Real-Time Eligibility Check (270/271) JSON
Submit a real-time 270/271 eligibility check in JSON format
/eligibility-checkReal-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.
- Call this endpoint with a JSON payload. The required information can vary depending on the circumstances, but we recommend starting with a basic eligibility request.
- Stedi translates your request to the X12 270 EDI format and sends it 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. Note that our documentation lists all enums officially allowed in the eligibility response. Some payers return non-compliant values, which Stedi passes through as is.
Test your integration with eligibility mock requests.
A Stedi API Key for authentication. Supports both test and production API keys.
Headers
(CMS requests only): Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request's point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS.
When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States.
Visit CMS traceability requirements for details and examples.
Body
A dependent for which you want to retrieve benefits information.
- You can only submit one dependent per eligibility check.
- Only include the patient's information here when they are listed as a dependent on the subscriber's insurance plan AND the payer cannot uniquely identify them through information outside the subscriber's policy. For example, if the dependent has their own member ID number, you should identify them in the
subscriberobject instead. This includes member IDs that differ only by a suffix, such as01, because the patient can still be uniquely identified. - Most Medicaid plans don't support dependents, with a few exceptions. Sending this information to payers that don't support dependents will either cause an error, or the payer may ignore the information and return results for the subscriber instead.
- Each payer has different requirements, so you should supply the fields necessary for each payer to identify the dependent in their system. However, we strongly recommend including the dependent's date of birth in the request when available because many payers return errors without it.
- Enter the patient's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit patient names for all best practices to avoid unnecessary failures.
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Additional identification numbers for the dependent.
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The agency claim number associated with the dependent.
The contract number associated with the dependent's insurance plan.
The eligibility category for the dependent.
The group number for the dependent's insurance plan.
The group or policy number.
The identification card serial number, when it differs from the member ID.
The dependent's identity card number. Include this when this number differs from the subscriber's member ID.
The dependent's insurance policy number.
The issue number for the dependent's insurance policy.
The dependent's Medicare Beneficiary Identifier (MBI). The 270 carries it as the Health Insurance Claim (HIC) number, which CMS retired in favor of the MBI.
The medical record identification number for the dependent.
The dependent's member ID. Only set this when checking eligibility with a Property and Casualty payer and the patient identifier is a member ID that would be used in an 837 claim. If the dependent has their own member ID for a health plan, identify them in the subscriber object instead.
The patient account number for the dependent.
The plan network identification number for the dependent.
The plan number for the dependent's insurance plan.
The dependent's Social Security Number (SSN). Don't use this for Federally-administered programs, such as Medicare.
The dependent's address.
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The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The dependent's date of birth (DOB). We strongly recommend including the DOB in your request. Many payers need this information to identify the patient in their system and may immediately return an error when it's not provided.
Code indicating the dependent's gender.
FEMALEMALEThe dependent's name.
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The dependent's name.
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The dependent's first name.
The dependent's last name. Don't include the dependent's name suffix, such as Jr. or III. Use the designated suffix property instead.
The dependent's middle name or middle initial.
The dependent's name suffix, such as Jr. or III. Only include the dependent's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
Information about a provider associated with the dependent who isn't the entity requesting the eligibility check, such as a referring provider. The requesting provider is specified in the request's root provider.
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A code indicating the type of provider. Visit Eligibility code lists for a complete list.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
The dependent's relationship to the subscriber.
SPOUSECHILDOTHER_ADULTAn identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an eligibility search.
Details about the eligibility or benefit information you are requesting for the patient.
- You can optionally include service type codes (STCs) or procedure codes to request benefits for specific services.
- You can specify either a single service date or a date range using
dates.service. The payer defaults to using the current date in their timezone if you don't include one. - When checking eligibility for today, omit the service date to ensure consistent behavior across payers.
- We recommend submitting dates up to 12 months in the past or up to the end of the current month. Payers aren't required to support dates outside these ranges. However, some payers such as the Centers for Medicare and Medicaid Services (CMS) do support requests for dates further in the future - especially the next calendar month. Check the payer's documentation to determine their specific behavior.
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Additional information about the encounter.
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The prior authorization number for a particular benefit or procedure.
The referral number for a particular benefit or procedure.
The dates of service for the eligibility inquiry.
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The service date or date range.
The type of facility where providers deliver the service. Uses one of the place of service codes.
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The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506One or more codes classifying the type of services for which you want to receive benefits information.
- You can include service type codes (STCs) or procedure codes to request specific types of benefits information. For medical benefits, you'll almost always need an STC because most medical payers don't support procedure codes (CPT/HCPCS/CDT). For dental benefits, many payers support procedure codes. Visit STCs and procedure codes for guidance on choosing the right codes.
- We recommend including one service per request. Not all payers support all service type codes, not all payers support multiple codes in the same request, and payers aren't required to respond with exactly the same codes you sent.
- If you don't specify any services, Stedi defaults to using service type code
30(Health Benefit Plan Coverage).
A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests.
The payer ID. Visit the Payer Network for a complete list.
- You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.
- You must include leading
0characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use00540for SISCO, not540.
The payer's name, such as Cigna or Aetna.
Information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider.
- You must provide the provider's name as either a person (with
name.person) or an organization (withname.organization). - You must also provide an identifier - this is typically the provider's National Provider Identifier (
npi). If the provider doesn't have an NPI, you can supply an alternative, such as theirtinorssn. - Don't include additional properties, such as
tinoraddress, unless they are specifically required or suggested by the payer.
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Additional identification numbers for the provider. Only include when specifically required by a payer.
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The provider's contract number.
The provider's electronic device PIN.
The ID number for the provider's facility.
The provider's facility network identification number.
The provider's Medicaid provider number.
The provider's Medicare provider number.
The provider's personal identification number.
The provider's plan network identification number.
The provider's prior identifier number.
The provider's state license information. If you include this, you must provide at least the license number.
The provider's submitter ID.
The provider's user ID.
The provider's address. Only include when specifically instructed by a payer, such as when the provider has multiple locations and you need to identify the specific location making the request.
