information in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ---------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Effective Date | `[plans[].benefits.statuses[].dates.plan.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.dates.plan.start)` | All of the following must be true:- `[status](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.status)` = `ACTIVE_COVERAGE` (Active Coverage)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A) or `MEDICARE_PART_B` (Medicare Part B)
If the payer returns a single date instead of a date range, only `start` is present. |
| Termination Date | `[plans[].benefits.statuses[].dates.plan.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.dates.plan.end)` | All of the following must be true:- `status` = `ACTIVE_COVERAGE` (Active Coverage)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A) or `MEDICARE_PART_B` (Medicare Part B)
If the payer returns a single date instead of a date range, only `start` is present. |
| Ineligible Start | `plans[].benefits.statuses[].dates.plan.start` | All of the following must be true:- `status` = `INACTIVE` (Inactive)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A) or `MEDICARE_PART_B` (Medicare Part B)
If the payer returns a single date instead of a date range, only `start` is present. |
| Ineligible End | `plans[].benefits.statuses[].dates.plan.end` | All of the following must be true:- `status` = `INACTIVE` (Inactive)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A) or `MEDICARE_PART_B` (Medicare Part B)
If the payer returns a single date instead of a date range, only `start` is present. |
| Date of Death | `[subscriber.dates.dateOfDeath.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.subscriber.dates.dateOfDeath.start)` |
|
| Smoking Cessation Days | `[plans[].benefits.limitations[].quantity.value](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.quantity.value)` | All of the following must be true:- `service.value` = `67` (Smoking Cessation)
- `insuranceType` = `MEDICARE_PART_B` (Medicare Part B)
- `[timePeriod](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.timePeriod)` = `SERVICE_YEAR` (Service Year)
- `[quantity.qualifier](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.quantity.qualifier)` = `VISITS` (Visits)
- `[serviceLimits[].delivery.period.qualifier](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.serviceLimits.delivery.period.qualifier)` = `REMAINING` (Remaining)
|
| Initial Cessation Date | `[plans[].benefits.limitations[].dates.plan.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.dates.plan.start)` | This information is only available if an initial counseling visit was used in the past 12 months. All of the following must be true:- `service.value` = `67` (Smoking Cessation)
- `insuranceType` = `MEDICARE_PART_B` (Medicare Part B)
- `timePeriod` = `SERVICE_YEAR` (Service Year)
- `quantity.qualifier` = `VISITS` (Visits)
- `serviceLimits[].delivery.period.qualifier` = `REMAINING` (Remaining)
|
| ESRD Dialysis Date | `[plans[].benefits.benefitDescription[].dates.discharge.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.dates.discharge.start)` | The following must be true:- `service.value` = `RN` (Renal)
|
| ESRD Transplant Date | `[plans[].benefits.benefitDescription[].dates.service.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.dates.service.start)` | The following must be true:- `service.value` = `RN` (Renal)
|
| ESRD Coverage Period | `[plans[].benefits.benefitDescription[].dates.plan](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.dates.plan)` | The following must be true:- `service.value` = `RN` (Renal)
|
## Plan Benefits
Plan Benefits in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| --------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Medicare Part A |
|
|
| Type | Use **Base** when all of the following are true:- `timePeriod` = `DAY` (Day)
- `[dates.admission](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment.dates.admission)` contains a full year date range, such as `2098-01-01` to `2099-12-31`.
Use **Spell** when all of the following are true:- `timePeriod` = `DAY` (Day)
- `dates.admission` contains a partial year date range, such as `2098-05-06` to `2098-05-08`.
|
|
| First Bill | `[plans[].benefits.coPayment[].dates.admission.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment.dates.admission.start)` |
|
| Last Bill | `[plans[].benefits.coPayment[].dates.admission.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment.dates.admission.end)` |
|
| Hospital Days Full | For a **Type** of **Base**, use `[plans[].benefits.coPayment[].serviceLimits[].delivery.period.value](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment.serviceLimits.delivery.period.value)` when `serviceLimits[].delivery.period.qualifier` = `NOT_EXCEEDED` (Not Exceeded).
For a **Type** of **Base**, use `plans[].benefits.coPayment[].serviceLimits[].delivery.period.value` when `serviceLimits[].delivery.period.qualifier` = `REMAINING` (Remaining). |
|
| Hospital Days Colns | For a **Type** of **Base**, use `plans[].benefits.coPayment[].serviceLimits[].delivery.period.value` when `serviceLimits[].delivery.period.qualifier` = `EXCEEDED` (Exceeded).
