Eligibility Check

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' \
  --header 'Stedi-Response-Type: <stedi-response-type>' \
  --data '{
  "submitterTransactionIdentifier": "123456789",
  "controlNumber": "123456789",
  "tradingPartnerServiceId": "AHS",
  "encounter": {
    "serviceTypeCodes": [
      "MH"
    ]
  },
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1234567891"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "memberId": "123456789"
  }
}'

{
  "meta": {
    "senderId": "1234567890",
    "submitterId": "AV11110000",
    "applicationMode": "production",
    "traceId": "123456789"
  },
  "controlNumber": "214976898",
  "reassociationKey": "123456789",
  "tradingPartnerServiceId": "123456789",
  "provider": {
    "providerName": "ACME HEALTH SERVICES",
    "entityIdentifier": "Provider",
    "entityType": "Non-Person Entity",
    "npi": "1234567890"
  },
  "subscriber": {
    "memberId": "1234567890",
    "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",
    "lastName": "ABCDE",
    "name": "ABCDE",
    "federalTaxpayersIdNumber": "123412345",
    "contactInformation": {
      "contacts": [
        {
          "communicationMode": "Telephone",
          "communicationNumber": "1234567890"
        },
        {
          "communicationMode": "UR",
          "communicationNumber": "website.company.com"
        }
      ]
    }
  },
  "planInformation": {
    "groupNumber": "12341234",
    "groupDescription": "Company Name",
    "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": "Mutually Defined",
        "industryCode": "Outpatient Hospital"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "02"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "02"
        }
      ]
    },
    {
      "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "02"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "02"
        }
      ]
    },
    {
      "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": "Mutually Defined",
        "industryCode": "02"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "02"
        }
      ]
    },
    {
      "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": "Mutually Defined",
        "industryCode": "02"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "02"
        }
      ]
    },
    {
      "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "02"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "02"
        }
      ]
    },
    {
      "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "Office"
        }
      ]
    },
    {
      "code": "A",
      "name": "Co-Insurance",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
      "serviceTypeCodes": [
        "7"
      ],
      "serviceTypes": [
        "Anesthesia"
      ],
      "benefitPercent": "0",
      "authOrCertIndicator": "Y",
      "inPlanNetworkIndicatorCode": "Y",
      "inPlanNetworkIndicator": "Yes",
      "eligibilityAdditionalInformation": {
        "codeListQualifierCode": "Mutually Defined",
        "industryCode": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "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": "Mutually Defined",
        "industryCode": "Outpatient Hospital"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "Mutually Defined",
          "industryCode": "Outpatient Hospital"
        }
      ]
    },
    {
      "code": "A",
      "name": "Co-Insurance",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
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