Batch Eligibility Check

Submit multiple eligibility checks for Stedi to process asynchronously

POST/eligibility-manager/batch-eligibility

You may want to periodically conduct asynchronous batch eligibility checks for your entire patient population or a subset of patients, such as those who have active care plans or who have future services scheduled. These data refreshes allow you to proactively reach out to patients when they lose or change coverage.

  • Call this endpoint with a JSON payload containing one or more eligibility checks. You can submit up to 10,000 individual eligibility checks within a single batch, and you can submit as many batches as you need to process. Use the optional maxRetryHours property to configure the automatic retry period for checks that fail due to payer connectivity issues.
  • The endpoint returns a synchronous response containing a batchId that you can use to retrieve the results of these checks later, using the Poll Batch Eligibility Checks endpoint.
  • Stedi translates each eligibility check included in the request to the X12 270 EDI format and sends it to the appropriate payer.

Visit Batch refresh checks for a complete how-to guide.

Start with real-time checks

Batch checks have a longer feedback cycle than real-time checks because you don’t receive the payer’s response immediately. That’s why we strongly recommend starting with real-time checks when integrating with a new payer or working with eligibility checks for the first time. To perform synchronous eligibility checks, use the Real-Time Eligibility Check endpoint.

Authorization
RequiredHeader

A Stedi API Key for authentication.

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. Visit CMS traceability requirements for details and examples.

Body

application/json
items
Array of ObjectsRequiredItems: 1 - 10000

Each entry in this array represents a single eligibility check. You can submit up to 10,000 eligibility checks in a single request. Warning: If any of the individual checks contain invalid JSON data, such as missing required properties or invalid values, Stedi rejects the entire batch with a 400 status code and returns errors to help you correct the issues.

Array item
controlNumber
items[].controlNumber
StringDeprecatedLength: 9

Stedi generates a control number for each eligibility check, so you don’t need to include this property in your request.

dependents
items[].dependents
Array of ObjectsItems: 1

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 subscriber object instead. This includes member IDs that differ only by a suffix, such as 01, because the patient can still be uniquely identified.
  • Most Medicaid plans don't support dependents, with a few exceptions. Sending this array 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.
Array item
additionalIdentification
items[].dependents[].additionalIdentification
Object

Use this object when you need to provide an additional identification number for the dependent. This is rarely required for standard eligibility checks.

Show attributes
agencyClaimNumber
items[].dependents[].additionalIdentification.agencyClaimNumber
StringLength: 1 - 50

The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer.

contractNumber
items[].dependents[].additionalIdentification.contractNumber
StringLength: 1 - 50

The contract number for an existing contract between the payer and the provider requesting the eligibility check.

healthInsuranceClaimNumber
items[].dependents[].additionalIdentification.healthInsuranceClaimNumber
StringLength: 1 - 50

This property is never used in practice.

identificationCardSerialNumber
items[].dependents[].additionalIdentification.identificationCardSerialNumber
StringLength: 1 - 50

The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card.

insurancePolicyNumber
items[].dependents[].additionalIdentification.insurancePolicyNumber
StringLength: 1 - 50

The insurance policy number.

medicalRecordIdentificationNumber
items[].dependents[].additionalIdentification.medicalRecordIdentificationNumber
StringLength: 1 - 50

The medical record identification number.

memberIdentificationNumber
items[].dependents[].additionalIdentification.memberIdentificationNumber
StringLength: 1 - 50

Not intended for most use cases. Only set this when the property and casualty patient identifier is a member ID that would be used in an 837 claim submission.

If the patient has their own member ID for the health plan, you should identify them in the subscriber object. If the patient doesn't have their own member ID, don't set this property.

patientAccountNumber
items[].dependents[].additionalIdentification.patientAccountNumber
StringLength: 1 - 50

The patient account number.

planNetworkIdentificationNumber
items[].dependents[].additionalIdentification.planNetworkIdentificationNumber
StringLength: 1 - 50

The plan network identification number.

planNumber
items[].dependents[].additionalIdentification.planNumber
StringLength: 1 - 50

The insurance plan number.

policyNumber
items[].dependents[].additionalIdentification.policyNumber
StringLength: 1 - 50

The insurance group or policy number.

address
items[].dependents[].address
Object

Address information for the dependent. The address1 and city properties are required for all standard eligibility checks. We also recommend including state for member identification.