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The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin. Only include when the payer requires it.
The provider's name, as either a person or an organization.
The name of a provider who is a person.
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The provider's first name.
The provider's last name.
The provider's middle name or middle initial.
The provider's name suffix, such as Jr. or III.
The provider's National Provider Identifier (NPI).
All healthcare providers eligible for an NPI must provide this identifier. Some non-traditional providers such as transportation services, durable medical equipment (DME) suppliers, or alternative medicine practitioners can't receive an NPI. If the provider doesn't have an NPI, payers virtually never support requests with alternate IDs. In the rare circumstance that a payer has instructed you to use an alternate ID, the payer will typically require you to supply either their tin or ssn instead.
The provider's pharmacy processor number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an NPI. This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.
Information about the provider's role and taxonomy. Only include when required by a payer.
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A code indicating the type of provider. Visit Eligibility code lists for a complete list.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
The provider's service provider number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an NPI. This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.
The provider's Social Security Number (SSN).
- Only include when specifically instructed by a payer - for example, if the provider doesn't have an NPI. This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service.
- If the payer has instructed you to send an EIN but the provider operates using their SSN, use
provider.tininstead of this field. - Don't use this for Federally-administered programs, such as Medicare.
The provider's Federal Taxpayer Identification Number. This is typically the provider's EIN (Employer Identification Number), but you may use the provider's SSN if the provider doesn't have an EIN. Only include if the payer requires it.
The type of provider making the request.
PROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERHOSPITALFACILITYThe primary policyholder for the insurance plan or a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave dependent empty.
- At a minimum, our API requires that you supply at least one of these fields in the request:
memberId,dateOfBirth, orname.person.lastName. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. - When you provide all four of
memberId,dateOfBirth,name.person.firstName, andname.person.lastName, payers must return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. - We recommend always including the patient's member ID when possible.
- Enter the patient's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit patient names for all best practices to avoid unnecessary failures.
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Additional identification numbers for the subscriber. Use this object when you need to provide an identification number other than or in addition to the subscriber's member ID. For example, you may provide the patient account number.
Don't include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID.
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The agency claim number associated with the subscriber.
The case number associated with the subscriber.
The contract number associated with the subscriber's insurance plan.
The group number associated with the subscriber's insurance policy.
The group or policy number.
The identification card serial number, when it differs from the member ID.
The subscriber's identity card number. Include this property when this number differs from the subscriber's member ID. This is common in Medicaid.
The subscriber's insurance policy number.
The subscriber's Medicare Beneficiary Identifier (MBI). The 270 carries it as the Health Insurance Claim (HIC) number, which CMS retired in favor of the MBI. Don't include it unless it differs from the member ID.
The Medicaid Recipient Identification Number. You can provide this number to identify the subscriber when it is the primary number the payer knows a member by (such as for Medicare or Medicaid). Don't supply this value unless it differs from the memberId.
The medical record identification number for the subscriber.
The patient account number for the subscriber.
The plan network identification number for the subscriber.
The plan number for the subscriber's insurance plan.
The subscriber's Social Security Number (SSN). Many commercial and government payers ignore this property due to concerns about member privacy. However, some Medicaid programs support alternative searches using the patient's Social Security Number, instead of the member ID.
The subscriber's address.
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The first line of the address. Required for all payers except payer ID MBILUNOSSN.
The second line of the address.
The city. Required for all payers except payer ID MBILUNOSSN.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code. Required for payer ID MBILUNOSSN.
The subscriber's date of birth.
Code indicating the subscriber's gender.
FEMALEMALEThe member ID for the subscriber's insurance policy.
The subscriber's name, as either a person or an organization.
The name of a subscriber who is a person.
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The subscriber's first name.
The subscriber's last name. Don't include the subscriber's name suffix, such as Jr. or III. Use the designated suffix property instead.
The subscriber's middle name or middle initial.
The subscriber's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
Information about a provider associated with the subscriber who isn't the entity requesting the eligibility check, such as a referring provider. The requesting provider is specified in the request's root provider.
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A code indicating the type of provider. Visit Eligibility code lists for a complete list.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Response
Information about the dependent from the eligibility check request. Note that the payer may return the dependent in the subscriber object instead. When present, this object will always include the dependent's name for identification, but many payers also include the date of birth and other identifying information.
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Additional identifying information for the dependent.
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The agency claim number, only used when the information source is a Property and Casualty payer.
The class of contract code - used to identify the applicable class of contract for claims processing.
The contract number of a contract between the payer and the provider that requested the eligibility check.
The eligibility category for the dependent.
The family unit number.
The group or policy number.
Used when the identification card has a number in addition to the member ID.
The identity card number. Present when this number differs from the member ID.
The insurance policy number.
The issue number.
The patient's Medicare Beneficiary Identifier (MBI). If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical record identification number.
The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer.
The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response.
The prior identifier number.
The patient's Social Security Number (SSN).
The address of the entity, such as a provider or organization.
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The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date.
The patient's date of birth as an ISO 8601 YYYY-MM-DD string. For example, 1985-03-15 represents March 15, 1985.
Dates associated with patient attributes, as ISO 8601 date ranges.
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Added date. Payers may return this information in the case of retroactive eligibility.
The admission date or dates.
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The certification date.
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Consolidated Omnibus Budget Reconciliation Act (COBRA) date.
The date of death.
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The date when the patient information was last updated.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
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The effective date of change.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
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The enrollment date.
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The issue date.
Plan effective dates.
The policy date.
Premium paid to date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
The status date.
Code indicating the patient's gender.
Payers may sometimes return other non-compliant values.
FEMALEMALEUNKNOWNMaintenance information indicating whether the payer signaled that the patient's identifying information differs from what you submitted.
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Whether the payer signaled that the patient's identifying information differs from what you submitted.
NONEPAYER_INDICATEDThe dependent's name.
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The person's name.
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The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Information about a provider associated with this entity.
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A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
The dependent's relationship to the subscriber.
Payers may sometimes return other non-compliant values.
