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' \
  --data '{
  "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~HL*3*2*22*0~TRN*1*11122-12345*1234567890~NM1*IL*1*JANE*DOE****MI*123456789~DMG*D8*19000101~DTP*291*D8*20240108~EQ*MH~SE*13*1234~GE*1*000000001~IEA*1*000000001~"
}'
{
  "meta": {
    "senderId": "STEDI",
    "submitterId": "117151744",
    "applicationMode": "production",
    "traceId": "01J2VZA127GH93JT74HJU",
    "outboundTraceId": "01J2VZA127GH93JT74HJU"
  },
  "controlNumber": "1001",
  "reassociationKey": "123456789",
  "tradingPartnerServiceId": "123456789",
  "provider": {
    "providerName": "ACME HEALTH SERVICES",
    "entityIdentifier": "Provider",
    "entityType": "Non-Person Entity",
    "npi": "1999999984"
  },
  "subscriber": {
    "memberId": "123456789",
    "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": "Uniform Resource Locator (URL)",
          "communicationNumber": "website.company.com"
        }
      ]
    }
  },
  "planInformation": {
    "groupNumber": "12341234",
    "groupDescription": "ABCDE",
    "priorIdNumber": "1234567890"
  },
  "planDateInformation": {
    "planBegin": "20240101",
    "planEnd": "20241231",
    "eligibilityBegin": "20240102"
  },
  "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "22",
        "industry": "Outpatient Hospital"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "02",
        "industry": "Telehealth Provided Other than in Patient’s Home"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "02",
          "industry": "Telehealth Provided Other than in Patient’s Home"
        }
      ]
    },
    {
      "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "02",
        "industry": "Telehealth Provided Other than in Patient’s Home"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "02",
          "industry": "Telehealth Provided Other than in Patient’s Home"
        }
      ]
    },
    {
      "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "02",
        "industry": "Telehealth Provided Other than in Patient’s Home"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "02",
          "industry": "Telehealth Provided Other than in Patient’s Home"
        }
      ]
    },
    {
      "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "02",
        "industry": "Telehealth Provided Other than in Patient’s Home"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "02",
          "industry": "Telehealth Provided Other than in Patient’s Home"
        }
      ]
    },
    {
      "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "02",
        "industry": "Telehealth Provided Other than in Patient’s Home"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "02",
          "industry": "Telehealth Provided Other than in Patient’s Home"
        }
      ]
    },
    {
      "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "Office"
        }
      ]
    },
    {
      "code": "A",
      "name": "Co-Insurance",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
      "serviceTypeCodes": [
        "7"
      ],
      "serviceTypes": [
        "Anesthesia"
      ],
      "benefitPercent": "0",
      "authOrCertIndicator": "Y",
      "inPlanNetworkIndicatorCode": "Y",
      "inPlanNetworkIndicator": "Yes",
      "eligibilityAdditionalInformation": {
        "codeListQualifierCode": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "11",
        "industry": "Office"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "11",
          "industry": "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": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "22",
        "industry": "Outpatient Hospital"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        }
      ]
    },
    {
      "code": "A",
      "name": "Co-Insurance",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
      "serviceTypeCodes": [
        "4"
      ],
      "serviceTypes": [
        "Diagnostic X-Ray"
      ],
      "benefitPercent": "0",
      "authOrCertIndicator": "N",
      "inPlanNetworkIndicatorCode": "Y",
      "inPlanNetworkIndicator": "Yes",
      "additionalInformation": [
        {
          "description": "Services rendered thru Client Specific Network"
        }
      ],
      "eligibilityAdditionalInformation": {
        "codeListQualifierCode": "ZZ",
        "codeListQualifier": "Mutually Defined",
        "industryCode": "22",
        "industry": "Outpatient Hospital"
      },
      "eligibilityAdditionalInformationList": [
        {
          "codeListQualifierCode": "ZZ",
          "codeListQualifier": "Mutually Defined",
          "industryCode": "22",
          "industry": "Outpatient Hospital"
        }
      ]
    },
    {
      "code": "C",
      "name": "Deductible",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
      "serviceTypeCodes": [
        "BB"
      ],
      "serviceTypes": [
        "Partial Hospitalization (Psychiatric)"
      ],
      "benefitAmount": "0",
      "authOrCertIndicator": "Y",
      "inPlanNetworkIndicatorCode": "Y",
      "inPlanNetworkIndicator": "Yes",
      "additionalInformation": [
        {
          "description": "Includes services provided by Client Specific Network"
        }
      ]
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "MH"
      ],
      "serviceTypes": [
        "Mental Health"
      ],
      "additionalInformation": [
        {
          "description": " Provider is out of network based on NPI ID provided in request."
        }
      ]
    },
    {
      "code": "G",
      "name": "Out of Pocket (Stop Loss)",
      "coverageLevelCode": "FAM",
      "coverageLevel": "Family",
      "serviceTypeCodes": [
        "30"
      ],
      "serviceTypes": [
        "Health Benefit Plan Coverage"
      ],
      "timeQualifierCode": "29",
      "timeQualifier": "Remaining",
      "benefitAmount": "5760",
      "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": "29",
      "timeQualifier": "Remaining",
      "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": "29",
      "timeQualifier": "Remaining",
      "benefitAmount": "2760",
      "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": "29",
      "timeQualifier": "Remaining",
      "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": "29",
      "timeQualifier": "Remaining",
      "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": "29",
      "timeQualifier": "Remaining",
      "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": "C",
      "name": "Deductible",
      "coverageLevelCode": "IND",
      "coverageLevel": "Individual",
      "serviceTypeCodes": [
        "30"
      ],
      "serviceTypes": [
        "Health Benefit Plan Coverage"
      ],
      "timeQualifierCode": "29",
      "timeQualifier": "Remaining",
      "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": "29",
      "timeQualifier": "Remaining",
      "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"
        }
      ]
    }
  ],
  "errors": [],
  "x12": "ISA*00*          *00*          *ZZ*STEDI          *01*117151744      *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~"
}