For a **Type** of **Base**, use `plans[].benefits.coPayment[].serviceLimits[].delivery.period.value` when `serviceLimits[].delivery.period.qualifier` = `REMAINING` (Remaining). |
|
| Hospital Days Base | `[plans[].benefits.coPayment[].amount](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.coPayment.amount)` |
|
| SNF Days Full | `plans[].benefits.coPayment[].serviceLimits[].delivery.period.value` | All of the following must be true:- `service.value` = `AG` (Skilled Nursing Care)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A)
- `serviceLimits[].delivery.period.qualifier` = `NOT_EXCEEDED` (Not Exceeded)
|
| SNF Days Colns | `plans[].benefits.coPayment[].serviceLimits[].delivery.period.value` | All of the following must be true:- `service.value` = `AG` (Skilled Nursing Care)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A)
- `serviceLimits[].delivery.period.qualifier` = `EXCEEDED` (Exceeded)
|
| SNF Days Base | `plans[].benefits.coPayment[].amount` | All of the following must be true:- `service.value` = `AG` (Skilled Nursing Care)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A)
- `timePeriod` = `DAY` (Day)
|
| Inpatient Deductible | `[plans[].benefits.deductible[].amount](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.deductible.amount)` | All of the following must be true:- `service.value` = `30` (Health Benefit Plan Coverage)
- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A)
- `timePeriod` = `REMAINING` (Remaining)
|
| Medicare Part B |
|
|
| Deductible Remaining | `plans[].benefits.deductible[].amount` | All of the following must be true:- `service.value` = `30` (Health Benefit Plan Coverage)
- `insuranceType` = `MEDICARE_PART_B` (Medicare Part B)
- `timePeriod` = `CALENDAR_YEAR` (Calendar Year)
|
| Physical Therapy | `[plans[].benefits.benefitDescription[].amount](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.amount)` | All of the following must be true:- `service.value` = `AE` (Physical Medicine)
- `insuranceType` = `MEDICARE_PART_B` (Medicare Part B)
|
| Occupational Therapy | `plans[].benefits.benefitDescription[].amount` | All of the following must be true:- `service.value` = `AD` (Occupational Therapy)
- `insuranceType` = `MEDICARE_PART_B` (Medicare Part B)
|
| Medicare Part A Stays |
|
|
| Type | Use **Hospital** when:- `service.value` = `30` (Health Benefit Plan Coverage)
Use **Hospital Stay** when:- `service.value` = `48` (Hospital - Inpatient)
Use **SNF Stay** when:- `service.value` = `AH` (Skilled Nursing Care - Room and Board)
| The following must be true:- `insuranceType` = `MEDICARE_PART_A` (Medicare Part A)
|
| Start Date | `[dates.plan.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.dates.plan.start)` | On the same benefit entry as the **Type**. If the payer returns a single date instead of a date range, only `start` is present. |
| End Date | `[dates.plan.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.dates.plan.end)` | On the same benefit entry as the **Type**. If the payer returns a single date instead of a date range, only `start` is present. |
| Billing NPI | `[relatedEntities[].facilityId](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.statuses.relatedEntities.facilityId)` | Stedi returns `FA` (Facility Identification) identifiers in `facilityId`. |
## Qualified Medicare Beneficiary (QMB) Status
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the [`otherOrAdditionalPayer`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer) array (Other or Additional Payor).
- `insuranceType` = `QUALIFIED_MEDICARE_BENEFICIARY`
Qualified Medicare Beneficiary (QMB) Status information in a CWF example
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| -------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Period From | `[plans[].benefits.otherOrAdditionalPayer[].dates.coordinationOfBenefits.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.dates.coordinationOfBenefits.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Period Through | `[plans[].benefits.otherOrAdditionalPayer[].dates.coordinationOfBenefits.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.dates.coordinationOfBenefits.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| QMB Plan | `[plans[].benefits.otherOrAdditionalPayer[].planCoverageDescription](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.planCoverageDescription)` | If it’s missing, use the plan’s `[plans[].name](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.name)`. Stedi omits `planCoverageDescription` when it matches the plan name. |
## Medicare Secondary Payor
Medicare Secondary Payor info in an example CWF file
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the `otherOrAdditionalPayer` array (Other or Additional Payor).
