curl --request POST \
--url https://api.example.com/api/v2/clearinghouse/patient-cost \
--header 'Content-Type: application/json' \
--data '
{
"eligibilityResponses": [
{
"inNetwork": true,
"meta": {
"senderId": "<string>",
"submitterId": "<string>",
"billerId": "<string>",
"applicationMode": "production",
"traceId": "<string>",
"outboundTraceId": "<string>"
},
"controlNumber": "<string>",
"reassociationKey": "<string>",
"tradingPartnerServiceId": "<string>",
"provider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"subscriber": {
"healthCareDiagnosisCodes": [
{
"diagnosisTypeCode": "<string>",
"diagnosisCode": "<string>"
}
],
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"gender": "M",
"entityType": "Person",
"uniqueHealthIdentifier": "<string>",
"dateOfBirth": "<string>",
"informationStatusCode": "A",
"employmentStatusCode": "AE",
"governmentServiceAffiliationCode": "A",
"description": "<string>",
"militaryServiceRankCode": "A1",
"dateTimePeriodFormatQualifier": "D8",
"dateTimePeriod": "<string>",
"startDateTimePeriod": "<string>",
"endDateTimePeriod": "<string>",
"ssn": "<string>",
"groupNumber": "<string>",
"planNumber": "<string>",
"planNetworkIdNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"maintenanceTypeCode": "001",
"maintenanceReasonCode": "25",
"birthSequenceNumber": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"responseProvider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"entityIdentifier": "Insured or Subscriber",
"relationToSubscriber": "Self",
"relationToSubscriberCode": "18",
"insuredIndicator": "Y",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"subscriberTraceNumbers": [
{
"traceTypeCode": "<string>",
"traceType": "<string>",
"referenceIdentification": "<string>",
"originatingCompanyIdentifier": "<string>",
"secondaryReferenceIdentification": "<string>"
}
],
"payer": {
"entityIdentifier": "Third-Party Administrator",
"entityType": "Person",
"firstName": "<string>",
"lastName": "<string>",
"name": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"federalTaxpayersIdNumber": "<string>",
"naic": "<string>",
"npi": "<string>",
"centersForMedicareAndMedicaidPlanId": "<string>",
"payorIdentification": "<string>",
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"etin": "<string>",
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "04",
"followupAction": "Please Correct and Resubmit"
}
]
},
"planInformation": {
"stateLicenseNumber": "<string>",
"medicareProviderNumber": "<string>",
"medicaidProviderNumber": "<string>",
"facilityIdNumber": "<string>",
"personalIdentificationNumber": "<string>",
"planNumber": "<string>",
"planDescription": "<string>",
"policyNumber": "<string>",
"memberId": "<string>",
"caseNumber": "<string>",
"familyUnitNumber": "<string>",
"groupNumber": "<string>",
"groupDescription": "<string>",
"referralNumber": "<string>",
"alternativeListId": "<string>",
"classOfContractCode": "<string>",
"coverageListId": "<string>",
"contractNumber": "<string>",
"medicalRecordIdentificationNumber": "<string>",
"electronicDevicePin": "<string>",
"submitterIdentificationNumber": "<string>",
"patientAccountNumber": "<string>",
"hicNumber": "<string>",
"drugFormularyNumber": "<string>",
"priorAuthorizationNumber": "<string>",
"idCardSerialNumber": "<string>",
"idCardNumber": "<string>",
"centersForMedicareAndMedicaidServicesNPI": "<string>",
"issueNumber": "<string>",
"insurancePolicyNumber": "<string>",
"userIdentification": "<string>",
"medicalAssistanceCategory": "<string>",
"eligibilityCategory": "<string>",
"planNetworkIdNumber": "<string>",
"planNetworkIdDescription": "<string>",
"facilityNetworkIdentificationNumber": "<string>",
"medicaidRecipientIdNumber": "<string>",