Show attributes
address1
items[].dependents[].address.address1
StringRequiredLength: 1 - 55

The first line of the address.

address2
items[].dependents[].address.address2
StringLength: 1 - 55

The second line of the address.

city
items[].dependents[].address.city
StringRequiredLength: 2 - 30

The city.

countryCode
items[].dependents[].address.countryCode
StringLength: 2

The two-letter country code from Part 1 of ISO 3166.

countrySubDivisionCode
items[].dependents[].address.countrySubDivisionCode
StringLength: 1 - 3

The country subdivision code from Part 2 of ISO 3166.

postalCode
items[].dependents[].address.postalCode
StringLength: 5 - 9

The United States or Canadian postal code, excluding punctuation and blanks.

state
items[].dependents[].address.state
String

The state or province code.

Possible values
NL
PE
NS
NB
QC
beginningCardIssueDate
items[].dependents[].beginningCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the endCardIssueDate property.

beginningPlanIssueDate
items[].dependents[].beginningPlanIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the endPlanIssueDate property.

birthSequenceNumber
items[].dependents[].birthSequenceNumber
StringRegex pattern: ^[0-9]+$Length: 1 - 9

The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date.

dateOfBirth
items[].dependents[].dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

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 will immediately return an error when it's not provided.

eligibilityCategory
items[].dependents[].eligibilityCategory
StringLength: 1 - 50

The eligibility category for the dependent.

endCardIssueDate
items[].dependents[].endCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance card expires. Use when you need to specify a date range. Provide the start of the range in the beginningCardIssueDate property.

endPlanIssueDate
items[].dependents[].endPlanIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the beginningPlanIssueDate property.

firstName
items[].dependents[].firstName
StringLength: 1 - 35

The dependent's first name.

gender
items[].dependents[].gender
String

Code indicating the dependent's gender.

Possible values
M
F
groupNumber
items[].dependents[].groupNumber
StringLength: 1 - 50

The group number for the dependent's insurance plan.

healthCareCodeInformation
items[].dependents[].healthCareCodeInformation
Array of ObjectsItems: 1 - 8

Information about the dependent's health care diagnosis. You can include up to eight entries in this array.

The first array entry must have diagnosisTypeCode set to ABK. All subsequent entries must have diagnosisTypeCode set to ABF.

Array item
diagnosisCode
items[].dependents[].healthCareCodeInformation[].diagnosisCode
StringRequiredRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 30

The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed.

diagnosisTypeCode
items[].dependents[].healthCareCodeInformation[].diagnosisTypeCode
StringRequired

The type of diagnosis code you are providing. You can set to BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, BF- International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or ABF- International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis.

Note that ICD-9 codes are deprecated and should no longer be used in eligibility checks.

Possible values
BK
ABK
BF
ABF
idCard
items[].dependents[].idCard
StringLength: 1 - 50

The dependent's insurance card number.

idCardIssueDate
items[].dependents[].idCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance card was issued. Use to specify a single date.

individualRelationshipCode
items[].dependents[].individualRelationshipCode
String

The dependent's relationship to the subscriber. You can set this to 01 - Spouse, 19 - Child, 34 - Other Adult.

Possible values
01
19
34
issueNumber
items[].dependents[].issueNumber
StringLength: 1 - 50

The issue number for the dependent's insurance policy.

lastName
items[].dependents[].lastName
StringLength: 1 - 60

The dependent's last name. Don't include the dependent's name suffix, such as Jr. or III. Use the designated suffix property instead.

memberId
items[].dependents[].memberId
StringDeprecatedRegex pattern: ^[A-Za-z0-9- ]+$Length: 2 - 80

This shape is deprecated: This property is no longer used.

middleName
items[].dependents[].middleName
StringLength: 1 - 25

The dependent's middle name or middle initial.

planIssueDate
items[].dependents[].planIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the insurance plan begins. Use to specify a single date.

providerCode
items[].dependents[].providerCode
String

Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role.

