> ## Documentation Index > Fetch the complete documentation index at: https://docs.samplehc.com/llms.txt > Use this file to discover all available pages before exploring further. # Calculate patient cost for a line item > Calculates the cost of a patient's services based on the provided information. ## OpenAPI ````yaml https://app.stainless.com/api/spec/documented/samplehc/openapi.documented.yml post /api/v2/clearinghouse/patient-cost openapi: 3.0.3 info: title: Sample Healthcare API description: API for Sample Healthcare version: 1.0.0 servers: [] security: [] paths: /api/v2/clearinghouse/patient-cost: post: tags: - Clearinghouse summary: Calculate patient cost for a line item description: >- Calculates the cost of a patient's services based on the provided information. requestBody: content: application/json: schema: type: object properties: eligibilityResponses: type: array items: type: object properties: meta: type: object properties: senderId: type: string submitterId: type: string billerId: type: string applicationMode: type: string enum: - production - test - information traceId: type: string outboundTraceId: type: string additionalProperties: false controlNumber: type: string reassociationKey: type: string tradingPartnerServiceId: type: string provider: type: object properties: providerName: type: string providerFirstName: type: string providerOrgName: type: string middleName: type: string suffix: type: string entityIdentifier: type: string enum: - Provider - Third-Party Administrator - Employer - Hospital - Facility - Gateway Provider - Plan Sponsor - Payer entityType: type: string enum: - Person - Non-Person Entity npi: type: string pattern: ^\d{10}$ providerCode: type: string enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string ssn: type: string pattern: ^\d{9}$ federalTaxpayersIdNumber: type: string pattern: ^\d{9}$ payorIdentification: type: string pharmacyProcessorNumber: type: string serviceProviderNumber: type: string servicesPlanID: type: string address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false employersId: type: string aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '15' - '41' - '43' - '44' - '45' - '46' - '47' - '48' - '50' - '51' - '79' - '97' - T4 followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false subscriber: type: object properties: healthCareDiagnosisCodes: type: array items: type: object properties: diagnosisTypeCode: type: string diagnosisCode: type: string additionalProperties: false memberId: type: string firstName: type: string lastName: type: string middleName: type: string suffix: type: string gender: type: string enum: - M - F - U entityType: type: string enum: - Person - Non-Person Entity uniqueHealthIdentifier: type: string dateOfBirth: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ informationStatusCode: type: string enum: - A - C - L - O - P - S - T employmentStatusCode: type: string enum: - AE - AO - AS - AT - AU - CC - DD - HD - IR - LX - PE - RE - RM - RR - RU governmentServiceAffiliationCode: type: string enum: - A - B - C - D - E - F - G - H - I - J - K - L - M - 'N' - O - Q - R - S - U - W description: type: string militaryServiceRankCode: type: string enum: - A1 - A2 - A3 - B1 - B2 - C1 - C2 - C3 - C4 - C5 - C6 - C7 - C8 - C9 - E1 - F1 - F2 - F3 - F4 - G1 - G4 - L1 - L2 - L3 - L4 - L5 - L6 - M1 - M2 - M3 - M4 - M5 - M6 - P1 - P2 - P3 - P4 - P5 - R1 - R2 - S1 - S2 - S3 - S4 - S5 - S6 - S7 - S8 - S9 - SA - SB - SC - T1 - V1 - W1 dateTimePeriodFormatQualifier: type: string enum: - D8 - RD8 dateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ startDateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ endDateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ ssn: type: string pattern: ^\d{9}$ groupNumber: type: string planNumber: type: string planNetworkIdNumber: type: string groupDescription: type: string planDescription: type: string planNetworkDescription: type: string maintenanceTypeCode: type: string enum: - '001' maintenanceReasonCode: type: string enum: - '25' birthSequenceNumber: type: string address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false responseProvider: type: object properties: providerName: type: string providerFirstName: type: string providerOrgName: type: string middleName: type: string suffix: type: string entityIdentifier: type: string enum: - Provider - Third-Party Administrator - Employer - Hospital - Facility - Gateway Provider - Plan Sponsor - Payer entityType: type: string enum: - Person - Non-Person Entity npi: type: string pattern: ^\d{10}$ providerCode: type: string enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string ssn: type: string pattern: ^\d{9}$ federalTaxpayersIdNumber: type: string pattern: ^\d{9}$ payorIdentification: type: string pharmacyProcessorNumber: type: string serviceProviderNumber: type: string servicesPlanID: type: string address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false employersId: type: string aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '15' - '41' - '43' - '44' - '45' - '46' - '47' - '48' - '50' - '51' - '79' - '97' - T4 followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false entityIdentifier: type: string enum: - Insured or Subscriber relationToSubscriber: type: string enum: - Self relationToSubscriberCode: type: string enum: - '18' insuredIndicator: type: string enum: - 'Y' aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '78' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false subscriberTraceNumbers: type: array items: type: object properties: traceTypeCode: type: string traceType: type: string referenceIdentification: type: string originatingCompanyIdentifier: type: string secondaryReferenceIdentification: type: string additionalProperties: false payer: type: object properties: entityIdentifier: type: string enum: - Third-Party Administrator - Employer - Gateway Provider - Plan Sponsor - Payer entityType: type: string enum: - Person - Non-Person Entity firstName: type: string lastName: type: string name: type: string middleName: type: string suffix: type: string federalTaxpayersIdNumber: type: string pattern: ^\d{9}$ naic: type: string npi: type: string pattern: ^\d{10}$ centersForMedicareAndMedicaidPlanId: type: string payorIdentification: type: string