"priorIdNumber": "<string>",
"socialSecurityNumber": "<string>",
"federalTaxpayersIdentificationNumber": "<string>",
"agencyClaimNumber": "<string>"
},
"planDateInformation": {
"discharge": "<string>",
"issue": "<string>",
"effectiveDateOfChange": "<string>",
"plan": "<string>",
"eligibility": "<string>",
"added": "<string>",
"cobraBegin": "<string>",
"cobraEnd": "<string>",
"premiumPaidToDateBegin": "<string>",
"premiumPaidToDateEnd": "<string>",
"planBegin": "<string>",
"planEnd": "<string>",
"eligibilityBegin": "<string>",
"eligibilityEnd": "<string>",
"enrollment": "<string>",
"admission": "<string>",
"dateOfDeath": "<string>",
"certification": "<string>",
"service": "<string>",
"policyEffective": "<string>",
"policyExpiration": "<string>",
"dateOfLastUpdate": "<string>",
"status": "<string>",
"periodStart": "<string>",
"periodEnd": "<string>",
"completion": "<string>",
"coordinationOfBenefits": "<string>",
"benefit": "<string>",
"primaryCareProvider": "<string>",
"latestVisitOrConsultation": "<string>",
"benefitBegin": "<string>",
"benefitEnd": "<string>"
},
"errors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "04",
"followupAction": "Please Correct and Resubmit"
}
],
"warnings": [
{
"code": "<string>",
"description": "<string>"
}
],
"status": "<string>",
"transactionSetAcknowledgement": "<string>",
"implementationTransactionSetSyntaxError": "<string>",
"x12": "<string>",
"planStatus": [
{
"statusCode": "<string>",
"status": "<string>",
"planDetails": "<string>",
"serviceTypeCodes": [
"1"
]
}
],
"dependents": [
{
"healthCareDiagnosisCodes": [
{
"diagnosisTypeCode": "<string>",
"diagnosisCode": "<string>"
}
],
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"gender": "M",
"entityType": "Person",
"uniqueHealthIdentifier": "<string>",
"dateOfBirth": "<string>",
"informationStatusCode": "A",
"employmentStatusCode": "AE",
"governmentServiceAffiliationCode": "A",
"description": "<string>",
"militaryServiceRankCode": "A1",
"dateTimePeriodFormatQualifier": "D8",
"dateTimePeriod": "<string>",
"startDateTimePeriod": "<string>",
"endDateTimePeriod": "<string>",
"ssn": "<string>",
"groupNumber": "<string>",
"planNumber": "<string>",
"planNetworkIdNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"maintenanceTypeCode": "001",
"maintenanceReasonCode": "25",
"birthSequenceNumber": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"responseProvider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"entityIdentifier": "Dependent",
"relationToSubscriber": "Spouse",
"relationToSubscriberCode": "01",
"insuredIndicator": "N",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"coverageLevelCode": "CHD",
"coverageLevel": "Children Only",
"serviceTypeCodes": [
"1"
],
"serviceTypes": [
"Medical Care"
],
"insuranceTypeCode": "12",
"insuranceType": "Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan",
"planCoverage": "<string>",
"timeQualifierCode": "6",
"timeQualifier": "Hour",
"benefitAmount": "<string>",
"benefitPercent": "<string>",
"quantityQualifierCode": "8H",
"quantityQualifier": "Minimum",
"benefitQuantity": "<string>",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"headerLoopIdentifierCode": "<string>",
"trailerLoopIdentifierCode": "<string>",
"compositeMedicalProcedureIdentifier": {
"productOrServiceIdQualifierCode": "<string>",
"productOrServiceIdQualifier": "<string>",
"procedureCode": "<string>",
"procedureModifiers": [
"<string>"
],
"productOrServiceID": "<string>",
"diagnosisCodePointer": [
"<string>"
]
},
"benefitsAdditionalInformation": {
"planNumber": "<string>",
"policyNumber": "<string>",
"memberId": "<string>",
"familyUnitNumber": "<string>",
"groupNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"referralNumber": "<string>",
