POST
/
change
/
medicalnetwork
/
eligibility
/
v3
/
raw-x12
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3/raw-x12 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --header 'Stedi-Response-Type: <stedi-response-type>' \
  --data '{
  "x12": "<string>"
}'
{
  "meta": {
    "senderId": "<string>",
    "submitterId": "<string>",
    "billerId": "<string>",
    "applicationMode": "<string>",
    "traceId": "<string>",
    "outboundTraceId": "<string>"
  },
  "controlNumber": "<string>",
  "reassociationKey": "<string>",
  "tradingPartnerServiceId": "<string>",
  "provider": {
    "providerName": "<string>",
    "providerFirstName": "<string>",
    "providerOrgName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "entityIdentifier": "<string>",
    "entityType": "<string>",
    "npi": "<string>",
    "providerCode": "<string>",
    "referenceIdentification": "<string>",
    "employersId": "<string>",
    "ssn": "<string>",
    "federalTaxpayersIdNumber": "<string>",
    "payorIdentification": "<string>",
    "pharmacyProcessorNumber": "<string>",
    "serviceProviderNumber": "<string>",
    "servicesPlanID": "<string>",
    "address": {
      "address1": "<string>",
      "address2": "<string>",
      "city": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "locationIdentifier": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "aaaErrors": [
      {
        "field": "<string>",
        "code": "<string>",
        "description": "<string>",
        "followupAction": "<string>",
        "location": "<string>",
        "possibleResolutions": "<string>"
      }
    ]
  },
  "subscriber": {
    "healthCareDiagnosisCodes": [
      {
        "diagnosisTypeCode": "<string>",
        "diagnosisCode": "<string>"
      }
    ],
    "memberId": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "gender": "M",
    "entityIdentifier": "<string>",
    "entityType": "<string>",
    "uniqueHealthIdentifier": "<string>",
    "dateOfBirth": "<string>",
    "informationStatusCode": "<string>",
    "employmentStatusCode": "<string>",
    "governmentServiceAffiliationCode": "<string>",
    "description": "<string>",
    "militaryServiceRankCode": "<string>",
    "dateTimePeriodFormatQualifier": "<string>",
    "dateTimePeriod": "<string>",
    "endDateTimePeriod": "<string>",
    "startDateTimePeriod": "<string>",
    "ssn": "<string>",
    "groupNumber": "<string>",
    "planNumber": "<string>",
    "planNetworkIdNumber": "<string>",
    "relationToSubscriber": "<string>",
    "relationToSubscriberCode": "<string>",
    "insuredIndicator": "<string>",
    "maintenanceTypeCode": "<string>",
    "maintenanceReasonCode": "<string>",
    "birthSequenceNumber": "<string>",
    "address": {
      "address1": "<string>",
      "address2": "<string>",
      "city": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "locationIdentifier": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "responseProvider": {
      "providerName": "<string>",
      "providerFirstName": "<string>",
      "providerOrgName": "<string>",
      "middleName": "<string>",
      "suffix": "<string>",
      "entityIdentifier": "<string>",
      "entityType": "<string>",
      "npi": "<string>",
      "providerCode": "<string>",
      "referenceIdentification": "<string>",
      "employersId": "<string>",
      "ssn": "<string>",
      "federalTaxpayersIdNumber": "<string>",
      "payorIdentification": "<string>",
      "pharmacyProcessorNumber": "<string>",
      "serviceProviderNumber": "<string>",
      "servicesPlanID": "<string>",
      "address": {
        "address1": "<string>",
        "address2": "<string>",
        "city": "<string>",
        "state": "<string>",
        "postalCode": "<string>",
        "countryCode": "<string>",
        "locationIdentifier": "<string>",
        "countrySubDivisionCode": "<string>"
      },
      "aaaErrors": [
        {
          "field": "<string>",
          "code": "<string>",
          "description": "<string>",
          "followupAction": "<string>",
          "location": "<string>",
          "possibleResolutions": "<string>"
        }
      ]
    },
    "aaaErrors": [
      {
        "field": "<string>",
        "code": "<string>",
        "description": "<string>",
        "followupAction": "<string>",
        "location": "<string>",
        "possibleResolutions": "<string>"
      }
    ]
  },
  "subscriberTraceNumbers": [
    {
      "traceTypeCode": "<string>",
      "traceType": "<string>",
      "referenceIdentification": "<string>",
      "originatingCompanyIdentifier": "<string>",
      "secondaryReferenceIdentification": "<string>"
    }
  ],
  "dependents": [
    {
      "healthCareDiagnosisCodes": [
        {
          "diagnosisTypeCode": "<string>",
          "diagnosisCode": "<string>"
        }
      ],
      "memberId": "<string>",
      "firstName": "<string>",
      "lastName": "<string>",
      "middleName": "<string>",