SPOUSECHILDEMPLOYEEUNKNOWNORGAN_DONORAn identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an eligibility search.
This property is for use by Stedi tools only, such as Stedi's MCP server.
AAA rejection errors from the payer. AAA errors specify the reasons for the rejection and any recommended follow-up actions.
Array item
The AAA reject reason code.
The human-readable description of the error.
The recommended follow-up action.
The location in the 271 response where the error occurred.
Payers may sometimes return other non-compliant values.
ENVELOPEPAYERPROVIDERSUBSCRIBERSUBSCRIBER_BENEFITSDetailed guidance on possible ways to resolve the error.
A globally unique identifier for this eligibility check across all Stedi accounts. It's formatted as ec_<uuid>. For example: ec_550e8400-e29b-41d4-a716-446655440000. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.
Metadata about the response. Stedi uses this data for tracking and troubleshooting.
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The transaction identifier Stedi assigns to the outbound request's BHT03 element.
Although this is a unique identifier, we recommend using id instead to identify and track eligibility checks. An eligibility check's id is guaranteed to be globally unique, and you can use it to deep link to the eligibility check's results within the Stedi portal.
A unique identifier the payer may assign to the transaction. Stedi doesn't support setting a subscriber trace number in the eligibility check request because there is no need to include a trace number for real-time queries.
Array item
The identifier of the organization that assigned the trace number.
The unique trace number assigned to the transaction.
Identifies a subdivision within the organization that assigned the trace number.
Whether the payer assigned this trace number to the current transaction (CURRENT_TRANSACTION) or is echoing one from the original request (REFERENCED_TRANSACTION).
Payers may sometimes return other non-compliant values.
CURRENT_TRANSACTIONREFERENCED_TRANSACTIONThe transaction identifier from the response's BHT03 element. Matches the request's BHT03 if provided, otherwise matches the Stedi-generated outboundTraceId.
Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer's tax ID. Most payers also include contact information.
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The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Typically the identification the payer reported for itself in the 271 response (NM109 with the PI qualifier). This value comes from the payer and may not match a Stedi Payer Network ID; use the root-level payerId for the canonical payer ID.
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
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The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
The Federal Taxpayer Identification Number.
The entity identifier code for the payer.
Payers may sometimes return other non-compliant values.
THIRD_PARTY_ADMINISTRATOREMPLOYERGATEWAY_PROVIDERPLAN_SPONSORPAYERThe primary payer ID from the Stedi Payer Network. This ID is consistent across eligibility and claims systems and matches the payer ID printed on the member's ID card. You can use it as the payerId in subsequent eligibility check requests.
The patient's insurance plans, grouped by plan name. Each plan contains the benefits that apply to the patient.
Array item
Benefit information from the payer, organized into categories like cost-sharing (co-insurance, deductibles, copayments), coverage details (exclusions, limitations), and eligibility statuses.
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A list of free-text benefit descriptions from the payer.
Payers sometimes use this type to communicate information that's difficult to capture elsewhere in the response. The description is included as free text in messages or identifiers in additionalInformation.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
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The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
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Added date. Payers may return this information in the case of retroactive eligibility.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of disclaimers from the payer.
A legal or advisory disclaimer attached to the benefit information. The X12 standard discourages use of this type, but many commercial payers still send disclaimers. When present, the disclaimer text arrives in messages, and there should be only one disclaimer per individual response.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of entries indicating the payer couldn't process your request.
Indicates that the payer couldn't process your request. A common cause is requesting benefits information for a service type or procedure code the payer doesn't support.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of entries indicating the patient's card has been reported lost or stolen.
This typically means that the payer has flagged the patient's member ID to prevent identity theft. The patient may still have active coverage, but you likely won't be able to run transactions with the patient's information until they resolve the issue.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of co-insurance benefit entries from the payer.
The percent is the patient's share of costs, expressed as a decimal (such as 0.8 for 80%). The decimal precision reflects what the payer sent. A value of 0 indicates the payer reported no co-insurance responsibility.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage value for this benefit, expressed as a decimal (e.g., 0.80 for 80%).
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of copayment benefit entries from the payer.
The amount is the fixed amount the patient pays for a service. The decimal precision reflects what the payer sent (for example, 25.0 or 40).
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity the amount applies to, when the payer sends one. For example, 60 days of inpatient care.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of entries directing you to contact another entity for benefit information.
Indicates that the payer can't supply the information you requested and is directing you to another entity. The entity's information is listed in the relatedEntities array.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of cost containment benefit entries from the payer.
Cost containment refers to rules a health plan may have in place to control the cost of care. This benefit is typically included when the patient has Medicaid coverage. The amount represents the total the patient pays out-of-pocket before benefits begin. The decimal precision reflects what the payer sent (for example, 500.0 or 500).
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity the amount applies to, when the payer sends one. For example, 60 days of inpatient care.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of coverage basis entries from the payer.
Describes the financial basis of the patient's health plan or eligibility for enrollment. For example, payers may use this type to indicate that a plan is fully insured, meaning the payer assumes full financial responsibility for medical claims. Payers may also use this type to indicate carve-out benefits, such as when the patient is enrolled in state-managed health programs, or to explain why a member was allowed to enroll in the plan (such as age range or having a disability). The detail is usually included as free text in messages or identifiers in additionalInformation.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of deductible benefit entries from the payer.
The amount is what the patient must pay before the plan begins covering costs. The decimal precision reflects what the payer sent (for example, 1500.0 or 1000). Check timePeriod to determine what the amount represents. A calendar-year deductible is the patient's total for the year, while a remaining deductible is the amount still owed before the plan pays.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity the amount applies to, when the payer sends one. For example, 60 days of inpatient care.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of services or conditions the plan excludes from coverage.
An exclusion is a service or condition the plan doesn't cover for any patient. This is different from a nonCovered entry, which reports that this patient doesn't have coverage for a specific service you submitted in the request.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of health care facility information relevant to the patient's benefits.