- `insuranceType` is one of the following:
- `MEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLAN`
- `MEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLAN`
- `MEDICARE_SECONDARY_NOFAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY`
- `MEDICARE_SECONDARY_WORKERS_COMPENSATION`
- `MEDICARE_SECONDARY_PUBLIC_HEALTH_SERVICE_PHS_OR_OTHER_FEDERAL_AGENCY`
- `MEDICARE_SECONDARY_BLACK_LUNG`
- `MEDICARE_SECONDARY_VETERANS_ADMINISTRATION`
- `MEDICARE_SECONDARY_DISABLED_BENEFICIARY_UNDER_AGE_65_WITH_LARGE_GROUP_HEALTH_PLAN_LGHP`
- `MEDICARE_SECONDARY_OTHER_LIABILITY_INSURANCE_IS_PRIMARY`
- `AUTO_INSURANCE_POLICY`
- `WORKERS_COMPENSATION`
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ---------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------ |
| Effective Date | `plans[].benefits.otherOrAdditionalPayer[].dates.coordinationOfBenefits.start` | If the payer returns a single date instead of a date range, only `start` is present. |
| Termination Date | `plans[].benefits.otherOrAdditionalPayer[].dates.coordinationOfBenefits.end` | If the payer returns a single date instead of a date range, only `start` is present. |
| Policy Number | `[plans[].benefits.otherOrAdditionalPayer[].additionalInformation.insurancePolicyNumber](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.additionalInformation.insurancePolicyNumber)` |
|
| Insurer | `[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].name.organization](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.name.organization)` |
|
| Address | `[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.addressLine1](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.address.addressLine1)``[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.addressLine2](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.address.addressLine2)``[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.city](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.address.city)``[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.state](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.address.state)``[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.postalCode](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.address.postalCode)` |
|
| Type | `[plans[].benefits.otherOrAdditionalPayer[].insuranceType](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.insuranceType)` |
|
## Medicare Advantage
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the [`contactFollowingEntityForInformation`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation) array (Contact Following Entity for Eligibility or Benefit Information).
- `service.value` = `30` (Health Benefit Plan Coverage). If the payer also lists `CQ` (Case Management), the response includes a second entry with the same details for `CQ`.
- `insuranceType` = `HEALTH_MAINTENANCE_ORGANIZATION_HMO`, `HEALTH_MAINTENANCE_ORGANIZATION_HMO_MEDICARE_RISK`, `INDEMNITY`, `PREFERRED_PROVIDER_ORGANIZATION_PPO`, or `POINT_OF_SERVICE_POS`
- [`relatedEntities[].type`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.type) = `PRIMARY_PAYER`
Medicare Advantage information in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ---------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------------------- |
| Effective Date | `[plans[].benefits.contactFollowingEntityForInformation[].dates.coordinationOfBenefits.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.dates.coordinationOfBenefits.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Termination Date | `[plans[].benefits.contactFollowingEntityForInformation[].dates.coordinationOfBenefits.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.dates.coordinationOfBenefits.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Plan Code | `[plans[].benefits.contactFollowingEntityForInformation[].additionalInformation.plan.number](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.additionalInformation.plan.number)` |
|
| Payer Name | `[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].name.organization](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.name.organization)` |
|
| Address | `[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].address.addressLine1](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.address.addressLine1)``[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].address.addressLine2](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.address.addressLine2)``[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].address.city](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.address.city)``[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].address.state](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.address.state)``[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].address.postalCode](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.address.postalCode)` |
|
| Plan Name | `plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].name.organization` |
|
| Website | `[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].contacts[].urls](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.contacts.urls)` | In most cases, CMS only provides just the payer’s domain name, such as `examplepayer.com`, not a complete URL. |
| Phone Number | `[plans[].benefits.contactFollowingEntityForInformation[].relatedEntities[].contacts[].phoneNumbers](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.relatedEntities.contacts.phoneNumbers)` |
|
| Message(s) | `[plans[].benefits.contactFollowingEntityForInformation[].messages](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.contactFollowingEntityForInformation.messages)` |
|
## Part D
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the `otherOrAdditionalPayer` array (Other or Additional Payor).
- `service.value` = `88` (Pharmacy)
Medicare Part D info in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ---------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------- |
| Effective Date | `[plans[].benefits.otherOrAdditionalPayer[].dates.benefit.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.dates.benefit.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Termination Date | `[plans[].benefits.otherOrAdditionalPayer[].dates.benefit.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.dates.benefit.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Plan Code | `[plans[].benefits.otherOrAdditionalPayer[].additionalInformation.plan.number](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.additionalInformation.plan.number)` |
|
| Payer Name | `plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].name.organization` |
|
| Address | `plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.addressLine1``plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.addressLine2``plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.city``plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.state``plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].address.postalCode` |
|
| Plan Name | `plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].name.organization` |
|
| Website | `[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].contacts[].urls](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.contacts.urls)` | In most cases, CMS only provides just the payer’s domain name, such as `examplepayer.com`, not a complete URL. |
| Phone Number | `[plans[].benefits.otherOrAdditionalPayer[].relatedEntities[].contacts[].phoneNumbers](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.otherOrAdditionalPayer.relatedEntities.contacts.phoneNumbers)` |
|
## Therapy Caps
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the [`benefitDescription`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription) array (Benefit Description).