      "suffix": "<string>",
      "gender": "M",
      "entityIdentifier": "<string>",
      "entityType": "<string>",
      "uniqueHealthIdentifier": "<string>",
      "dateOfBirth": "<string>",
      "informationStatusCode": "<string>",
      "employmentStatusCode": "<string>",
      "governmentServiceAffiliationCode": "<string>",
      "description": "<string>",
      "militaryServiceRankCode": "<string>",
      "dateTimePeriodFormatQualifier": "<string>",
      "dateTimePeriod": "<string>",
      "endDateTimePeriod": "<string>",
      "startDateTimePeriod": "<string>",
      "ssn": "<string>",
      "groupNumber": "<string>",
      "planNumber": "<string>",
      "planNetworkIdNumber": "<string>",
      "relationToSubscriber": "<string>",
      "relationToSubscriberCode": "<string>",
      "insuredIndicator": "<string>",
      "maintenanceTypeCode": "<string>",
      "maintenanceReasonCode": "<string>",
      "birthSequenceNumber": "<string>",
      "address": {
        "address1": "<string>",
        "address2": "<string>",
        "city": "<string>",
        "state": "<string>",
        "postalCode": "<string>",
        "countryCode": "<string>",
        "locationIdentifier": "<string>",
        "countrySubDivisionCode": "<string>"
      },
      "responseProvider": {
        "providerName": "<string>",
        "providerFirstName": "<string>",
        "providerOrgName": "<string>",
        "middleName": "<string>",
        "suffix": "<string>",
        "entityIdentifier": "<string>",
        "entityType": "<string>",
        "npi": "<string>",
        "providerCode": "<string>",
        "referenceIdentification": "<string>",
        "employersId": "<string>",
        "ssn": "<string>",
        "federalTaxpayersIdNumber": "<string>",
        "payorIdentification": "<string>",
        "pharmacyProcessorNumber": "<string>",
        "serviceProviderNumber": "<string>",
        "servicesPlanID": "<string>",
        "address": {
          "address1": "<string>",
          "address2": "<string>",
          "city": "<string>",
          "state": "<string>",
          "postalCode": "<string>",
          "countryCode": "<string>",
          "locationIdentifier": "<string>",
          "countrySubDivisionCode": "<string>"
        },
        "aaaErrors": [
          {
            "field": "<string>",
            "code": "<string>",
            "description": "<string>",
            "followupAction": "<string>",
            "location": "<string>",
            "possibleResolutions": "<string>"
          }
        ]
      },
      "aaaErrors": [
        {
          "field": "<string>",
          "code": "<string>",
          "description": "<string>",
          "followupAction": "<string>",
          "location": "<string>",
          "possibleResolutions": "<string>"
        }
      ]
    }
  ],
  "payer": {
    "entityIdentifier": "<string>",
    "entityType": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "name": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "employersId": "<string>",
    "federalTaxpayersIdNumber": "<string>",
    "naic": "<string>",
    "npi": "<string>",
    "centersForMedicareAndMedicaidPlanId": "<string>",
    "payorIdentification": "<string>",
    "contactInformation": {
      "name": "<string>",
      "contacts": [
        {
          "communicationMode": "<string>",
          "communicationNumber": "<string>"
        }
      ]
    },
    "aaaErrors": [
      {
        "field": "<string>",
        "code": "<string>",
        "description": "<string>",
        "followupAction": "<string>",
        "location": "<string>",
        "possibleResolutions": "<string>"
      }
    ],
    "etin": "<string>"
  },
  "planInformation": {
    "stateLicenseNumber": "<string>",
    "medicareProviderNumber": "<string>",
    "medicaidProviderNumber": "<string>",
    "facilityIdNumber": "<string>",
    "personalIdentificationNumber": "<string>",
    "planNumber": "<string>",
    "planDescription": "<string>",
    "policyNumber": "<string>",
    "memberId": "<string>",
    "caseNumber": "<string>",
    "familyUnitNumber": "<string>",
    "groupNumber": "<string>",
    "groupDescription": "<string>",
    "referralNumber": "<string>",
    "alternativeListId": "<string>",
    "classOfContractCode": "<string>",
    "coverageListId": "<string>",
    "contractNumber": "<string>",
    "medicalRecordIdentificationNumber": "<string>",
    "electronicDevicePin": "<string>",
    "submitterIdentificationNumber": "<string>",
    "patientAccountNumber": "<string>",
    "hicNumber": "<string>",
    "drugFormularyNumber": "<string>",
    "priorAuthorizationNumber": "<string>",
    "idCardSerialNumber": "<string>",
    "idCardNumber": "<string>",
    "centersForMedicareAndMedicaidServicesNPI": "<string>",
    "issueNumber": "<string>",
    "insurancePolicyNumber": "<string>",
    "userIdentification": "<string>",
    "medicalAssistanceCategory": "<string>",