These typically indicate an institution or provider network the patient is required or expected to use. The facility's information is available in the relatedEntities array. Rarely returned.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Benefit entries that Stedi couldn't include in the standard arrays due to data validation issues, such as missing required amounts or incorrect unit types.
Show attributes
Invalid co-insurance entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid co-payment entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid cost containment entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid deductible entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid limitation entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid out-of-pocket entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARInvalid spend down entries.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount, if present.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANReasons explaining why this entry is invalid.
Array item
A machine-readable code identifying the validation issue.
Payers may sometimes return other non-compliant values.
MISSING_AMOUNTMISSING_PERCENTUNEXPECTED_AMOUNTUNEXPECTED_PERCENTA human-readable description of the validation issue.
Free-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage, if present.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity, if present.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of benefit limitation entries, expressed as an amount, percent, or quantity.
Dental and vision plans often use this benefit type to specify an annual maximum benefit amount.
The Affordable Care Act prevents most commercial health plans from imposing limits on annual or lifetime benefit amounts, but this generally doesn't apply to government health plans and some commercial health plans may be exempt.
When present, the amount indicates the maximum benefit amount the plan allocates to the patient. The messages array often includes values like "ANNUAL MAXIMUM".
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this limitation.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage value for this limitation, expressed as a decimal (e.g., 0.80 for 80%).
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity for this limitation, when the payer expresses the limit as a count rather than an amount or percentage. For example, 20 visits.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of managed care coordinator information for the patient.
When present, the care coordinator's details are in the relatedEntities array.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of non-covered services for the patient.
Indicates that the patient's plan doesn't cover a specific service type you submitted in the eligibility check. Note that the absence of a nonCovered entry doesn't mean that a specific service is covered.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of services the payer determined aren't medically necessary for the patient.
Indicates the payer has determined this service isn't medically necessary and won't cover it on that basis.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of other payers with coverage responsibility for the patient.
Indicates another payer that has coverage responsibility for the patient. This is the signal for coordination of benefits (COB) scenarios. The other payer's details are available in the relatedEntities array.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of entries indicating the benefit information originates from another source.
Indicates the information provided came from a source other than the payer's own system. Rarely returned.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of out-of-pocket maximum benefit entries from the payer.
The amount is the limit on what the patient pays. The decimal precision reflects what the payer sent (for example, 5000.0 or 5000). Check timePeriod to determine whether an amount is the full maximum or the amount remaining.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity the amount applies to, when the payer sends one. For example, 60 days of inpatient care.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEARA list of coverage restrictions due to pre-existing conditions.
Indicates coverage for this benefit is restricted because of a pre-existing condition.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of primary care providers for the patient.
A PCP is the main healthcare provider responsible for managing a patient's care and coordinating referrals to specialists. When present, the provider's information is available in the relatedEntities array.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of historical benefits information for the patient.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of reserve benefits for the patient.
This type is primarily used by Medicare (HETS) to indicate lifetime reserve benefit amounts separate from annual limits. For example, Medicare Lifetime Reserve days – the limited pool of additional inpatient hospital days a patient can use after exhausting a benefit period.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of benefits requiring a second surgical opinion for coverage.
Indicates the plan requires a second surgical opinion before this benefit is available. This is a precondition for obtaining the benefit.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of services restricted to specific providers.
Indicates the benefit is available only when delivered by a particular provider, identified in relatedEntities. This doesn't confirm whether that provider is in or out of network with the payer.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
A list of spend down benefit entries from the payer.
Spend down is a process that allows individuals with high medical expenses to qualify for Medicaid even if their income is above the Medicaid income limit. The amount represents the total the patient pays out-of-pocket before they can receive Medicaid benefits. The decimal precision reflects what the payer sent (for example, 1500.0 or 1500).
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount for this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDThe quantity the amount applies to, when the payer sends one. For example, 60 days of inpatient care.
Show attributes
The unit of measure for value.
Payers may sometimes return other non-compliant values.
MINIMUMQUANTITY_USEDCOVERED_ACTUALCOVERED_ESTIMATEDNUMBER_OF_CO_INSURANCE_DAYSThe numeric quantity. For example, 10 when the qualifier is VISITS.
Another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
Code specifying the time period for the benefit information. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
HOURDAY24_HOURSYEARSSERVICE_YEAREligibility status benefit entries from the payer. Each entry indicates whether the patient has active or inactive coverage for a specific service, network, and coverage level.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
Show attributes
The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
Show attributes
The last code in the range. The range is inclusive of this code.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
Show attributes
The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
The patient's coverage status, indicating whether their coverage is active or inactive for specific services.
ACTIVE_COVERAGEACTIVE_FULL_RISK_CAPITATIONACTIVE_SERVICES_CAPITATEDACTIVE_SERVICES_CAPITATED_TO_PRIMARY_CARE_PROVIDERACTIVE_PENDING_INVESTIGATIONA list of unlimited benefits for the patient's plan.
For example, unlimited physical therapy visits or unlimited preventive care.
Array item
Additional plan, group, and policy identification numbers for this benefit entry.
Show attributes
The alternative list ID. This identifier lets the payer point to a list of drugs and their alternatives, along with the formulary status that applies to the patient.
The coverage list ID. This identifier lets the payer point to a list of drugs that have coverage limitations for the patient.
The drug formulary number.
The family unit number. Pharmacy benefits managers (PBMs) return this when the patient has a suffix to their member ID. For all other payers, the suffix is considered part of the member ID.
The group number for the patient's health insurance plan and, when the payer sends one, the group name.
A group or policy number from the payer. Present when Stedi can't determine the type. Contact the payer for confirmation.
The insurance policy number.
The Medicare Beneficiary Identifier (MBI), the randomized identifier CMS uses to identify Medicare beneficiaries. If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical assistance category.
The patient's member ID.
The insurance plan number and, when the payer sends one, the plan name.
The prior authorization number.
The referral number.
The monetary amount associated with this benefit.
The level of coverage this benefit applies to, such as INDIVIDUAL or FAMILY. Defaults to INDIVIDUAL when the payer doesn't send a coverage level.