"alternativeListId": "<string>",
"coverageListId": "<string>",
"hicNumber": "<string>",
"drugFormularyNumber": "<string>",
"priorAuthorizationNumber": "<string>",
"insurancePolicyNumber": "<string>",
"medicalAssistanceCategory": "<string>",
"planNetworkIdNumber": "<string>",
"medicaidRecepientIdNumber": "<string>"
},
"benefitsServiceDelivery": [
{
"quantityQualifierCode": "DY",
"quantityQualifier": "Days",
"quantity": "<string>",
"unitForMeasurementCode": "Days",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days",
"sampleSelectionModulus": "<string>",
"timePeriodQualifierCode": "6",
"timePeriodQualifier": "Hour",
"numOfPeriods": "<string>",
"deliveryOrCalendarPatternCode": "1st Week of the Month",
"deliveryOrCalendarPatternQualifierCode": "1",
"deliveryOrCalendarPatternQualifier": "1st Week of the Month",
"deliveryPatternTimeCode": "1st Shift (Normal Working Hours)",
"deliveryPatternTimeQualifierCode": "A",
"deliveryPatternTimeQualifier": "1st Shift (Normal Working Hours)"
}
],
"additionalInformation": [
{
"description": "<string>"
}
],
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "GR",
"codeListQualifier": "<string>",
"industryCode": "<string>",
"industry": "<string>",
"codeCategory": "44",
"injuredBodyPartName": "<string>"
}
],
"benefitsRelatedEntities": [
{
"entityIdentifier": "Contracted Service Provider",
"entityType": "Person",
"entityName": "<string>",
"entityFirstname": "<string>",
"entityMiddlename": "<string>",
"entitySuffix": "<string>",
"entityIdentification": "24",
"entityIdentificationValue": "<string>",
"entityRelationship": "01",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"providerInformation": {
"providerCode": "AD",
"referenceIdentification": "<string>"
}
}
],
"benefitsDateInformation": {
"discharges": [
{
"date": "<string>",
"startDate": "<string>",
"endDate": "<string>"
}
],
"issue": "<string>",
"effectiveDateOfChange": "<string>",
"periodStart": "<string>",
"periodEnd": "<string>",
"completion": "<string>",
"coordinationOfBenefits": "<string>",
"plan": "<string>",
"benefit": "<string>",
"primaryCareProvider": "<string>",
"latestVisitOrConsultation": "<string>",
"eligibility": "<string>",
"added": "<string>",
"cobraBegin": "<string>",
"cobraEnd": "<string>",
"premiumPaidtoDateBegin": "<string>",
"premiumPaidToDateEnd": "<string>",
"planBegin": "<string>",
"planEnd": "<string>",
"benefitBegin": "<string>",
"benefitEnd": "<string>",
"eligibilityBegin": "<string>",
"eligibilityEnd": "<string>",
"enrollment": "<string>",
"admissions": [
{
"date": "<string>",
"startDate": "<string>",
"endDate": "<string>"
}
],
"dateOfDeath": "<string>",
"certification": "<string>",
"service": "<string>",
"policyEffective": "<string>",
"policyExpiration": "<string>",
"dateOfLastUpdate": "<string>",
"status": "<string>",
"discharge": "<string>",
"admission": "<string>"
},
"benefitsRelatedEntity": {
"entityIdentifier": "Contracted Service Provider",
"entityType": "Person",
"entityName": "<string>",
"entityFirstname": "<string>",
"entityMiddlename": "<string>",
"entitySuffix": "<string>",
"entityIdentification": "24",
"entityIdentificationValue": "<string>",
"entityRelationship": "01",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"providerInformation": {
"providerCode": "AD",
"referenceIdentification": "<string>"
}
},
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "GR",
"codeListQualifier": "<string>",
"industryCode": "<string>",
"industry": "<string>",
"codeCategory": "44",
"injuredBodyPartName": "<string>"
}
}
]
}
],
"lineItems": [
{
"id": "<string>",
"cptCode": "<string>",
"serviceDate": "<string>",
"serviceAmount": 123
}
]
}
'Calculates the cost of a patient’s services based on the provided information.