    "eligibilityCategory": "<string>",
    "planNetworkIdNumber": "<string>",
    "planNetworkIdDescription": "<string>",
    "facilityNetworkIdentificationNumber": "<string>",
    "medicaidRecipientIdNumber": "<string>",
    "priorIdNumber": "<string>",
    "socialSecurityNumber": "<string>",
    "federalTaxpayersIdentificationNumber": "<string>",
    "agencyClaimNumber": "<string>"
  },
  "planDateInformation": {
    "discharge": "<string>",
    "issue": "<string>",
    "effectiveDateOfChange": "<string>",
    "periodStart": "<string>",
    "periodEnd": "<string>",
    "completion": "<string>",
    "coordinationOfBenefits": "<string>",
    "plan": "<string>",
    "benefit": "<string>",
    "primaryCareProvider": "<string>",
    "latestVisitOrConsultation": "<string>",
    "eligibility": "<string>",
    "added": "<string>",
    "cobraBegin": "<string>",
    "cobraEnd": "<string>",
    "premiumPaidToDateBegin": "<string>",
    "premiumPaidToDateEnd": "<string>",
    "planBegin": "<string>",
    "planEnd": "<string>",
    "benefitBegin": "<string>",
    "benefitEnd": "<string>",
    "eligibilityBegin": "<string>",
    "eligibilityEnd": "<string>",
    "enrollment": "<string>",
    "admission": "<string>",
    "dateOfDeath": "<string>",
    "certification": "<string>",
    "service": "<string>",
    "policyEffective": "<string>",
    "policyExpiration": "<string>",
    "dateOfLastUpdate": "<string>",
    "status": "<string>"
  },
  "planStatus": [
    {
      "statusCode": "<string>",
      "status": "<string>",
      "planDetails": "<string>",
      "serviceTypeCodes": [
        "<string>"
      ]
    }
  ],
  "benefitsInformation": [
    {
      "code": "<string>",
      "name": "<string>",
      "coverageLevelCode": "<string>",
      "coverageLevel": "<string>",
      "serviceTypeCodes": [
        "<string>"
      ],
      "serviceTypes": [
        "<string>"
      ],
      "insuranceTypeCode": "<string>",
      "insuranceType": "<string>",
      "planCoverage": "<string>",
      "timeQualifierCode": "<string>",
      "timeQualifier": "<string>",
      "benefitAmount": "<string>",
      "benefitPercent": "<string>",
      "quantityQualifierCode": "<string>",
      "quantityQualifier": "<string>",
      "benefitQuantity": "<string>",
      "authOrCertIndicator": "<string>",
      "inPlanNetworkIndicatorCode": "<string>",
      "inPlanNetworkIndicator": "<string>",
      "headerLoopIdentifierCode": "<string>",
      "trailerLoopIdentifierCode": "<string>",
      "compositeMedicalProcedureIdentifier": {
        "productOrServiceIdQualifierCode": "<string>",
        "productOrServiceIdQualifier": "<string>",
        "procedureCode": "<string>",
        "procedureModifiers": [
          "<string>"
        ],
        "productOrServiceID": "<string>",
        "diagnosisCodePointer": [
          "<string>"
        ]
      },
      "benefitsAdditionalInformation": {
        "stateLicenseNumber": "<string>",
        "medicareProviderNumber": "<string>",
        "medicaidProviderNumber": "<string>",
        "facilityIdNumber": "<string>",
        "personalIdentificationNumber": "<string>",
        "planNumber": "<string>",
        "policyNumber": "<string>",
        "memberId": "<string>",
        "caseNumber": "<string>",
        "familyUnitNumber": "<string>",
        "groupNumber": "<string>",
        "referralNumber": "<string>",
        "alternativeListId": "<string>",
        "classOfContractCode": "<string>",
        "coverageListId": "<string>",
        "contractNumber": "<string>",
        "medicalRecordIdentificationNumber": "<string>",
        "electronicDevicePin": "<string>",
        "submitterIdentificationNumber": "<string>",
        "patientAccountNumber": "<string>",
        "hicNumber": "<string>",
        "drugFormularyNumber": "<string>",
        "priorAuthorizationNumber": "<string>",
        "idCardSerialNumber": "<string>",
        "idCardNumber": "<string>",
        "centersForMedicareAndMedicaidServicesNPI": "<string>",
        "issueNumber": "<string>",
        "insurancePolicyNumber": "<string>",
        "userIdentification": "<string>",
        "medicalAssistanceCategory": "<string>",
        "eligibilityCategory": "<string>",
        "planNetworkIdNumber": "<string>",
        "facilityNetworkIdentificationNumber": "<string>",
        "medicaidRecepientIdNumber": "<string>",
        "priorIdNumber": "<string>",
        "socialSecurityNumber": "<string>",
        "federalTaxpayersIdentificationNumber": "<string>",
        "agencyClaimNumber": "<string>"
      },
      "benefitsDateInformation": {
        "discharge": "<string>",
        "discharges": [
          {
            "date": "<string>",
            "startDate": "<string>",
            "endDate": "<string>"
          }
        ],
        "issue": "<string>",
        "effectiveDateOfChange": "<string>",
        "periodStart": "<string>",
        "periodEnd": "<string>",
        "completion": "<string>",
