Insurance Discovery

Beta

POST

/eligibility-checks/v1/insurance-discovery

POST

/eligibility-checks/v1/insurance-discovery

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

200Successful

1 {
2   "discovery_id": "discovery_id",
3   "status": "PENDING",
4   "items": [
5     {
6       "key": "value"
7     },
8     {
9       "key": "value"
10     }
11   ],
12   "coverages_found": 1,
13   "errors": [
14     {
15       "field?": "field?",
16       "description?": "description?",
17       "location?": "location?",
18       "possibleResolutions?": "possibleResolutions?",
19       "code?": "code?",
20       "followupAction?": "followupAction?"
21     },
22     {
23       "field?": "field?",
24       "description?": "description?",
25       "location?": "location?",
26       "possibleResolutions?": "possibleResolutions?",
27       "code?": "code?",
28       "followupAction?": "followupAction?"
29     }
30   ]
31 }

Sends an insurance discovery check to find potential coverage matches for a patient through Stedi. Given patient demographics, this endpoint discovers what insurance coverages exist for the patient.

Authentication

AuthorizationBearer

OAuth authentication of the form <token>.

Request

This endpoint expects an object.

providerobjectRequired

Information about the provider requesting the insurance discovery check.

subscriberobjectRequired

Demographic information for the patient when they are the health plan subscriber. Providing as much information as possible improves the probability of finding matching coverage. SSN and address (especially zip code) are strongly recommended.

dependentobjectOptional

Demographic information for the patient when they are a dependent on a health plan. If you only have the dependent's information, identify them in the subscriber object instead and leave this empty.

encounterobjectOptional

The date range for the service. If not specified, Stedi defaults to the current date. You can specify either a single date_of_service or a beginning_date_of_service and end_date_of_service.

Response

This endpoint returns an object.

discovery_idstring

A unique ID for this insurance discovery check.

statusenum

The status of the discovery check. COMPLETE means items are populated. PENDING means the check is still in progress.

itemslist of any

An array of potential coverage matches for the patient. Only populated when status is COMPLETE. Each item is a raw passthrough of Stedi’s deeply nested coverage-match object (provider, subscriber, payer, plan, and benefits details).

coverages_foundinteger

The number of potential coverage matches found. 0 if no matching coverage was found.

errorslist of objects