Get token

Auth

Create billing note

Billing Notes

Get contract

Get all contracts

Creates a new contract within the user's current organization

Create contract

Delete contract

Update contract

Contracts

Submit encounter eligibility check

Submit encounter eligibility check (Availity)

Eligibility

Get all encounters

Get encounter

Create encounter

Update encounter

Encounters

Computes the expected network status given the provided information.

Compute network status

Computes the expected network status for a given rendering provider.
This endpoint is not available to all customers. Reach out to the Candid sales team
to discuss enabling this endpoint if it is not available for your organization.

Compute for rendering provider

Computes all the in network providers for a given set of inputs.
This endpoint is not available to all customers. Reach out to the Candid sales team
to discuss enabling this endpoint if it is not available for your organization.

Compute for all in-network providers

Expected Network Status

Get exports

Exports

Gets the rate that matches a service line. No result means no rate exists matching the service line's dimensions.

Get Match

Tests a service line against a rate to see if it matches.

Test Match

Gets a list of dimensions with their rates. The rates returned will always be the most recent versions of those rates.

Get Multi

Gets unique values for a dimension based on other selection criteria. The response is a list of dimensions with your criteria and the unique values populated. This API is useful for driving pivots on dimension values.

Get Unique Values For Dimension

Get Rate History

Uploads a new fee schedule.\n Each rate may either be totally new as qualified by it's dimensions or a new version for an existing rate.\n If adding a new version to an existing rate, the rate must be posted with the next version number (previous version + 1) or a EntityConflictError will be returned.\n Use the dry run flag to discover already existing rates and to run validations. If validations for any rate fail, no rates will be saved to the system.

Upload a fee schedule (a collection of rates)

Soft deletes a rate from the system. Only the most recent version of a rate can be deleted.

Delete a rate

Get Payer Thresholds Default

Gets a list of payers and thresholds by their uuids

Get Payer Thresholds

Sets the threshold information for a payer

Set Payer Threshold

Fee Schedules

Creates a new guarantor and returns the newly created Guarantor object.

Create guarantor

Get guarantor

Update guarantor

Guarantor

Get insurance adjudication

Creates a new insurance adjudication record and returns the newly created InsuranceAdjudication object.

Create insurance adjudication

Delete insurance adjudication

Insurance Adjudications

Returns all non-ERA originated insurance payments satisfying the search criteria

Get insurance payments

Get insurance payment

Create insurance payment

Update

Delete insurance payment

Insurance Payments

Get insurance refunds

Get insurance refund

Create insurance refund

Delete insurance refund

Insurance Refunds

Get organization service facility

Get all organization service facilities

Create organization service facility

Update organization service facility

Delete organization service facility

Organization Service Facilities

Get organization provider

Get all organization providers

Create organization provider

Update organization provider

Organization Providers

Get patient payments

Get patient payment

Creates a new patient payment record and returns the newly created PatientPayment object.
The allocations can describe whether the payment is being applied toward a specific service line,
claim, or billing provider.

Create patient payment

Delete patient payment

Patient Payments

Get patient refunds

Get patient refund

Creates a new patient refund record and returns the newly created PatientRefund object.
The allocations can describe whether the refund is being applied toward a specific service line,
claim, or billing provider.

Create patient refund

Delete patient refund

Patient Refunds

Get payer

Get all payers

Payers

Get task actions

Get all tasks

Get task

Create task

Update task

Tasks

Returns all write-offs satisfying the search criteria.

Get all write-offs

Get write-off

Creates one or many write-offs given a specific set of allocations.
The allocations can describe whether the refund is being applied toward a specific service line,
claim, or billing provider.

Create write-off

Revert write-off

Write Offs

Service Facility

AuthGetTokenRequest

AuthGetTokenResponse

TooManyRequestsErrorType

BillingNote

BillingNoteBase

BillingNoteId

ClaimFrequencyTypeCode

ClaimSubmissionRecordCreate

When the claim was submitted to the payer.

The medium by which the claim was submitted to the payer: paper or electronic.
If omitted, defaults to electronic.

ExternalClaimSubmissionCreate

When the claim was created in the external system.

The Patient Control Number sent on the claim to the payer. To guarantee compatibility with all payers, this field must consist
only of uppercase letters and numbers and be no more than 14 characters long.

A successful claim submission record will be created for each value provided.
An empty list may be provided for cases where the claim originated in an external system but was never submitted to a payer.