curl --request POST \
--url https://api.example.com/api/v2/clearinghouse/patient-cost \
--header 'Content-Type: application/json' \
--data '
{
"eligibilityResponses": [
{
"inNetwork": true,
"meta": {
"senderId": "<string>",
"submitterId": "<string>",
"billerId": "<string>",
"applicationMode": "production",
"traceId": "<string>",
"outboundTraceId": "<string>"
},
"controlNumber": "<string>",
"reassociationKey": "<string>",
"tradingPartnerServiceId": "<string>",
"provider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"subscriber": {
"healthCareDiagnosisCodes": [
{
"diagnosisTypeCode": "<string>",
"diagnosisCode": "<string>"
}
],
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"gender": "M",
"entityType": "Person",
"uniqueHealthIdentifier": "<string>",
"dateOfBirth": "<string>",
"informationStatusCode": "A",
"employmentStatusCode": "AE",
"governmentServiceAffiliationCode": "A",
"description": "<string>",
"militaryServiceRankCode": "A1",
"dateTimePeriodFormatQualifier": "D8",
"dateTimePeriod": "<string>",
"startDateTimePeriod": "<string>",
"endDateTimePeriod": "<string>",
"ssn": "<string>",
"groupNumber": "<string>",
"planNumber": "<string>",
"planNetworkIdNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"maintenanceTypeCode": "001",
"maintenanceReasonCode": "25",
"birthSequenceNumber": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"responseProvider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"entityIdentifier": "Insured or Subscriber",
"relationToSubscriber": "Self",
"relationToSubscriberCode": "18",
"insuredIndicator": "Y",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"subscriberTraceNumbers": [
{
"traceTypeCode": "<string>",
"traceType": "<string>",
"referenceIdentification": "<string>",
"originatingCompanyIdentifier": "<string>",
"secondaryReferenceIdentification": "<string>"
}
],
"payer": {
"entityIdentifier": "Third-Party Administrator",
"entityType": "Person",
"firstName": "<string>",
"lastName": "<string>",
"name": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"federalTaxpayersIdNumber": "<string>",
"naic": "<string>",
"npi": "<string>",
"centersForMedicareAndMedicaidPlanId": "<string>",
"payorIdentification": "<string>",
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"etin": "<string>",
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "04",
"followupAction": "Please Correct and Resubmit"
}
]
},
"planInformation": {
"stateLicenseNumber": "<string>",
"medicareProviderNumber": "<string>",
"medicaidProviderNumber": "<string>",
"facilityIdNumber": "<string>",
"personalIdentificationNumber": "<string>",
"planNumber": "<string>",
"planDescription": "<string>",
"policyNumber": "<string>",
"memberId": "<string>",
"caseNumber": "<string>",
"familyUnitNumber": "<string>",
"groupNumber": "<string>",
"groupDescription": "<string>",
"referralNumber": "<string>",
"alternativeListId": "<string>",
"classOfContractCode": "<string>",
"coverageListId": "<string>",
"contractNumber": "<string>",
"medicalRecordIdentificationNumber": "<string>",
"electronicDevicePin": "<string>",
"submitterIdentificationNumber": "<string>",
"patientAccountNumber": "<string>",
"hicNumber": "<string>",
"drugFormularyNumber": "<string>",
"priorAuthorizationNumber": "<string>",
"idCardSerialNumber": "<string>",
"idCardNumber": "<string>",
"centersForMedicareAndMedicaidServicesNPI": "<string>",
"issueNumber": "<string>",
"insurancePolicyNumber": "<string>",
"userIdentification": "<string>",
"medicalAssistanceCategory": "<string>",
"eligibilityCategory": "<string>",
"planNetworkIdNumber": "<string>",
"planNetworkIdDescription": "<string>",
"facilityNetworkIdentificationNumber": "<string>",
"medicaidRecipientIdNumber": "<string>",
"priorIdNumber": "<string>",
"socialSecurityNumber": "<string>",
"federalTaxpayersIdentificationNumber": "<string>",
"agencyClaimNumber": "<string>"
},
"planDateInformation": {
"discharge": "<string>",
"issue": "<string>",
"effectiveDateOfChange": "<string>",
"plan": "<string>",
"eligibility": "<string>",
"added": "<string>",
"cobraBegin": "<string>",
"cobraEnd": "<string>",