You can use one of the following: AD - Admitting, AT - Attending, BI - Billing, CO - Consulting, CV - Covering, H - Hospital, HH - Home Health Care, LA - Laboratory, OT - Other Physician, P1 - Pharmacist, P2 - Pharmacy, PC - Primary Care Physician, PE- Performing, R- Rural Health Clinic, RF - Referring, SB - Submitting, SK - Skilled Nursing Facility, SU - Supervising

Possible values
AD
AT
BI
CO
CV
providerIdentifier
items[].dependents[].providerIdentifier
StringRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 50

The provider identifier you specified in the referenceIdentificationQualifier property. For example, the provider's National Provider ID or Federal Taxpayer Identification number. If you set the referenceIdentificationQualifier to PXC, then this property should contain the provider's taxonomy code.

referenceIdentificationQualifier
items[].dependents[].referenceIdentificationQualifier
String

The type of providerIdentifier you are using. Use for providers that are not requesting the eligibility check, such as the referring provider.

  • Set to HPI when the National Provider ID is mandated for use.
  • Set to PXC if you're identifying a type of specialty associated with services provided to the dependent.

Otherwise, you can set to the following: 9K - Servicer, D3 - National Council for Prescription Drug Programs Pharmacy Number, EI - Employer's Identification Number, HPI - Centers for Medicare and Medicaid Services National Provider Identifier, PXC - Health Care Provider Taxonomy Code, SY - Social Security Number, TJ - Federal Taxpayer's Identification Number

Possible values
9K
D3
EI
HPI
PXC
ssn
items[].dependents[].ssn
StringRegex pattern: ^\d{9}$

The dependent's social security number. Don't use this for Federally-administered programs, such as Medicare.

suffix
items[].dependents[].suffix
StringLength: 1 - 10

The dependent's name suffix, such as Sr. or III. Only include the dependent's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.

eligibilitySearchId
items[].eligibilitySearchId
String

An identifier that allows Stedi to group eligibility checks for the same patient into a unified record within Eligibility Manager called an eligibility search.

This property is for use by Stedi tools only, such as Stedi's MCP server.

encounter
items[].encounter
Object

Details about the eligibility or benefit information you are requesting for the patient.

  • If you don't specify either serviceTypeCodes or a procedureCode and productOrServiceIDQualifier, Stedi defaults to using 30 (Plan coverage and general benefits) as the only serviceTypeCodes value.
  • You can specify either a single dateOfService or a beginningDateOfService and endDateOfService. The payer defaults to using the current date in their timezone if you don't include one.
  • When checking eligibility for today, omit the dateOfService property 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.
Show attributes
beginningDateOfService
items[].encounter.beginningDateOfService
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The beginning date of service. If you include this value, you must also include the endDateOfService.

dateOfService
items[].encounter.dateOfService
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date of service. You can use this value to specify a single occasion, such as a doctor's visit. If you don't specify a service date (either a single day or a range of dates), the payer defaults to using the current date in their timezone.

diagnosisCodePointer
items[].encounter.diagnosisCodePointer
Array of StringsItems: 1 - 4

Diagnosis code pointers in order of importance to the service. These pointers are an index to the ICD-10 codes you included in the subscriber.healthCareCodeInformation or dependents.healthCareCodeInformation object arrays. The pointer values can be from 1 - 8 (integer numbers). If you are including diagnosis codes, you must set at least one pointer here for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total). Don't put ICD-10 codes here.

endDateOfService
items[].encounter.endDateOfService
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The end date of service. If you include this value, you must also include the beginningDateOfService.

industryCode
items[].encounter.industryCode
String

The type of facility where the service was provided. You can set this to one of the place of service codes.

Possible values
01
02
03
04
05
medicalProcedures
items[].encounter.medicalProcedures
Array of ObjectsItems: 1 - 98

Use only when you need to send multiple procedure codes in a single request. Otherwise, use the encounter.procedureCode and encounter.productOrServiceIDQualifier properties.

Array item
diagnosisCodePointer
items[].encounter.medicalProcedures[].diagnosisCodePointer
Array of StringsItems: 1 - 4

The diagnosis code pointer.

procedureCode
items[].encounter.medicalProcedures[].procedureCode
StringRequiredLength: 1 - 48

The procedure code.

procedureModifiers
items[].encounter.medicalProcedures[].procedureModifiers
Array of StringsItems: 1 - 4

Procedure modifiers that provide additional information related to the service.

productOrServiceIDQualifier
items[].encounter.medicalProcedures[].productOrServiceIDQualifier
StringRequired

Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, CJ - Current Procedural Terminology (CPT) Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ID - International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, N4 - National Drug Code in 5-4-2 Format, or ZZ - Mutually Defined.