Claim

ClaimStatus

ClaimAdjustmentGroupCodes

ClaimId

ClaimSubmissionPayerResponsibilityType

ISO 8601 date; formatted YYYY-MM-DD (i.e. 2012-02-01)

Date

DateRangeOptionalEnd

String representation of a Decimal that can be parsed by most libraries.

Decimal

Code indicating the reason why a request was delayed

DelayReasonCode

Proof of Eligibility Unknown or Unavailable

Delay in Delivery of Custom-made Appliances

Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules

Administration Delay in the Prior Approval Process

Email

EmrPayerCrosswalk

EncounterExternalId

EncounterId

EntityConflictErrorMessage

EntityNotFoundErrorMessage

ErrorMessage

FacilityTypeCode

Psychiatric Facility (Partial Hospitalization)

Intermediate Care Facility/Individuals with Intellectual Disabilities

Residential Substance Abuse Treatment Facility

Non-residential Substance Abuse Treatment Facility

Non-residential Opioid Treatment Facility

Comprehensive Inpatient Rehabilitation Facility

Comprehensive Outpatient Rehabilitation Facility

End Stage Renal Disease Treatment Facility

HttpServiceUnavailableErrorMessage

Code identifying the type of insurance policy within a specific insurance program (X12 008020 Element 1336)

InsuranceTypeCode

Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan

Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan

Medicare Secondary, No-fault Insurance including Auto is Primary

Medicare Secondary Public Health Service (PHS) or Other Federal Agency

Medicare Secondary Veteran's Administration

Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)

Medicare Secondary, Other Liability Insurance is Primary

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Disability - Provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury or disease

Exclusive Provider Organization - Gives subscriber a choice of providers from an approved/contracted payer list; there are fixed dollar co-payments for most covered services in return for using plan providers

Group Policy - Two or more people who are part of complete unit who enter into an insurance contract with an insurance company

Health Maintenance Organization (HMO) - Medicare Risk

Special Low Income Medicare Beneficiary - An individual eligible for Medicare for whom Medicaid pays only Medicare premiums

Indemnity - Gives a subscriber the choice to select any provider. Payment is fixed percentage of the cost for covered care after satisfying an annual deductible

Long Term Care - Coverage designed to help pay for some or all long term care costs, reducing the risk that a policy-holder would need to deplete all of his or her assets to pay for long term care

Medicare Advantage Point of Service (POS) Plan that excludes Part D coverage

Medicaid - Program of health care services made available to medically indigent and other needy persons, regardless of age, under terms of a 1965 amendment to the U.S. Social Security Act

Medicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage

Medicare Advantage Private Fee for Service

Medigap Part A - Health insurance policy intended to cover the non-covered portion of expenses eligible for Medicare Part A reimbursement which must be paid by a Medicare beneficiary for health care services and/or supplies received

Medigap Part B - Health insurance policy intended to cover the non-covered portion of expenses eligible for Medicare Part B reimbursement which must be paid by a Medicare beneficiary for health care services and/or supplies received

Medicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage

Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage

Medicare Advantage Indemnity Plan that includes Part D Coverage

Medicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage

Medicare Advantage Indemnity Plan that excludes Part D coverage

Medicare Advantage Point of Service (POS) Plan that includes Part D Coverage

Medicare Primary - Medicare has the primary responsibility to pay for health care services and/or supplies received by a covered beneficiary (a person entitled to Medicare benefits)

Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage

Medicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage

Qualified Medicare Beneficiary - Coverage for a Medicare eligible individual for whom Medicaid pays only for Medicare premiums, co-insurance, and deductibles

Supplemental Policy - An insurance policy intended to cover non-covered charges of another insurance policy

Tax Equity Fiscal Responsibility Act (TEFRA)

Workers Compensation - Coverage provides medical treatment, rehabilitation, lost wages and related expenses arising from a job related injury or disease

Wrap Up Policy - A Workers Compensation Policy written for a specific job site, which will include or cover more than one insured

The medium (paper or electronic) via which we intended to submit the claim. The clearinghouse to which we sent the claim may use a different medium in certain cases, e.g., if the payer does not support electronic claims.

1	curl -X POST https://api.joincandidhealth.com/api/eligibility/v2 \
2	-H "Authorization: Bearer <token>" \
3	-H "Content-Type: application/json" \
4	-d '{}'

Introduction

API Principles

Additional Resources

API Reference

Submit encounter eligibility check

Request

Response

Errors