Coordination Of Benefits

Beta

POST

/eligibility-checks/v1/coordination-of-benefits

POST

/eligibility-checks/v1/coordination-of-benefits

$ curl -X POST https://pre-api.joincandidhealth.com/eligibility-checks/v1/coordination-of-benefits \
>      -H "Authorization: Bearer <token>" \
>      -H "Content-Type: application/json" \
>      -d '{
>   "trading_partner_service_id": "trading_partner_service_id",
>   "provider": {
>     "npi": "npi"
>   },
>   "subscriber": {
>     "first_name": "first_name",
>     "last_name": "last_name",
>     "date_of_birth": "date_of_birth"
>   },
>   "encounter": {}
> }'

200Successful

1 {
2   "provider": {
3     "provider_name": "provider_name",
4     "provider_first_name": "provider_first_name",
5     "provider_org_name": "provider_org_name",
6     "npi": "npi",
7     "aaa_errors": [
8       {
9         "field?": "field?",
10         "description?": "description?",
11         "location?": "location?",
12         "possibleResolutions?": "possibleResolutions?",
13         "code?": "code?",
14         "followupAction?": "followupAction?"
15       },
16       {
17         "field?": "field?",
18         "description?": "description?",
19         "location?": "location?",
20         "possibleResolutions?": "possibleResolutions?",
21         "code?": "code?",
22         "followupAction?": "followupAction?"
23       }
24     ]
25   },
26   "subscriber": {
27     "member_id": "member_id",
28     "first_name": "first_name",
29     "last_name": "last_name",
30     "middle_name": "middle_name",
31     "gender": "gender",
32     "date_of_birth": "date_of_birth",
33     "ssn": "ssn",
34     "group_number": "group_number",
35     "birth_sequence_number": "birth_sequence_number",
36     "address": {
37       "address_1": "address_1",
38       "address_2": "address_2",
39       "city": "city",
40       "state": "state",
41       "postal_code": "postal_code",
42       "country_code": "country_code",
43       "country_sub_division_code": "country_sub_division_code"
44     },
45     "aaa_errors": [
46       {
47         "field?": "field?",
48         "description?": "description?",
49         "location?": "location?",
50         "possibleResolutions?": "possibleResolutions?",
51         "code?": "code?",
52         "followupAction?": "followupAction?"
53       },
54       {
55         "field?": "field?",
56         "description?": "description?",
57         "location?": "location?",
58         "possibleResolutions?": "possibleResolutions?",
59         "code?": "code?",
60         "followupAction?": "followupAction?"
61       }
62     ]
63   },
64   "dependent": {
65     "member_id": "member_id",
66     "first_name": "first_name",
67     "last_name": "last_name",
68     "middle_name": "middle_name",
69     "gender": "gender",
70     "date_of_birth": "date_of_birth",
71     "ssn": "ssn",
72     "group_number": "group_number",
73     "relation_to_subscriber": "relation_to_subscriber",
74     "relation_to_subscriber_code": "relation_to_subscriber_code",
75     "birth_sequence_number": "birth_sequence_number",
76     "address": {
77       "address_1": "address_1",
78       "address_2": "address_2",
79       "city": "city",
80       "state": "state",
81       "postal_code": "postal_code",
82       "country_code": "country_code",
83       "country_sub_division_code": "country_sub_division_code"
84     },
85     "aaa_errors": [
86       {
87         "field?": "field?",
88         "description?": "description?",
89         "location?": "location?",
90         "possibleResolutions?": "possibleResolutions?",
91         "code?": "code?",
92         "followupAction?": "followupAction?"
93       },
94       {
95         "field?": "field?",
96         "description?": "description?",
97         "location?": "location?",
98         "possibleResolutions?": "possibleResolutions?",
99         "code?": "code?",
100         "followupAction?": "followupAction?"
101       }
102     ]
103   },
104   "payer": {
105     "name": "name",
106     "payer_identification": "payer_identification"
107   },
108   "plan_date_information": {
109     "plan_begin": "plan_begin",
110     "plan_end": "plan_end"
111   },
112   "benefits_information": [
113     {
114       "key": "value"
115     },
116     {
117       "key": "value"
118     }
119   ],
120   "errors": [
121     {
122       "field?": "field?",
123       "description?": "description?",
124       "location?": "location?",
125       "possibleResolutions?": "possibleResolutions?",
126       "code?": "code?",
127       "followupAction?": "followupAction?"
128     },
129     {
130       "field?": "field?",
131       "description?": "description?",
132       "location?": "location?",
133       "possibleResolutions?": "possibleResolutions?",
134       "code?": "code?",
135       "followupAction?": "followupAction?"
136     }
137   ],
138   "coordination_of_benefits": {
139     "classification": "classification",
140     "instance_exists": true,
141     "primacy_determined": true,
142     "coverage_overlap": true,
143     "benefit_overlap": true
144   }
145 }

Sends a coordination of benefits check through Stedi to determine whether a patient has coverage overlap across multiple payers and, if so, which payer is primary. Medicare and Medicare Advantage plans are not supported.

Authentication

AuthorizationBearer

OAuth authentication of the form <token>.

Request

This endpoint expects an object.

trading_partner_service_idstringRequired

The Payer ID. Each check must be for a participating health plan for which the patient has coverage. Medicare and Medicare Advantage plans are not supported.

providerobjectRequired

Information about the entity requesting the COB check. Provide either organization_name (for organizations) or first_name and last_name (for individuals), plus npi.

subscriberobjectRequired

The primary policyholder for the insurance plan or a dependent with a unique member ID. You must provide at least one of member_id or ssn.

encounterobjectRequired

Information about the encounter for the COB check. Service dates must be within the past 2 years and must not be in the future.

dependentobjectOptional

A dependent for which you want to check coordination of benefits. If the dependent has their own member ID, include their information in the subscriber object instead.

Response

This endpoint returns an object.

providerobject

Information about the provider who submitted the COB request.

subscriberobject

Information about the primary policyholder.

dependentobject

Information about the dependent listed in the COB request.

payerobject

Information about the payer listed in the COB request.

plan_date_informationobject

Date information for the plan.

benefits_informationlist of any

Raw passthrough of Stedi’s benefits information (coverage, service types, related entities, etc.).

errorslist of objects

coordination_of_benefitsobject

Overview of the COB response including whether coverage overlap exists and payer primacy.