Possible values
AD
CJ
HC
ID
IV
priorAuthorizationOrReferralNumber
items[].encounter.priorAuthorizationOrReferralNumber
String

The prior authorization or referral number for a particular benefit or procedure.

procedureCode
items[].encounter.procedureCode
StringLength: 1 - 48

The procedure code.

procedureModifiers
items[].encounter.procedureModifiers
Array of StringsItems: 1 - 4

The procedure modifier that provides additional information related to the performance of the service.

productOrServiceIDQualifier
items[].encounter.productOrServiceIDQualifier
String

Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, CJ - Current Procedural Terminology (CPT) Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ID - International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, N4 - National Drug Code in 5-4-2 Format, or ZZ - Mutually Defined.

Possible values
AD
CJ
HC
ID
IV
referenceIdentificationQualifier
items[].encounter.referenceIdentificationQualifier
String

The type of information you provided in the priorAuthorizationOrReferralNumber property. You can set this to 9F - Referral Number or G1 - Prior Authorization Number.

Possible values
9F
G1
serviceTypeCodes
items[].encounter.serviceTypeCodes
Array of StringsItems: 1 - 99

One or more codes classifying the type of services for which you want to receive benefits information.

If you don't specify a service type code or a procedureCode and productOrServiceIDQualifier, Stedi defaults to using 30 - Health Benefit Plan Coverage. Visit Service Type Codes for a complete list.

Not all payers support all service type codes, and not all payers support multiple service type codes in the same request. We recommend including one service type code per request unless you're sure the payer supports multiple.

Payers aren't required to respond with exactly the same STC(s) in the response, so you may receive benefits information for STCs you didn't request. However, receiving different STCs can mean that the payer is ignoring the STC you sent, which is why we recommend testing payers to determine their support for specific STCs.

Possible values
1
2
3
4
5
externalPatientId
items[].externalPatientId
StringMax length: 36

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.

informationReceiverName
items[].informationReceiverName
ObjectDeprecated

Use the corresponding properties in the provider object instead.

Show attributes
address
items[].informationReceiverName.address
ObjectDeprecated

Address information for the provider.

  • 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.
  • You must include at least the address1 and city properties.
Show attributes
address1
items[].informationReceiverName.address.address1
StringRequiredLength: 1 - 55

The first line of the address.

address2
items[].informationReceiverName.address.address2
StringLength: 1 - 55

The second line of the address.

city
items[].informationReceiverName.address.city
StringRequiredLength: 2 - 30

The city.

countryCode
items[].informationReceiverName.address.countryCode
StringLength: 2

The two-letter country code from Part 1 of ISO 3166.

countrySubDivisionCode
items[].informationReceiverName.address.countrySubDivisionCode
StringLength: 1 - 3

The country subdivision code from Part 2 of ISO 3166.

postalCode
items[].informationReceiverName.address.postalCode
StringLength: 5 - 9

The United States or Canadian postal code, excluding punctuation and blanks.

state
items[].informationReceiverName.address.state
String

The state or province code.

Possible values
NL
PE
NS
NB
QC
contactNumber
items[].informationReceiverName.contactNumber
StringDeprecatedLength: 1 - 50
contractNumber
items[].informationReceiverName.contractNumber
StringDeprecatedLength: 1 - 50
devicePinNumber
items[].informationReceiverName.devicePinNumber
StringDeprecatedLength: 1 - 50
facilityIdNumber
items[].informationReceiverName.facilityIdNumber
StringDeprecatedLength: 1 - 50
facilityNetworkIdNumber
items[].informationReceiverName.facilityNetworkIdNumber
StringDeprecatedLength: 1 - 50
federalTaxpayerIdentificationNumber
items[].informationReceiverName.federalTaxpayerIdentificationNumber
StringDeprecatedLength: 1 - 50
informationReceiverAdditionalIdentifierState
items[].informationReceiverName.informationReceiverAdditionalIdentifierState
StringDeprecatedLength: 1 - 80
medicaidProviderNumber
items[].informationReceiverName.medicaidProviderNumber
StringDeprecatedLength: 1 - 50

The provider's Medicaid provider number.