"premiumPaidToDateBegin": "<string>",
"premiumPaidToDateEnd": "<string>",
"planBegin": "<string>",
"planEnd": "<string>",
"eligibilityBegin": "<string>",
"eligibilityEnd": "<string>",
"enrollment": "<string>",
"admission": "<string>",
"dateOfDeath": "<string>",
"certification": "<string>",
"service": "<string>",
"policyEffective": "<string>",
"policyExpiration": "<string>",
"dateOfLastUpdate": "<string>",
"status": "<string>",
"periodStart": "<string>",
"periodEnd": "<string>",
"completion": "<string>",
"coordinationOfBenefits": "<string>",
"benefit": "<string>",
"primaryCareProvider": "<string>",
"latestVisitOrConsultation": "<string>",
"benefitBegin": "<string>",
"benefitEnd": "<string>"
},
"errors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "04",
"followupAction": "Please Correct and Resubmit"
}
],
"warnings": [
{
"code": "<string>",
"description": "<string>"
}
],
"status": "<string>",
"transactionSetAcknowledgement": "<string>",
"implementationTransactionSetSyntaxError": "<string>",
"x12": "<string>",
"planStatus": [
{
"statusCode": "<string>",
"status": "<string>",
"planDetails": "<string>",
"serviceTypeCodes": [
"1"
]
}
],
"dependents": [
{
"healthCareDiagnosisCodes": [
{
"diagnosisTypeCode": "<string>",
"diagnosisCode": "<string>"
}
],
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"gender": "M",
"entityType": "Person",
"uniqueHealthIdentifier": "<string>",
"dateOfBirth": "<string>",
"informationStatusCode": "A",
"employmentStatusCode": "AE",
"governmentServiceAffiliationCode": "A",
"description": "<string>",
"militaryServiceRankCode": "A1",
"dateTimePeriodFormatQualifier": "D8",
"dateTimePeriod": "<string>",
"startDateTimePeriod": "<string>",
"endDateTimePeriod": "<string>",
"ssn": "<string>",
"groupNumber": "<string>",
"planNumber": "<string>",
"planNetworkIdNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"maintenanceTypeCode": "001",
"maintenanceReasonCode": "25",
"birthSequenceNumber": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"responseProvider": {
"providerName": "<string>",
"providerFirstName": "<string>",
"providerOrgName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"entityIdentifier": "Provider",
"entityType": "Person",
"npi": "<string>",
"providerCode": "AD",
"referenceIdentification": "<string>",
"ssn": "<string>",
"federalTaxpayersIdNumber": "<string>",
"payorIdentification": "<string>",
"pharmacyProcessorNumber": "<string>",
"serviceProviderNumber": "<string>",
"servicesPlanID": "<string>",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"employersId": "<string>",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
},
"entityIdentifier": "Dependent",
"relationToSubscriber": "Spouse",
"relationToSubscriberCode": "01",
"insuredIndicator": "N",
"aaaErrors": [
{
"field": "<string>",
"description": "<string>",
"location": "<string>",
"possibleResolutions": "<string>",
"code": "15",
"followupAction": "Please Correct and Resubmit"
}
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"coverageLevelCode": "CHD",
"coverageLevel": "Children Only",
"serviceTypeCodes": [
"1"
],
"serviceTypes": [
"Medical Care"
],
"insuranceTypeCode": "12",
"insuranceType": "Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan",
"planCoverage": "<string>",
"timeQualifierCode": "6",
"timeQualifier": "Hour",
"benefitAmount": "<string>",
"benefitPercent": "<string>",
"quantityQualifierCode": "8H",
"quantityQualifier": "Minimum",
"benefitQuantity": "<string>",
"authOrCertIndicator": "N",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"headerLoopIdentifierCode": "<string>",
"trailerLoopIdentifierCode": "<string>",
"compositeMedicalProcedureIdentifier": {
"productOrServiceIdQualifierCode": "<string>",
"productOrServiceIdQualifier": "<string>",
"procedureCode": "<string>",
"procedureModifiers": [
"<string>"
],
"productOrServiceID": "<string>",
"diagnosisCodePointer": [
"<string>"
]
},
"benefitsAdditionalInformation": {
"planNumber": "<string>",
"policyNumber": "<string>",
"memberId": "<string>",
"familyUnitNumber": "<string>",
"groupNumber": "<string>",
"groupDescription": "<string>",