        "coordinationOfBenefits": "<string>",
        "plan": "<string>",
        "benefit": "<string>",
        "primaryCareProvider": "<string>",
        "latestVisitOrConsultation": "<string>",
        "eligibility": "<string>",
        "added": "<string>",
        "cobraBegin": "<string>",
        "cobraEnd": "<string>",
        "premiumPaidtoDateBegin": "<string>",
        "premiumPaidToDateEnd": "<string>",
        "planBegin": "<string>",
        "planEnd": "<string>",
        "benefitBegin": "<string>",
        "benefitEnd": "<string>",
        "eligibilityBegin": "<string>",
        "eligibilityEnd": "<string>",
        "enrollment": "<string>",
        "admission": "<string>",
        "admissions": [
          {
            "date": "<string>",
            "startDate": "<string>",
            "endDate": "<string>"
          }
        ],
        "dateOfDeath": "<string>",
        "certification": "<string>",
        "service": "<string>",
        "policyEffective": "<string>",
        "policyExpiration": "<string>",
        "dateOfLastUpdate": "<string>",
        "status": "<string>"
      },
      "benefitsRelatedEntity": {
        "entityIdentifier": "<string>",
        "entityType": "<string>",
        "entityName": "<string>",
        "entityFirstname": "<string>",
        "entityMiddlename": "<string>",
        "entitySuffix": "<string>",
        "entityIdentification": "<string>",
        "entityIdentificationValue": "<string>",
        "entityRelationship": "<string>",
        "address": {
          "address1": "<string>",
          "address2": "<string>",
          "city": "<string>",
          "state": "<string>",
          "postalCode": "<string>",
          "countryCode": "<string>",
          "locationIdentifier": "<string>",
          "countrySubDivisionCode": "<string>"
        },
        "contactInformation": {
          "name": "<string>",
          "contacts": [
            {
              "communicationMode": "<string>",
              "communicationNumber": "<string>"
            }
          ]
        },
        "providerInformation": {
          "providerCode": "<string>",
          "referenceIdentification": "<string>"
        }
      },
      "benefitsRelatedEntities": [
        {
          "entityIdentifier": "<string>",
          "entityType": "<string>",
          "entityName": "<string>",
          "entityFirstname": "<string>",
          "entityMiddlename": "<string>",
          "entitySuffix": "<string>",
          "entityIdentification": "<string>",
          "entityIdentificationValue": "<string>",
          "entityRelationship": "<string>",
          "address": {
            "address1": "<string>",
            "address2": "<string>",
            "city": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "locationIdentifier": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "contacts": [
              {
                "communicationMode": "<string>",
                "communicationNumber": "<string>"
              }
            ]
          },
          "providerInformation": {
            "providerCode": "<string>",
            "referenceIdentification": "<string>"
          }
        }
      ],
      "benefitsServiceDelivery": [
        {
          "quantityQualifierCode": "<string>",
          "quantityQualifier": "<string>",
          "quantity": "<string>",
          "unitForMeasurementCode": "<string>",
          "sampleSelectionModulus": "<string>",
          "timePeriodQualifierCode": "<string>",
          "timePeriodQualifier": "<string>",
          "numOfPeriods": "<string>",
          "deliveryOrCalendarPatternCode": "<string>",
          "deliveryPatternTimeCode": "<string>",
          "unitForMeasurementQualifierCode": "<string>",
          "unitForMeasurementQualifier": "<string>",
          "deliveryOrCalendarPatternQualifierCode": "<string>",
          "deliveryOrCalendarPatternQualifier": "<string>",
          "deliveryPatternTimeQualifierCode": "<string>",
          "deliveryPatternTimeQualifier": "<string>"
        }
      ],
      "additionalInformation": [
        {
          "description": "<string>"
        }
      ],
      "eligibilityAdditionalInformation": {
        "codeListQualifierCode": "<string>",
        "industryCode": "<string>",
        "codeCategory": "<string>",
        "injuredBodyPartName": "<string>"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "<string>",
          "industryCode": "<string>",
          "codeCategory": "<string>",
          "injuredBodyPartName": "<string>"
        }
      ]
    }
  ],
  "errors": [
    {
      "field": "<string>",
      "code": "<string>",
      "description": "<string>",
      "followupAction": "<string>",
      "location": "<string>",
      "possibleResolutions": "<string>"
    }
  ],
  "status": "<string>",
  "transactionSetAcknowledgement": "<string>",
  "implementationTransactionSetSyntaxError": "<string>",
  "x12": "<string>"
}