medicareProviderNumber
items[].informationReceiverName.medicareProviderNumber
StringDeprecatedLength: 1 - 50
nationalProviderIdentifier
items[].informationReceiverName.nationalProviderIdentifier
StringDeprecatedLength: 1 - 50
priorIdentifierNumber
items[].informationReceiverName.priorIdentifierNumber
StringDeprecatedLength: 1 - 50
providerPlanNetworkIdNumber
items[].informationReceiverName.providerPlanNetworkIdNumber
StringDeprecatedLength: 1 - 50
socialSecurityNumber
items[].informationReceiverName.socialSecurityNumber
StringDeprecatedLength: 1 - 50
stateLicenceNumber
items[].informationReceiverName.stateLicenceNumber
StringDeprecatedLength: 1 - 50
submitterIdNumber
items[].informationReceiverName.submitterIdNumber
StringDeprecatedLength: 1 - 50
portalPassword
items[].portalPassword
StringLength: 1 - 50

The password that the provider uses to log in to the payer's portal. This is not commonly used.

portalUsername
items[].portalUsername
StringLength: 1 - 50

The username that the provider uses to log in to the payer's portal. This is not commonly used.

provider
items[].provider
ObjectRequired

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 organizationName (if the entity is an organization), or firstName and lastName (if the provider is an individual).
  • 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 their taxId or ssn.
  • Don't include additional properties, such as taxId or address, unless they are specifically required or suggested by the payer.
Show attributes
address
items[].provider.address
Object

Address information for the provider.

  • 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.
  • You must include at least the address1 and city properties.
Show attributes
address1
items[].provider.address.address1
StringRequiredLength: 1 - 55

The first line of the address.

address2
items[].provider.address.address2
StringLength: 1 - 55

The second line of the address.

city
items[].provider.address.city
StringRequiredLength: 2 - 30

The city.

countryCode
items[].provider.address.countryCode
StringLength: 2

The two-letter country code from Part 1 of ISO 3166.

countrySubDivisionCode
items[].provider.address.countrySubDivisionCode
StringLength: 1 - 3

The country subdivision code from Part 2 of ISO 3166.

postalCode
items[].provider.address.postalCode
StringLength: 5 - 9

The United States or Canadian postal code, excluding punctuation and blanks.

state
items[].provider.address.state
String

The state or province code.

Possible values
NL
PE
NS
NB
QC
contactNumber
items[].provider.contactNumber
StringDeprecatedLength: 1 - 50

The provider's contract number. Only include when required by a payer. This shape is deprecated: Use contractNumber instead.

contractNumber
items[].provider.contractNumber
StringLength: 1 - 50

The provider's contract number. Only include when required by a payer.

devicePinNumber
items[].provider.devicePinNumber
StringLength: 1 - 50

The provider's electronic device pin number. Only include when required by a payer.

employersId
items[].provider.employersId
StringDeprecatedLength: 2 - 80

Deprecated; The submitter's Employer's Identification Number (EIN). Only use when an employer is checking the eligibility and benefits of their employees. This shape is deprecated: This property is no longer used.

facilityIdNumber
items[].provider.facilityIdNumber
StringLength: 1 - 50

The ID number for the provider's facility. Only include when required by a payer.

facilityNetworkIdNumber
items[].provider.facilityNetworkIdNumber
StringLength: 1 - 50

The provider's facility network identification number. Only include when required by a payer.

firstName
items[].provider.firstName
StringLength: 1 - 35

The provider's first name. This property is required if the provider is an individual.

informationReceiverAdditionalIdentifierState
items[].provider.informationReceiverAdditionalIdentifierState
StringLength: 1 - 80

The two-character state ID of the state that assigned the stateLicenseNumber. Only include when required by a payer.

lastName
items[].provider.lastName
StringLength: 1 - 60

The provider's last name. This property is required if the provider is an individual.

medicaidProviderNumber
items[].provider.medicaidProviderNumber
StringLength: 1 - 50

The provider's Medicaid provider number. Only include when required by a payer.

medicareProviderNumber
items[].provider.medicareProviderNumber
StringLength: 1 - 50

The provider's Medicare provider number. Only include when required by a payer.