"planDescription": "<string>",
"planNetworkDescription": "<string>",
"referralNumber": "<string>",
"alternativeListId": "<string>",
"coverageListId": "<string>",
"hicNumber": "<string>",
"drugFormularyNumber": "<string>",
"priorAuthorizationNumber": "<string>",
"insurancePolicyNumber": "<string>",
"medicalAssistanceCategory": "<string>",
"planNetworkIdNumber": "<string>",
"medicaidRecepientIdNumber": "<string>"
},
"benefitsServiceDelivery": [
{
"quantityQualifierCode": "DY",
"quantityQualifier": "Days",
"quantity": "<string>",
"unitForMeasurementCode": "Days",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days",
"sampleSelectionModulus": "<string>",
"timePeriodQualifierCode": "6",
"timePeriodQualifier": "Hour",
"numOfPeriods": "<string>",
"deliveryOrCalendarPatternCode": "1st Week of the Month",
"deliveryOrCalendarPatternQualifierCode": "1",
"deliveryOrCalendarPatternQualifier": "1st Week of the Month",
"deliveryPatternTimeCode": "1st Shift (Normal Working Hours)",
"deliveryPatternTimeQualifierCode": "A",
"deliveryPatternTimeQualifier": "1st Shift (Normal Working Hours)"
}
],
"additionalInformation": [
{
"description": "<string>"
}
],
"eligibilityAdditionalInformationList": [
{
"codeListQualifierCode": "GR",
"codeListQualifier": "<string>",
"industryCode": "<string>",
"industry": "<string>",
"codeCategory": "44",
"injuredBodyPartName": "<string>"
}
],
"benefitsRelatedEntities": [
{
"entityIdentifier": "Contracted Service Provider",
"entityType": "Person",
"entityName": "<string>",
"entityFirstname": "<string>",
"entityMiddlename": "<string>",
"entitySuffix": "<string>",
"entityIdentification": "24",
"entityIdentificationValue": "<string>",
"entityRelationship": "01",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"providerInformation": {
"providerCode": "AD",
"referenceIdentification": "<string>"
}
}
],
"benefitsDateInformation": {
"discharges": [
{
"date": "<string>",
"startDate": "<string>",
"endDate": "<string>"
}
],
"issue": "<string>",
"effectiveDateOfChange": "<string>",
"periodStart": "<string>",
"periodEnd": "<string>",
"completion": "<string>",
"coordinationOfBenefits": "<string>",
"plan": "<string>",
"benefit": "<string>",
"primaryCareProvider": "<string>",
"latestVisitOrConsultation": "<string>",
"eligibility": "<string>",
"added": "<string>",
"cobraBegin": "<string>",
"cobraEnd": "<string>",
"premiumPaidtoDateBegin": "<string>",
"premiumPaidToDateEnd": "<string>",
"planBegin": "<string>",
"planEnd": "<string>",
"benefitBegin": "<string>",
"benefitEnd": "<string>",
"eligibilityBegin": "<string>",
"eligibilityEnd": "<string>",
"enrollment": "<string>",
"admissions": [
{
"date": "<string>",
"startDate": "<string>",
"endDate": "<string>"
}
],
"dateOfDeath": "<string>",
"certification": "<string>",
"service": "<string>",
"policyEffective": "<string>",
"policyExpiration": "<string>",
"dateOfLastUpdate": "<string>",
"status": "<string>",
"discharge": "<string>",
"admission": "<string>"
},
"benefitsRelatedEntity": {
"entityIdentifier": "Contracted Service Provider",
"entityType": "Person",
"entityName": "<string>",
"entityFirstname": "<string>",
"entityMiddlename": "<string>",
"entitySuffix": "<string>",
"entityIdentification": "24",
"entityIdentificationValue": "<string>",
"entityRelationship": "01",
"address": {
"address1": "<string>",
"address2": "<string>",
"city": "<string>",
"state": "NL",
"postalCode": "<string>",
"countryCode": "<string>",
"countrySubDivisionCode": "<string>"
},
"contactInformation": {
"name": "<string>",
"contacts": [
{
"communicationMode": "Electronic Data Interchange Access Number",
"communicationNumber": "<string>"
}
]
},
"providerInformation": {
"providerCode": "AD",
"referenceIdentification": "<string>"
}
},
"eligibilityAdditionalInformation": {
"codeListQualifierCode": "GR",
"codeListQualifier": "<string>",
"industryCode": "<string>",
"industry": "<string>",
"codeCategory": "44",
"injuredBodyPartName": "<string>"
}
}
]
}
],
"lineItems": [
{
"id": "<string>",
"cptCode": "<string>",
"serviceDate": "<string>",
"serviceAmount": 123
}
]
}
'Default Response