- `service.value` = `AD` (Occupational Therapy) or `AE` (Physical Medicine)
Therapy Caps information in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------ |
| Period Begin | `[plans[].benefits.benefitDescription[].dates.benefit.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.dates.benefit.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Period End | `[plans[].benefits.benefitDescription[].dates.benefit.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.dates.benefit.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| PT/ST Applied | `[plans[].benefits.benefitDescription[].messages](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.benefitDescription.messages)` |
|
| OT Applied | `plans[].benefits.benefitDescription[].messages` |
|
## Hospice
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the [`healthCareFacility`](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility) array (Health Care Facility).
- `service.value` = `45` (Hospice)
Hospice info in a CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------- |
| Benefit Period | No direct mapping. Calculated by ordering the episodes by date for the calendar year. |
|
| Benefit Period Start Date | `[plans[].benefits.healthCareFacility[].dates.benefit.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.dates.benefit.start)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Benefit Period End Date | `[plans[].benefits.healthCareFacility[].dates.benefit.end](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.dates.benefit.end)` | If the payer returns a single date instead of a date range, only `start` is present. |
| Provider | `[plans[].benefits.healthCareFacility[].relatedEntities[].npi](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.relatedEntities.npi)` | The following must be true:- `relatedEntities[].type` = `PROVIDER` (Provider)
|
| Provider Name | `[plans[].benefits.healthCareFacility[].relatedEntities[].name.organization](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.relatedEntities.name.organization)` | The following must be true:- `relatedEntities[].type` = `PROVIDER` (Provider)
|
| **Hospice Elections** |
|
|
| Election Date | `plans[].benefits.healthCareFacility[].dates.benefit.start` | If the payer returns a single date instead of a date range, only `start` is present. |
| Election Receipt Date | `[plans[].benefits.healthCareFacility[].dates.added.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.dates.added.start)` |
|
| Election Revocation Code | `[plans[].benefits.healthCareFacility[].messages](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.messages)` |
|
| Election NPI | `plans[].benefits.healthCareFacility[].relatedEntities[].npi` |
|
## Home Health Certification
Home Health Certification information in an example CWF
In the JSON 271 eligibility response, this information is only available when all of the following is true:
- The entry is in the `healthCareFacility` array (Health Care Facility).
- `service.value` = `G0180`, with a `service.system` of `HCPCS`
| **CWF field** | **JSON 271 eligibility response property** |
| ------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| Certification HCPCS Code | `[plans[].benefits.healthCareFacility[].service.value](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.service.value)` |
| Process Date | `[plans[].benefits.healthCareFacility[].dates.period.start](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.healthCareFacility.dates.period.start)` |
## Rehabilitation Services
Rehabilitation Services information in an example CWF
| **CWF field** | **JSON 271 eligibility response property** | **When to use** |
| ----------------------------------------------------- | ----------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Pulmonary Remaining (G0424) Technical | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BF` (Pulmonary Rehabilitation)
- `timePeriod` = `REMAINING` (Remaining)
- `[messages](https://www.stedi.com/docs/healthcare/api-reference/post-eligibility-check#response.plans.benefits.limitations.messages)` includes `Technical`
|
| Pulmonary Remaining (G0424) Professional | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BF` (Pulmonary Rehabilitation)
- `timePeriod` = `REMAINING` (Remaining)
- `messages` includes `Professional`
|
| Cardiac Applied (93797, 93798) Technical | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BG` (Cardiac Rehabilitation)
- `quantity.qualifier` = `QUANTITY_USED`
- `messages` includes `Technical`
|
| Cardiac Applied (93797, 93798) Professional | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BG` (Cardiac Rehabilitation)
- `quantity.qualifier` = `QUANTITY_USED`
- `messages` includes `Professional`
|
| Intensive Cardiac Applied (G0422, G0423) Technical | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BG` (Cardiac Rehabilitation)
- `quantity.qualifier` = `QUANTITY_USED`
- `messages` includes `Intensive Cardiac Rehabilitation - Technical`
|
| Intensive Cardiac Applied (G0422, G0423) Professional | `plans[].benefits.limitations[].quantity.value` | All of the following must be true:- `service.value` = `BG` (Cardiac Rehabilitation)
- `quantity.qualifier` = `QUANTITY_USED`
- `messages` includes `Intensive Cardiac Rehabilitation - Professional`
|