npi
items[].provider.npi
StringRegex pattern: ^\d{10}$

The provider's National Provider Identifier (NPI). This identifier is required for all healthcare providers who are eligible to receive an NPI. Some non-traditional providers such as transportation services, durable medical equipment (DME) suppliers, or alternative medicine practitioners are not eligible to receive an NPI. If the provider doesn't have an NPI, requests with alternate IDs are virtually never supported. 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 taxId or ssn instead.

organizationName
items[].provider.organizationName
StringLength: 1 - 60

The provider's business name. This property is required if the provider is not an individual.

payorId
items[].provider.payorId
StringLength: 2 - 80

Only used for payer-to-payer transactions, which are not currently supported. Do not use.

pharmacyProcessorNumber
items[].provider.pharmacyProcessorNumber
StringLength: 2 - 80

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.

priorIdentifierNumber
items[].provider.priorIdentifierNumber
StringLength: 1 - 50

The provider's prior identifier number. Only include when required by a payer.

providerCode
items[].provider.providerCode
String

Communicate the provider's role in the type of benefits specified in the request. Visit Eligibility code lists for a complete list. Only include when required by a payer.

Possible values
AD
AT
BI
CO
CV
providerPlanNetworkIdNumber
items[].provider.providerPlanNetworkIdNumber
StringLength: 1 - 50

The provider's plan network identification number. Only include when required by a payer.

providerType
items[].provider.providerType
String

Identify the type of provider.

Possible values
payer
third-party administrator
employer
hospital
facility
referenceIdentification
items[].provider.referenceIdentification
String

The provider's Taxonomy Code. Only used when the provider's taxonomy code is relevant to the eligibility/benefit inquiry. For example, an institutional provider such as a hospital may need to use a taxonomy code to specify a specific unit or department.

serviceProviderNumber
items[].provider.serviceProviderNumber
StringLength: 2 - 80

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.

servicesPlanID
items[].provider.servicesPlanID
StringDeprecatedLength: 2 - 80
ssn
items[].provider.ssn
StringRegex pattern: ^\d{9}$

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.taxId instead of this field. - Don't use this for Federally-administered programs, such as Medicare.

stateLicenceNumber
items[].provider.stateLicenceNumber
StringLength: 1 - 50

The provider's state license number. If you include this information, you must also include the informationReceiverAdditionalIdentifierState. Only include when required by a payer.

submitterIdNumber
items[].provider.submitterIdNumber
StringLength: 1 - 50

The provider's submitter identification number. Only include when required by a payer.

taxId
items[].provider.taxId
StringRegex pattern: ^\d{9}$

The provider's Federal Taxpayer Identification Number. This is typically the provider's EIN (Employer Identification Number), but the provider's SSN may be used if the provider does not have an EIN. Only include if required by the payer.

submitterTransactionIdentifier
items[].submitterTransactionIdentifier
StringRequired

A unique identifier for the eligibility check within this batch request. Stedi returns this identifier in the response for the Poll Batch Eligibility Checks endpoint.

subscriber
items[].subscriber
ObjectRequired

The 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 dependents empty.

  • At a minimum, our API requires that you supply at least one of these fields in the request: memberId, dateOfBirth, or 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, firstName, and lastName, payers are required to 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.
Show attributes
additionalIdentification
items[].subscriber.additionalIdentification
Object

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.

Show attributes
agencyClaimNumber
items[].subscriber.additionalIdentification.agencyClaimNumber
StringLength: 1 - 50

The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer.

contractNumber
items[].subscriber.additionalIdentification.contractNumber
StringLength: 1 - 50

The contract number for an existing contract between the payer and the provider requesting the eligibility check.

healthInsuranceClaimNumber
items[].subscriber.additionalIdentification.healthInsuranceClaimNumber
StringLength: 1 - 50

The health insurance claim number.

identificationCardSerialNumber
items[].subscriber.additionalIdentification.identificationCardSerialNumber
StringLength: 1 - 50

The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card.

insurancePolicyNumber
items[].subscriber.additionalIdentification.insurancePolicyNumber
StringLength: 1 - 50

The insurance policy number.

medicalRecordIdentificationNumber
items[].subscriber.additionalIdentification.medicalRecordIdentificationNumber
StringLength: 1 - 50

The medical record identification number.

memberIdentificationNumber
items[].subscriber.additionalIdentification.memberIdentificationNumber
StringLength: 1 - 50

