Compute network status

Beta
POST

Computes the expected network status given the provided information.

Request

This endpoint expects an object.
subscriber_payer_idstringRequired
subscriber_payer_namestringRequired
billing_provider_npistringRequired

The National Provider Identifier (NPI) of the healthcare provider responsible for billing. A unique 10-digit identification number.

billing_provider_tinstringRequired

Follow the 9-digit format of the Taxpayer Identification Number (TIN).

rendering_provider_npistringRequired

The National Provider Identifier (NPI) of the healthcare provider who delivered the services. A unique 10-digit identification number.

contracted_stateenumRequired

The state in which the healthcare provider has a contractual agreement with the insurance payer.

date_of_servicestringRequired

Date formatted as YYYY-MM-DD; eg: 2019-08-25.

external_patient_idstringOptional
subscriber_insurance_typeenumOptional

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

subscriber_plan_namestringOptional

The descriptive name of the insurance plan selected by the subscriber, often indicating coverage specifics or tier.

Response

This endpoint returns an object.
expected_network_statusenum
Allowed values: in_networkout_of_networkunknown

The anticipated classification of a healthcare provider within the insurance plan’s network.

explanationstring
contract_idUUIDOptional