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          • POSTCreate
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          • GETGet Multi
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          • POSTBatch Update Ppg
          • POSTCheck Eligibility
          • GETGet Eligibility
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API ReferencePre EncounterCoveragesV1

Get Eligibility

Beta
GET
/coverages/v1//:id/eligibility/:check_id
GET
/coverages/v1//:id/eligibility/:check_id
$curl https://pre-api.joincandidhealth.com/coverages/v1/d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32/eligibility/check_id \
>     -H "Authorization: Bearer <token>"
200Retrieved
1{
2  "metadata": {
3    "check_id": "check_id",
4    "service_code": "1",
5    "status": "COMPLETED",
6    "initiated_by": "initiated_by",
7    "initiated_at": "2024-01-15T09:30:00Z"
8  },
9  "check": {
10    "response": {
11      "key": "value"
12    },
13    "batch_id": "batch_id",
14    "errors": [
15      {
16        "source": "CANDID",
17        "errorDetails": {
18          "field?": "field?",
19          "description?": "description?",
20          "location?": "location?",
21          "possibleResolutions?": "possibleResolutions?",
22          "code?": "code?",
23          "followupAction?": "followupAction?"
24        }
25      },
26      {
27        "source": "CANDID",
28        "errorDetails": {
29          "field?": "field?",
30          "description?": "description?",
31          "location?": "location?",
32          "possibleResolutions?": "possibleResolutions?",
33          "code?": "code?",
34          "followupAction?": "followupAction?"
35        }
36      }
37    ],
38    "request": {
39      "payer_id": "payer_id",
40      "provider": {
41        "first_name": "first_name",
42        "last_name": "last_name",
43        "npi": "npi"
44      },
45      "subscriber": {
46        "first_name": "first_name",
47        "last_name": "last_name",
48        "member_id": "member_id",
49        "date_of_birth": "2023-01-15"
50      },
51      "submitter_transaction_identifier": "submitter_transaction_identifier",
52      "dependent": {
53        "first_name": "first_name",
54        "last_name": "last_name",
55        "member_id": "member_id",
56        "date_of_birth": "2023-01-15"
57      },
58      "encounter": {
59        "date_of_service": "2023-01-15",
60        "service_type_codes": [
61          "service_type_codes",
62          "service_type_codes"
63        ]
64      },
65      "get_existing_check_initiated_after": "2024-01-15T09:30:00Z",
66      "source": "source",
67      "portal_password": "portal_password",
68      "portal_username": "portal_username"
69    },
70    "parsed_response": {
71      "eligibility_status": "ACTIVE",
72      "plan_metadata": {
73        "payer_name": "payer_name",
74        "insurance_type": "insurance_type",
75        "insurance_type_code": "insurance_type_code",
76        "plan_name": "plan_name",
77        "member_id": "member_id",
78        "group_number": "group_number",
79        "start_date": "2023-01-15",
80        "end_date": "2023-01-15",
81        "plan_dates": [
82          {
83            "start_date": "2023-01-15",
84            "field_name": "field_name"
85          },
86          {
87            "start_date": "2023-01-15",
88            "field_name": "field_name"
89          }
90        ],
91        "subscriber": {
92          "member_id": "member_id",
93          "group_number": "group_number",
94          "first_name": "first_name",
95          "middle_name": "middle_name",
96          "last_name": "last_name",
97          "date_of_birth": "date_of_birth",
98          "gender": "gender",
99          "address": {}
100        },
101        "dependent": {
102          "member_id": "member_id",
103          "group_number": "group_number",
104          "first_name": "first_name",
105          "middle_name": "middle_name",
106          "last_name": "last_name",
107          "date_of_birth": "date_of_birth",
108          "gender": "gender",
109          "address": {}
110        }
111      },
112      "benefits": {
113        "plan_coverage": {
114          "in_network": {},
115          "in_network_flat": [],
116          "out_of_network": {},
117          "out_of_network_flat": []
118        },
119        "service_specific_coverage": [
120          {
121            "service_code": "1"
122          },
123          {
124            "service_code": "1"
125          }
126        ],
127        "benefits_related_entities": [
128          {},
129          {}
130        ],
131        "non_covered_details": [
132          {
133            "type": "DEDUCTIBLE",
134            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
135            "unit": "PERCENT",
136            "value": 1.1
137          },
138          {
139            "type": "DEDUCTIBLE",
140            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
141            "unit": "PERCENT",
142            "value": 1.1
143          }
144        ],
145        "notes": "notes",
146        "autoUpdatedEligibilityCheckId": "autoUpdatedEligibilityCheckId"
147      }
148    },
149    "request_corrections": [
150      {
151        "property": "property",
152        "request_value": "request_value",
153        "corrected_value": "corrected_value"
154      },
155      {
156        "property": "property",
157        "request_value": "request_value",
158        "corrected_value": "corrected_value"
159      }
160    ]
161  }
162}
Gets the eligibility of a patient for a specific coverage if successful.
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Authentication

AuthorizationBearer

OAuth authentication of the form <token>.

Path parameters

idUUIDRequired
The unique identifier for a Coverage in the database
check_idstringRequired

Response

This endpoint returns an object.
metadataobject
checkobject