This property is never used in practice. Supply the subscriber's member ID in subscriber.memberId.

patientAccountNumber
items[].subscriber.additionalIdentification.patientAccountNumber
StringLength: 1 - 50

The patient account number.

planNetworkIdentificationNumber
items[].subscriber.additionalIdentification.planNetworkIdentificationNumber
StringLength: 1 - 50

The plan network identification number.

planNumber
items[].subscriber.additionalIdentification.planNumber
StringLength: 1 - 50

The insurance plan number.

policyNumber
items[].subscriber.additionalIdentification.policyNumber
StringLength: 1 - 50

The insurance group or policy number.

address
items[].subscriber.address
Object

Address information for the subscriber.

  • The address1 and city properties are required for all standard eligibility checks and MBI lookups with SSN. We also recommend including state for member identification.
  • When performing an MBI lookup without SSN (Payer ID: MBILUNOSSN), only state is required. You can omit address1 and city.
Show attributes
address1
items[].subscriber.address.address1
StringLength: 1 - 55

The first line of the address. Required for all payers except payer ID MBILUNOSSN.

address2
items[].subscriber.address.address2
StringLength: 1 - 55

The second line of the address.

city
items[].subscriber.address.city
StringLength: 2 - 30

The city. Required for all payers except payer ID MBILUNOSSN.

countryCode
items[].subscriber.address.countryCode
StringLength: 2

The two-letter country code from Part 1 of ISO 3166.

countrySubDivisionCode
items[].subscriber.address.countrySubDivisionCode
StringLength: 1 - 3

The country subdivision code from Part 2 of ISO 3166.

postalCode
items[].subscriber.address.postalCode
StringLength: 5 - 9

The United States or Canadian postal code, excluding punctuation and blanks.

state
items[].subscriber.address.state
String

The state or province code. Required for payer ID MBILUNOSSN.

Possible values
NL
PE
NS
NB
QC
beginningCardIssueDate
items[].subscriber.beginningCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the endCardIssueDate property.

beginningPlanIssueDate
items[].subscriber.beginningPlanIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the endPlanIssueDate property.

birthSequenceNumber
items[].subscriber.birthSequenceNumber
StringRegex pattern: ^[0-9]$Length: 1 - 9

The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date.

caseNumber
items[].subscriber.caseNumber
StringRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 50

The case number associated with the subscriber.

coverageLevelCode
items[].subscriber.coverageLevelCode
String

This property is no longer used.

dateOfBirth
items[].subscriber.dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The subscriber's date of birth.

endCardIssueDate
items[].subscriber.endCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance card expires. Use when you need to specify a date range. Provide the start of the range in the beginningCardIssueDate property.

endPlanIssueDate
items[].subscriber.endPlanIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the beginningPlanIssueDate property.

firstName
items[].subscriber.firstName
StringLength: 1 - 35

The patient's first name.

gender
items[].subscriber.gender
String

Code indicating the subscriber's gender.

Possible values
M
F
groupNumber
items[].subscriber.groupNumber
StringLength: 1 - 50

The group number associated with the subscriber's insurance policy.

healthCareCodeInformation
items[].subscriber.healthCareCodeInformation
Array of ObjectsItems: 1 - 8

Information about the subscriber's health care diagnosis. You can include up to eight entries in this array.

The first array entry must have diagnosisTypeCode set to ABK. All subsequent entries must have diagnosisTypeCode set to ABF.

Array item
diagnosisCode
items[].subscriber.healthCareCodeInformation[].diagnosisCode
StringRequiredRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 30

The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed.

diagnosisTypeCode
items[].subscriber.healthCareCodeInformation[].diagnosisTypeCode
StringRequired

The type of diagnosis code you are providing. You can set to BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, BF- International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or ABF- International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis.

Note that ICD-9 codes are deprecated and should no longer be used in eligibility checks.