A direct replacement for Change Healthcare’s Check Eligibility x12 API.

Authorizations

Authorization
string
headerrequired

API key authentication via the 'Authorization' header

Headers

Stedi-Response-Type
enum<string>
required

Temporary parameter used to control the returned response shape.

Available options:
change-beta

Body

application/json
x12
string
required

Response

200 - application/json
meta
object

Meta data about the response

controlNumber
string

Segment: ISA, Element: ISA13, Notes: Interchange Control Number original request

reassociationKey
string

Segment: ISA, Element: ISA13, Notes: Interchange Control Number

tradingPartnerServiceId
string

This is the payorId or Identification Code that was sent in the 270

provider
object

Provider

subscriber
object

ResponseMember

subscriberTraceNumbers
object[]

Loop: 2100C and 2100D, Segment: TRN, Notes: Subscriber Trace Numbers

dependents
object[]

Loop: 2100D, Notes: Dependent Details

payer
object

Payer

planInformation
object

PlanInformation

planDateInformation
object

PlanDateInformation

planStatus
object[]

Loop: 2110C and 2110D, Segments: EB, Notes: Subscriber/Dependent Eligibility Benefit Information - Deprecated please use benefitsInformation

benefitsInformation
object[]

Loop: 2110C and 2110D, Segments: NM1, PER, PRV, N3, N4, EB, H SD, MSG, LS, LE, REF, DTP, Notes: Subscriber/Dependent Eligibility Benefit Information

errors
object[]
status
string
transactionSetAcknowledgement
string
implementationTransactionSetSyntaxError
string
x12
string