API ReferencePre EncounterEligibility Checks

Mocking Eligibility Checks

In our Staging/Sandbox environment, we connect to Stedi’s Test API to run eligibility checks.

We have created a set of mock requests that can be used to verify the behavior of the system. These requests are based on Stedi’s Test API own mock request documentation and are designed to cover various scenarios.

To get a mock eligibility check response, you can use the following request body:

Aetna with dependent
1{
2  "payer_id": "60054",
3  "provider": {
4    "organization_name": "Provider Name",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "John",
9    "last_name": "Doe",
10    "member_id": "AETNA9wcSu",
11    "date_of_birth": "2000-01-01"
12  },
13  "dependent": {
14    "first_name": "Jordan",
15    "last_name": "Doe",
16    "date_of_birth": "2001-07-14"
17  },
18  "encounter": {
19    "service_type_codes": [
20      "30"
21    ]
22  }
23}
Aetna with subscriber only
1{
2  "payer_id": "60054",
3  "provider": {
4    "organization_name": "Provider Name",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "Jane",
9    "last_name": "Doe",
10    "date_of_birth": "2004-04-04",
11    "member_id": "AETNA12345"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 42 payer unreachable
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "Jane",
9    "last_name": "Doe",
10    "date_of_birth": "2001-01-01",
11    "member_id": "UHCAAA42"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 43 invalid missing provider id
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "Jane",
9    "last_name": "Doe",
10    "date_of_birth": "1970-01-01",
11    "member_id": "UHCAAA43"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 72 invalid missing subscriber insured id
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "John",
9    "last_name": "Doe",
10    "date_of_birth": "1990-01-01",
11    "member_id": "UHCAAA72"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 73 invalid missing subscriber insured name
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "John",
9    "last_name": "Doe",
10    "date_of_birth": "1990-01-01",
11    "member_id": "UHCAAA73"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 75 subscriber insured not found
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "Jane",
9    "last_name": "Doe",
10    "date_of_birth": "1990-01-01",
11    "member_id": "UHCAAA75"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}
Aaa 79 invalid participant id
1{
2  "payer_id": "87726",
3  "provider": {
4    "organization_name": "Medical Provider",
5    "npi": "1999999984"
6  },
7  "subscriber": {
8    "first_name": "John",
9    "last_name": "Doe",
10    "date_of_birth": "1970-01-01",
11    "member_id": "UHCAAA79"
12  },
13  "encounter": {
14    "service_type_codes": [
15      "30"
16    ]
17  }
18}