Possible values
BK
ABK
BF
ABF
idCard
items[].subscriber.idCard
StringLength: 1 - 50

The subscriber's identification card number. Include this property when this number is different than the subscriber's member ID. This is common in Medicaid.

idCardIssueDate
items[].subscriber.idCardIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance card was issued. Use to specify a single date.

lastName
items[].subscriber.lastName
StringLength: 1 - 60

The subscriber's last name. Don't include the subscriber's name suffix, such as Jr. or III. Use the designated suffix property instead.

medicaidRecipientIdentificationNumber
items[].subscriber.medicaidRecipientIdentificationNumber
StringRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 50

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). Do not supply this value unless it is different from the memberId.

memberId
items[].subscriber.memberId
StringRegex pattern: ^[A-Za-z0-9- ]+$Length: 2 - 80

The member ID for the subscriber's insurance policy.

middleName
items[].subscriber.middleName
StringLength: 1 - 25

The patient's middle name or middle initial.

planIssueDate
items[].subscriber.planIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the subscriber's insurance plan begins. Use to specify a single date.

providerCode
items[].subscriber.providerCode
String

Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital making an eligibility request, this is where you would specify information about a referring provider's role.

This property is required when the providerIdentifier and referenceIdentificationQualifier properties are populated.

You can use one of the following: AD - Admitting, AT - Attending, BI - Billing, CO - Consulting, CV - Covering, H - Hospital, HH - Home Health Care, LA - Laboratory, OT - Other Physician, P1 - Pharmacist, P2 - Pharmacy, PC - Primary Care Physician, PE - Performing, R - Rural Health Clinic, RF - Referring, SB - Submitting, SK - Skilled Nursing Facility, SU - Supervising

Possible values
AD
AT
BI
CO
CV
providerIdentifier
items[].subscriber.providerIdentifier
StringRegex pattern: ^[A-Za-z0-9]+$Length: 1 - 50

The provider identifier you specified in the referenceIdentificationQualifier property. It is required if you set the referenceIdentificationQualifier. For example, this property could contain the provider's National Provider ID or Federal Taxpayer Identification number.

If you set the referenceIdentificationQualifier to PXC, then this property should contain the provider's taxonomy code.

referenceIdentificationQualifier
items[].subscriber.referenceIdentificationQualifier
String

Use this for providers that are not requesting the eligibility check. This is the type of providerIdentifier you are providing.

  • Set to HPI when the National Provider ID is mandated for use.
  • Set to PXC if you're identifying a type of specialty associated with services provided to the subscriber.

Otherwise, you can set to the following: 9K - Servicer, D3 - National Council for Prescription Drug Programs Pharmacy Number, EI - Employer's Identification Number, HPI - Centers for Medicare and Medicaid Services National Provider Identifier, PXC - Health Care Provider Taxonomy Code, SY - Social Security Number, TJ` - Federal Taxpayer's Identification Number

Possible values
9K
D3
EI
HPI
PXC
spendDownAmount
items[].subscriber.spendDownAmount
StringLength: 1 - 15

Identify the dollar amount the subscriber will apply toward their spend down amount, if required. For some Medicaid programs, individuals must pay a certain amount towards their healthcare cost (spend down) before coverage starts.

spendDownTotalBilledAmount
items[].subscriber.spendDownTotalBilledAmount
StringLength: 1 - 15

The subscriber's spend down total billed amount.

ssn
items[].subscriber.ssn
StringRegex pattern: ^\d{9}$

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.

suffix
items[].subscriber.suffix
StringLength: 1 - 10

The name suffix, such as Jr., Sr., or III. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.

tradingPartnerName
items[].tradingPartnerName
StringLength: 1 - 80

The payer's name, such as Cigna or Aetna.

tradingPartnerServiceId
items[].tradingPartnerServiceId
StringRequiredLength: 1 - 80

This is 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.

maxRetryHours
IntegerRange: ≥ 8 and ≤ 24

The maximum number of hours that Stedi will retry eligibility checks in this batch that fail due to payer connectivity issues. Must be an integer between 8 and 24 hours. If not specified, the default is 8 hours.

name
StringRegex pattern: ^[a-zA-Z0-9-_]{1,100}$

The name that Stedi will use when displaying this batch on the Eligibility check batches page. It must be unique within your Stedi account. If you don't specify a name, Stedi sets this property to the autogenerated batchId returned in the response.

Response

application/json

BatchEligibilityChecks 200 response

batchId
StringRequired

An identifier for this batch of eligibility checks. You can use this identifier to retrieve the results of this batch using the Poll Batch Eligibility Checks endpoint.

submittedAt
StringRequiredFormat: date-time

The date and time that the batch of eligibility checks was submitted to Stedi for processing.