This endpoint sends real-time eligibility checks to payers in raw X12 EDI format. This is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi.

  • Call this endpoint with payload in 270 X12 EDI format.
  • Stedi validates the EDI and sends the eligibility check to the payer.
  • The endpoint returns a synchronous response from the payer in both JSON and raw X12 EDI format. The response contains the patient’s eligibility and benefits information.

Real-time eligibility checks are ideal for in-person patient visits, telehealth appointments, and other scenarios where you need immediate information about a patient’s coverage.

We recommend always starting with real-time checks when integrating with a new payer. This approach allows you to quickly test and refine your pipeline through fast feedback loops. Once you’re comfortable with real-time checks, you may also want to start sending asynchronous batch checks to perform periodic refreshes for all or a subset of patients.

​
Payer ID

You must submit a payer identifier in Loop 2100A NM109. This identifier must be an official Payer ID or alias listed in the Payer Network. Stedi uses this ID to route the eligibility check to the correct payer.

For example, you could use 60054, HPQRS, AETNA, or any other listed alias for Aetna.

​
Required transaction identifier BHT03

The BHT03 (Submitter Transaction Identifier) element is required when submitting real-time eligibility checks through this endpoint. The identifier you choose must be:

  • An alphanumeric string from 1-50 characters long.
  • Different from the value you choose for ST02 (Transaction Set Control Number).

We also strongly recommend using a unique value. This approach makes it easier for Stedi to troubleshoot eligibility checks in your account.

If you don’t include BHT03 in the request, Stedi returns a 200 with the status property set to ERROR and the implementationTransactionSetSyntaxError property set to 5. The response also includes a negative 999 Implementation Acknowledgment in the x12 property.

The payer returns the identifier in the BHT03 element of the 271 eligibility response, and Stedi returns it in the meta.traceId JSON property.

​
Don’t send fake data

Some payers, particularly CMS (HETS), prohibit sending test eligibility checks for fake patients or providers to their production systems. Payers may block your access if you send these types of test transactions.

If you need to send test data to payers in production, you must contact Stedi support to coordinate with the payer and obtain approval. For example, some payers require that you use specific test credentials.

​
Character restrictions

Only use the following characters as delimiters: ~, *, : and ^. The X12 format doesn’t support using escape sequences, so you can’t include delimiters or special characters as part of the request data. Stedi returns a 400 error if you include restricted characters as anything other than delimiters in the request.

Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP 400 errors.

​
Autocorrection

Stedi automatically replaces backticks (`), also known as backquotes or grave accents, with a single quote (') in subscriber and dependents first and last names. This autocorrection prevents errors when submitting your request to payers and intermediary clearinghouses. Stedi returns a message in the response’s warnings array when it makes this replacement.

​
MBI lookup for CMS

You must include the patient’s Medicare Beneficiary Identifier (MBI) in every eligibility check to the Centers for Medicare and Medicaid Services (Payer ID: CMS).

If the patient doesn’t know their MBI, you can perform an MBI lookup using their Social Security Number instead. Learn more

​
Eligibility response

Visit Determine patient benefits for detailed explanations of how to determine the patient’s active coverage, financial responsibility, whether referrals and authorizations are required, and more.

Network status: The response typically doesn’t confirm whether the requesting provider is in- or out-of-network. The most reliable way to confirm network status is by checking with the payer or provider directly. Learn more

Our documentation lists all enums officially allowed in the eligibility response. Some payers return non-compliant values, which Stedi passes through as is.

Implementing the right retry strategy for eligibility check failures saves a lot of time and money.

At a minimum, we strongly recommend automatically retrying every request that fails due to payer connectivity issues. Automatic retries resolve a significant portion of these types of failures without manual intervention. Visit Retry strategy for details.

​
Concurrency and timeout

For details about timeout and concurrency limits as well as strategies to avoid payer throttling visit Real-time eligibility checks.

​
Troubleshooting

For a list of possible errors and resolution steps, visit Eligibility troubleshooting.

Authorizations

​
Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json

Response

200
application/json

EligibilityRawX12Check 200 response

The response is of type object.