Payers may sometimes return other non-compliant values.
CHILDREN_ONLYDEPENDENTS_ONLYEMPLOYEE_AND_CHILDRENEMPLOYEE_ONLYEMPLOYEE_AND_SPOUSEDates associated with this benefit, as ISO 8601 date ranges.
Show attributes
Added date. Payers may return this information in the case of retroactive eligibility.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The admission date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The benefit date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The completion date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The coordination of benefits date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The date when the plan information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The latest visit or consultation date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
A period date range.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan effective dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The primary care provider date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The status date.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The diagnosis this benefit covers. Present when the benefit is limited to specific diagnoses from the patient's diagnosis list.
Show attributes
The code system for diagnosis codes. Only supports ICD-10-CM.
ICD-10-CMDiagnosis codes associated with this benefit entry.
Array item
The human-readable definition of the diagnosis code.
The diagnosis code value.
Code identifying the type of insurance policy.
Payers may sometimes return other non-compliant values.
DISABILITYMEDICARE_POINT_OF_SERVICE_POSMULTIPLE_OPTIONS_HEALTH_PLANMEDICARE_SECONDARY_WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EMPLOYER_GROUP_HEALTH_PLANMEDICARE_SECONDARY_ENDSTAGE_RENAL_DISEASE_BENEFICIARY_IN_THE_MANDATED_COORDINATION_PERIOD_WITH_AN_EMPLOYERS_GROUP_HEALTH_PLANFree-form messages from the payer providing additional information about this benefit entry, like prior authorization requirements, network restrictions, benefit limits, or plan details. Message content isn't standardized and varies by payer.
Network information for a benefit, including the in-plan network indicator and plan network identification.
Show attributes
The plan, group, or plan network name.
The plan network identification number.
Code indicating whether the benefit is in-network or out-of-network.
Payers may sometimes return other non-compliant values.
IN_NETWORKOUT_OF_NETWORKIN_AND_OUT_OF_NETWORKThe percentage associated with this benefit.
The locations where providers may deliver healthcare services for this benefit. Common examples include physician offices, hospitals, and patient homes. When present, this indicates facility-specific coverage details.
Array item
The place of service code identifying the type of facility.
Payers may sometimes return other non-compliant values.
0103040506The human-readable name of the place of service.
The plan coverage description from EB05. Populated when the EB05 value doesn't relate to a plan (e.g., payer used EB05 for benefit-level info rather than a plan name).
Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.
REQUIREDNOT_REQUIREDAnother entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer.
Array item
The address of the entity, such as a provider or organization.
Show attributes
The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The entity's contact information.
Array item
The contact's EDI numbers.
The contact's email addresses.
The contact's fax numbers.
The name of the contact person.
The contact's phone numbers.
The contact's URLs.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
Electronic Transmitter Identification Number.
Facility Identification.
Member Identification Number
National Association of Insurance Commissioners Identification
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Centers for Medicare and Medicaid Services National Provider Identifier
Payer Identification
Pharmacy Processor Number
Information about a provider associated with the related entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.
PARENTCHILDDOMESTIC_PARTNERSPOUSEEMPLOYEEService Provider Number
Social Security Number.
The Federal Taxpayer Identification Number.
The entity identifier code for the benefit related entity.
Payers may sometimes return other non-compliant values.
CONTRACTED_SERVICE_PROVIDERPREFERRED_PROVIDER_ORGANIZATIONPROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERThe service or procedure that this benefit applies to, using a code or code range within a code system like CPT, HCPCS, or NDC.
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The human-readable definition of the code.
A range of service or procedure codes, defined by start and end codes. For example, CPT codes 99201 through 99215.
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The last code in the range. The range is inclusive of this code.
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The human-readable definition of the code.
The service or procedure code value.
The first code in the range.
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The human-readable definition of the code.
The service or procedure code value.
The code system that the value belongs to, such as CPT, HCPCS, or STC.
Payers may sometimes return other non-compliant values.
STCCDTCPTNDCHCPCSThe service or procedure code value.
Service delivery limits for this benefit, like visit frequency restrictions, age boundaries, or delivery schedules.
Array item
The maximum patient age (in years) for this benefit.
The name of the plan. Stedi derives this from the plan names the payer sends in the benefit entries. This property is present when the payer sends consistent plan names, and absent when the data is missing, ambiguous, or contradictory. When absent, check each benefit's planCoverageDescription for the plan information.
Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. This object will always include at least one identifier, such as the provider's NPI, tax ID, or EIN.
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Additional identifying information for the provider.
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The provider's contract number.
The provider's electronic device PIN.
The ID number for the provider's facility.
The provider's facility network identification number.
The provider's Medicaid provider number.
The provider's Medicare provider number.
The provider's personal identification number.
The provider's plan network identification number.
The provider's prior identifier number.
The provider's submitter ID.
The provider's user ID.
The address of the entity, such as a provider or organization.
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The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The Employer Identification Number (EIN), distinct from the Federal Taxpayer Identification Number in tin.
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
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The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
The provider's National Provider Identifier (NPI).
The pharmacy processor number.
Information about the provider's role and taxonomy.
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A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
The service provider number. This is an identification number the payer assigns.
The Social Security Number (SSN).
The Federal Taxpayer Identification Number.
A code identifying the type of provider.
Payers may sometimes return other non-compliant values.
PROVIDERTHIRD_PARTY_ADMINISTRATOREMPLOYERHOSPITALFACILITYInformation about the primary policyholder for the insurance plan listed in the original eligibility check request. The response will always include either the subscriber's name or member ID for identification, but most payers will also return the subscriber's date of birth and other identifying information.
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Additional identifying information for the subscriber.
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The agency claim number, only used when the information source is a Property and Casualty payer.
The case number associated with the subscriber.
The class of contract code - used to identify the applicable class of contract for claims processing.
The contract number of a contract between the payer and the provider that requested the eligibility check.
The family unit number.
The group or policy number.
Used when the identification card has a number in addition to the member ID.
The identity card number. Present when this number differs from the member ID.
The insurance policy number.
