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.
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.
Expected place of service
Information present on the patient’s insurance card
The id of the service facility where the appointment will be rendered
Expected date of service