Expected Network StatusV2

Compute for all in-network providers

Beta
POST
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.

Request

This endpoint expects an object.
service_type
enumRequired

For some payers, payer routing depends on whether the rendered service qualifies as a behavioral health visit (e.g. Blue Shield of California routes to Magellan for behavioral health visits).

For post appointment payer routing, Candid uses a CPT code list to determine whether the appointment qualifies as a behavioral health visit (see “Inputs: Service Type” in the appendix for list of qualifying CPT codes and behavioral health routing logic). Since CPT codes are not available pre-appointment, the service type input is used to determine whether the appointment is expected to qualify as behavioral health.

place_of_service_code
enumRequired
Expected place of service
subscriber_information
objectRequired
Information present on the patient's insurance card
patient_address
objectRequired
billing_provider_id
UUIDRequired
organization_service_facility_id
UUIDRequired
The id of the service facility where the appointment will be rendered
date_of_service
dateRequired
Expected date of service

Response

This endpoint returns an object
computed_network_status
union
network_status_check_id
UUID
Unique network status check ID for this request

Errors

POST
1curl -X POST https://api.joincandidhealth.com/api/expected-network-status/v2/compute \
2     -H "Authorization: Bearer <token>" \
3     -H "Content-Type: application/json" \
4     -d '{
5  "service_type": "new_patient_video_appt",
6  "place_of_service_code": "01",
7  "subscriber_information": {
8    "payer_uuid": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
9    "member_id": "string",
10    "insurance_type": {
11      "line_of_business": "medicare",
12      "insurance_type_codes": {
13        "type": "insurance_type_code",
14        "value": "01"
15      }
16    }
17  },
18  "patient_address": {
19    "address1": "string",
20    "city": "string",
21    "state": "AA",
22    "zip_code": "string"
23  },
24  "billing_provider_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
25  "organization_service_facility_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
26  "date_of_service": "2023-01-01"
27}'
1{
2  "computed_network_status": {
3    "type": "rendering_providers",
4    "rendering_providers": [
5      "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
6    ],
7    "routed_billing_provider_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
8    "routed_payer_uuid": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
9  },
10  "network_status_check_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"
11}
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