The issue number.
The patient's Medicare Beneficiary Identifier (MBI). If you receive an MBI, we recommend sending a follow-up eligibility check to CMS (payer ID: CMS) for additional benefits data. Visit Medicare Beneficiary Identifier documentation for more information about the MBI format. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
The Medicaid recipient identification number.
The medical record identification number.
The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer.
The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response.
The prior identifier number.
The patient's Social Security Number (SSN).
The address of the entity, such as a provider or organization.
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The first line of the address.
The second line of the address.
The city.
The two-letter country code from Part 1 of ISO 3166.
The country subdivision code from Part 2 of ISO 3166.
The United States or Canadian postal code, excluding punctuation and blanks.
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick.
The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date.
The patient's date of birth as an ISO 8601 YYYY-MM-DD string. For example, 1985-03-15 represents March 15, 1985.
Dates associated with patient attributes, as ISO 8601 date ranges.
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Added date. Payers may return this information in the case of retroactive eligibility.
The admission date or dates.
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The certification date.
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Consolidated Omnibus Budget Reconciliation Act (COBRA) date.
The date of death.
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The date when the patient information was last updated.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The discharge date.
Show attributes
The effective date of change.
Show attributes
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
Plan eligibility dates.
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The enrollment date.
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The issue date.
Plan effective dates.
The policy date.
Premium paid to date.
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^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The inclusive end of the range.
^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$The start of the range, or a single point-in-time date.
The service date or dates.
The status date.
Code indicating the patient's gender.
Payers may sometimes return other non-compliant values.
FEMALEMALEUNKNOWNMaintenance information indicating whether the payer signaled that the patient's identifying information differs from what you submitted.
Show attributes
Whether the payer signaled that the patient's identifying information differs from what you submitted.
NONEPAYER_INDICATEDThe member ID for the insurance policy.
The entity's name, as either a person or an organization.
A person's name. Maps to elements NM103 through NM107.
Show attributes
The person's first name.
The person's last name.
The person's middle name or initial.
The person's name suffix, such as Jr. or III.
Information about a provider associated with this entity.
Show attributes
A code that communicates the entity's role in the type of benefits information in the response. Visit Eligibility code lists for a complete list.
Payers may sometimes return other non-compliant values.
ADMITTINGATTENDINGBILLINGCONSULTINGCOVERINGThe provider's taxonomy code.
Issues with your eligibility request that could affect the results, or information about the response. For example, warnings can help explain why the request was rejected.
Array item
The warning code.
The warning description.
Typically this property contains the raw X12 EDI 271 Eligibility Benefit Response from the payer.
In some circumstances, this property may contain a 999 Implementation Acknowledgment instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values.
If this property contains a 999, many of the other response properties will be empty, as Stedi populates them with information from the 271.
curl --request POST \ --url "https://healthcare.us.stedi.com/2024-04-01/eligibility-check" \ --header "Authorization: <api_key>" \ --header "Content-Type: application/json" \ --data '{ "encounter": { "services": [ { "system": "STC", "value": "30" } ] }, "payerId": "61101", "provider": { "name": { "organization": "Provider Name" }, "npi": "1999999984" }, "subscriber": { "dateOfBirth": "1975-05-05", "memberId": "HUMANA123", "name": { "person": { "firstName": "Jane", "lastName": "Doe" } } } }'{
"eligibilitySearchId": "01a06d4a-a0fa-77d2-8b49-caa0546ed292",
"id": "ec_01a06d4a-a0fa-77d2-8b49-ca9a74c9888a",
"meta": {
"outboundTraceId": "01M1PMN87VXMME0ZV6SHJP3B9V",
"subscriberTraceNumbers": [
{
"originatingCompanyIdentifier": "0101010101",
"referenceIdentification": "000011112222333",
"type": "CURRENT_TRANSACTION"
}
],
"traceId": "01M1PMN87VXMME0ZV6SHJP3B9V"
},
"payer": {
"identification": "61101",
"name": {
"organization": "HUMANA"
},
"type": "PAYER"
},
"payerId": "61101",
"plans": [
{
"benefits": {
"benefitDisclaimer": [
{
"coverageLevel": "INDIVIDUAL",
"messages": [
"THIS IS ONLY AN ESTIMATION OF BENEFITS, AND ALL PAYMENTS ARE SUBJECT TO POLICY GUIDELINES, MEDICAL NECESSITY, AND MEMBER ELIGIBILITY AT THE TIME SERVICES ARE PERFORMED."
],
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
}
}
],
"coInsurance": [
{
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"INPATIENT HOSPITAL ROOM AND BOARD"
],
"network": {
"indicator": "IN_NETWORK"
},
"percent": "0",
"service": {
"definition": "Hospital - Room and Board",
"system": "STC",
"value": "49"
},
"timePeriod": "ADMISSION"
}
],
"coPayment": [
{
"amount": "2000",
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"INPATIENT HOSPITAL ROOM AND BOARD"
],
"network": {
"indicator": "IN_NETWORK"
},
"service": {
"definition": "Hospital - Room and Board",
"system": "STC",
"value": "49"
},
"timePeriod": "ADMISSION"
},
{
"amount": "100",
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"ER"
],
"network": {
"indicator": "IN_NETWORK"
},
"service": {
"definition": "Emergency Services",
"system": "STC",
"value": "86"
},
"timePeriod": "EPISODE"
}
],
"deductible": [
{
"amount": "0",
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"INPATIENT HOSPITAL ROOM AND BOARD"
],
"network": {
"indicator": "IN_NETWORK"
},
"service": {
"definition": "Hospital - Room and Board",
"system": "STC",
"value": "49"
}
}
],
"limitations": [
{
"coverageLevel": "INDIVIDUAL",
"messages": [
"MAX DEPENDENT AGE"
],
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
},
"quantity": {
"qualifier": "YEARS",
"value": "26"
},
"service": {
"definition": "Health Benefit Plan Coverage",
"system": "STC",
"value": "30"
}
}
],
"nonCovered": [
{
"amount": "0",
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"VIEW CONTRACT FOR COVERAGE DETAILS"
],
"network": {
"indicator": "IN_NETWORK"
},
"service": {
"definition": "Dental Care",
"system": "STC",
"value": "35"
}
}
],
"otherSourceOfData": [
{
"coverageLevel": "INDIVIDUAL",
"messages": [
"NO DESCRIPTION PROVIDED"
],
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
}
}
],
"outOfPocket": [
{
"amount": "8000",
"coverageLevel": "INDIVIDUAL",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"network": {
"indicator": "IN_NETWORK"
},
"service": {
"definition": "Health Benefit Plan Coverage",
"system": "STC",
"value": "30"
},
"timePeriod": "CALENDAR_YEAR"
}
],
"primaryCareProvider": [
{
"coverageLevel": "INDIVIDUAL",
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
},
"relatedEntities": [
{
"address": {
"addressLine1": "202 Main St",
"city": "Tulsa",
"postalCode": "74008",
"state": "OK"
},
"contacts": [
{
"phoneNumbers": [
"9999999999"
]
}
],
"name": {
"person": {
"firstName": "Dough",
"lastName": "John"
}
},
"type": "PRIMARY_CARE_PROVIDER"
}
]
}
],
"statuses": [
{
"coverageLevel": "EMPLOYEE_ONLY",
"insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
"messages": [
"000 111",
"Medicare PPO",
"Member cannot be balanced billed for medical copayments, coinsurance or deductibles on this Plan. Member is cost-share protected by the state Medicaid. In WA if Medicaid is not cost-share protecting members, Humana will process the claim paying member cost share.",
"THIS MEMBER MAY BE ELIGIBLE FOR A FREE FITNESS MEMBERSHIP."
],
"network": {
"indicator": "IN_AND_OUT_OF_NETWORK"
},
"planCoverageDescription": "Humana Gold Plan",
"service": {
"definition": "Health Benefit Plan Coverage",
"system": "STC",
"value": "30"
},
"status": "ACTIVE_COVERAGE"
}
]
}
}
],
"provider": {
"name": {
"organization": "MEDICAL PROVIDER"
},
"npi": "1999999984",
"type": "PROVIDER"
},
"subscriber": {
"additionalInformation": {
"group": {
"name": "HUMANA INSURANCE COMPANY",
"number": "11223344"
},
"mbi": "1A22BB3CC44"
},
"address": {
"addressLine1": "101 MAIN ST",
"city": "ATLANTA",
"postalCode": "303010001",
"state": "GA"
},
"dateOfBirth": "1975-05-05",
"dates": {
"plan": {
"start": "2024-01-01"
},
"service": {
"start": "2024-09-17"
}
},
"gender": "FEMALE",
"memberId": "HUMANA123",
"name": {
"person": {
"firstName": "JANE",
"lastName": "DOE",
"middleName": "L"
}
}
},
"x12": "ISA*00* *00* *ZZ*STEDI *01*117151744 *260904*1640*^*00501*263887373*0*T*`~GS*HB*STEDI*117151744*20260904*164002*1*X*005010X279A1~ST*271*0001*005010X279A1~BHT*0022*11*01M1PMN87VXMME0ZV6SHJP3B9V*20260325*0901~HL*1**20*1~NM1*PR*2*HUMANA*****PI*61101~HL*2*1*21*1~NM1*1P*2*MEDICAL PROVIDER*****XX*1999999984~HL*3*2*22*0~TRN*1*000011112222333*0101010101~NM1*IL*1*DOE*JANE*L***MI*HUMANA123~REF*6P*11223344~REF*6P*11223344*HUMANA INSURANCE COMPANY~REF*F6*1A22BB3CC44~N3*101 MAIN ST~N4*ATLANTA*GA*303010001~DMG*D8*19750505*F~DTP*346*D8*20240101~DTP*472*D8*20240917~EB*1*EMP*30*PR*Humana Gold Plan*******W~MSG*000 111~MSG*Medicare PPO~MSG*Member cannot be balanced billed for medical copayments, coinsurance or deductibles on this Plan. Member is cost-share protected by the state Medicaid. In WA if Medicaid is not cost-share protecting members, Humana will process the claim paying member cost share.~MSG*THIS MEMBER MAY BE ELIGIBLE FOR A FREE FITNESS MEMBERSHIP.~EB*L***********W~LS*2120~NM1*P3*1*John*Dough~N3*202 Main St~N4*Tulsa*OK*74008~PER*IC**TE*9999999999~LE*2120~EB*F**30******YY*26**W~MSG*MAX DEPENDENT AGE~EB*F**30******YY*31**W~MSG*MAX STUDENT AGE~EB*L****AFFILIATION/CENTER*******W~LS*2120~NM1*GW*2*OK EMP PPO*****PI*34343434~LE*2120~EB*W***********W~MSG*NO DESCRIPTION PROVIDED~EB*1**1^54^33^98^88^UC^47^50^AL^MH^35^86^48*********W~EB*1*IND*1*PR***0*****Y~EB*A*IND*49*PR**36**0****Y~MSG*INPATIENT HOSPITAL ROOM AND BOARD~EB*B*IND*49*PR**36*2000*****Y~MSG*INPATIENT HOSPITAL ROOM AND BOARD~EB*C*IND*49*PR***0*****Y~MSG*INPATIENT HOSPITAL ROOM AND BOARD~EB*A*IND*48*PR**23**0****Y~MSG*INPATIENT HOSPITAL~EB*C*IND*48*PR***0*****Y~MSG*INPATIENT HOSPITAL~EB*A*IND*86*PR**23**0****Y~MSG*ER~EB*B*IND*86*PR**26*100*****Y~MSG*ER~EB*A*IND*86*PR**23**0****Y~MSG*ANESTHESIA~EB*B*IND*86*PR**26*100*****Y~MSG*ANESTHESIA~EB*C*IND*86*PR***0*****Y~MSG*ER~EB*C*IND*86*PR***0*****Y~MSG*ANESTHESIA~EB*I*IND*35*PR***0*****Y~MSG*VIEW CONTRACT FOR COVERAGE DETAILS~EB*A*IND*MH^98*PR**23**0****Y~MSG*TELEHEALTH VISIT PCP~III*ZZ*10~EB*A*IND*MH*PR**23**0****Y~MSG*TELEHEALTH VISIT SPECIALIST~III*ZZ*10~EB*C*IND*MH^98*PR***0*****Y~MSG*TELEHEALTH VISIT PCP~III*ZZ*10~EB*C*IND*MH^98*PR***0*****Y~MSG*TELEHEALTH VISIT SPECIALIST~III*ZZ*10~EB*1*IND*MH*PR***0*****Y~MSG*PHYSICIAN OFFICE VISIT SPECIALIST~EB*A*IND*AL*PR**23**0****Y~MSG*ROUTINE VISION EXAM~EB*F*IND*AL*PR**23*40*****Y~MSG*ROUTINE VISION EXAM~EB*C*IND*AL*PR***0*****Y~MSG*ROUTINE VISION EXAM~EB*A*IND*50*PR****.2****Y~MSG*OUTPATIENT HOSPITAL SURGERY~EB*A*IND*50*PR****.2****Y~MSG*OUTPATIENT HOSPITAL ANESTHESIA~EB*A*IND*50*PR****.2****Y~MSG*OUTPATIENT HOSPITAL MRI SCAN~EB*A*IND*50*PR****.2****Y~MSG*OUTPATIENT HOSPITAL CAT SCAN~EB*C*IND*50*PR***250*****Y~MSG*OUTPATIENT HOSPITAL SURGERY~EB*C*IND*50*PR***250*****Y~MSG*OUTPATIENT HOSPITAL ANESTHESIA~EB*C*IND*50*PR***250*****Y~MSG*OUTPATIENT HOSPITAL MRI SCAN~EB*C*IND*50*PR***250*****Y~MSG*OUTPATIENT HOSPITAL CAT SCAN~EB*1*IND*47*PR***0*****Y~MSG*INPATIENT HOSPITAL~EB*A*IND*UC*PR****.2****Y~MSG*PHYSICIAN OFFICE URGENT CARE~EB*A*IND*UC*PR****.2****Y~MSG*PHYSICIAN OFFICE PREFERRED URGENT CARE~EB*A*IND*UC*PR****.2****Y~MSG*TELEHEALTH URGENT CARE~EB*C*IND*UC*PR***0*****Y~MSG*PHYSICIAN OFFICE URGENT CARE~EB*C*IND*UC*PR***0*****Y~MSG*PHYSICIAN OFFICE PREFERRED URGENT CARE~EB*C*IND*UC*PR***0*****Y~MSG*TELEHEALTH URGENT CARE~EB*C**88****550*****Y~EB*C**88****0*****Y~EB*B**88****35*****Y~MSG*LEVEL 3~EB*B**88****35*****Y~EB*A*IND*98*PR****.2****Y~MSG*PHYSICIAN OFFICE VISIT PCP~EB*A*IND*98*PR****.2****Y~MSG*PHYSICIAN OFFICE VISIT SPECIALIST~EB*A*IND*98*PR****.2****Y~MSG*PHYSICIAN OFFICE VISIT FREESTANDING RAD CTR~EB*A*IND*98*PR****.2****Y~MSG*PHYSICIAN OFFICE VISIT COMP OUTPT REHAB FACILITY~EB*B*IND*98*PR**23*0*****Y~MSG*TELEHEALTH VISIT PCP~III*ZZ*10~EB*F*IND*98*PR**23**1****Y~MSG*TELEHEALTH VISIT PCP~III*ZZ*10~EB*A*IND*98*PR****.2****Y~MSG*TELEHEALTH VISIT SPECIALIST~III*ZZ*10~EB*C*IND*98*PR***250*****Y~MSG*PHYSICIAN OFFICE VISIT PCP~EB*C*IND*98*PR***250*****Y~MSG*PHYSICIAN OFFICE VISIT SPECIALIST~EB*C*IND*98*PR***250*****Y~MSG*PHYSICIAN OFFICE VISIT FREESTANDING RAD CTR~EB*C*IND*98*PR***250*****Y~MSG*PHYSICIAN OFFICE VISIT COMP OUTPT REHAB FACILITY~EB*I*IND*98*PR***0*****Y~MSG*PHYSICIAN OFFICE DOCTOR ON DEMAND NOT COVERED~EB*A*IND*33*PR****.2****Y~MSG*MEDICARE COVERED MANIPULATIONS~EB*I*IND*33*PR***0*****Y~MSG*MANIPULATIONS~EB*I*IND*33*PR***0*****Y~MSG*RADIOLOGY~EB*C*IND*33*PR***250*****Y~MSG*MEDICARE COVERED MANIPULATIONS~EB*C*IND*30*PR**23*250*****Y~MSG*SEE EXACT BENEFIT TO VERIFY IF DEDUCTIBLE APPLIES~EB*G*IND*30*PR**23*8000*****Y~EB*G*IND*30***24*200*****W~EB*G*IND*30***29*8500*****W~EB*G*IND*30***24*200*****Y~EB*G*IND*30***29*4000*****Y~EB*F*IND*30***24*30000*****W~EB*F*IND*30***29*9000000*****W~EB*C*IND*30***24*250*****W~EB*C*IND*30***29*0*****W~EB*F*IND*30***24*10000*****W~EB*F*IND*30***29*9000000*****W~EB*G*IND*30***24*400*****W~EB*G*IND*30***29*12000*****W~EB*G*IND*30***24*400*****Y~EB*G*IND*30***29*7500*****Y~EB*P***********W~MSG*THIS IS ONLY AN ESTIMATION OF BENEFITS, AND ALL PAYMENTS ARE SUBJECT TO POLICY GUIDELINES, MEDICAL NECESSITY, AND MEMBER ELIGIBILITY AT THE TIME SERVICES ARE PERFORMED.~SE*175*0001~GE*1*1~IEA*1*263887373~"
}