contactInformation: type: object properties: name: type: string contacts: type: array items: type: object properties: communicationMode: type: string enum: - >- Electronic Data Interchange Access Number - Electronic Mail - Facsimile - Telephone - Uniform Resource Locator (URL) communicationNumber: type: string additionalProperties: false additionalProperties: false etin: type: string employersId: type: string aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '04' - '41' - '42' - '79' - '80' - T4 followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Please Resubmit Original Transaction - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false planInformation: type: object properties: stateLicenseNumber: type: string medicareProviderNumber: type: string medicaidProviderNumber: type: string facilityIdNumber: type: string personalIdentificationNumber: type: string planNumber: type: string planDescription: type: string policyNumber: type: string memberId: type: string caseNumber: type: string familyUnitNumber: type: string groupNumber: type: string groupDescription: type: string referralNumber: type: string alternativeListId: type: string classOfContractCode: type: string coverageListId: type: string contractNumber: type: string medicalRecordIdentificationNumber: type: string electronicDevicePin: type: string submitterIdentificationNumber: type: string patientAccountNumber: type: string hicNumber: type: string drugFormularyNumber: type: string priorAuthorizationNumber: type: string idCardSerialNumber: type: string idCardNumber: type: string centersForMedicareAndMedicaidServicesNPI: type: string pattern: ^\d{10}$ issueNumber: type: string insurancePolicyNumber: type: string userIdentification: type: string medicalAssistanceCategory: type: string eligibilityCategory: type: string planNetworkIdNumber: type: string planNetworkIdDescription: type: string facilityNetworkIdentificationNumber: type: string medicaidRecipientIdNumber: type: string priorIdNumber: type: string socialSecurityNumber: type: string federalTaxpayersIdentificationNumber: type: string agencyClaimNumber: type: string additionalProperties: false planDateInformation: type: object properties: discharge: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ issue: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ effectiveDateOfChange: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ plan: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ eligibility: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ added: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ cobraBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ cobraEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ premiumPaidToDateBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ premiumPaidToDateEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ planBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ planEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ eligibilityBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ eligibilityEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ enrollment: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ admission: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ dateOfDeath: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ certification: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ service: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ policyEffective: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ policyExpiration: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ dateOfLastUpdate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ status: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ periodStart: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ periodEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ completion: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ coordinationOfBenefits: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ benefit: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ primaryCareProvider: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ latestVisitOrConsultation: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ benefitBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ benefitEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ additionalProperties: false errors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '04' - '15' - '33' - '35' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '97' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA - T4 followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Please Resubmit Original Transaction - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false warnings: type: array items: type: object properties: code: type: string description: type: string additionalProperties: false status: type: string transactionSetAcknowledgement: type: string implementationTransactionSetSyntaxError: type: string x12: type: string planStatus: type: array items: type: object properties: statusCode: type: string status: type: string planDetails: type: string serviceTypeCodes: type: array items: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '30' - '32' - '33' - '34' - '35' - '36' - '37' - '38' - '39' - '40' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '83' - '84' - '85' - '86' - '87' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AC - AD - AE - AF - AG - AH - AI - AJ - AK - AL - AM - AN - AO - AQ - AR - B1 - B2 - B3 - BA - BB - BC - BD - BE - BF - BG - BH - BI - BJ - BK - BL - BM - BN - BP - BQ - BR - BS - BT - BU - BV - BW - BX - BY - BZ - C1 - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CO - CP - CQ - DG - DM - DS - GF - GN - GY - IC - MH - NI - 'ON' - PT - PU - RN - RT - TC - TN - UC additionalProperties: false dependents: type: array items: type: object properties: healthCareDiagnosisCodes: type: array items: type: object properties: diagnosisTypeCode: type: string diagnosisCode: type: string additionalProperties: false memberId: type: string firstName: type: string lastName: type: string middleName: type: string suffix: type: string gender: type: string enum: - M - F - U entityType: type: string enum: - Person - Non-Person Entity uniqueHealthIdentifier: type: string dateOfBirth: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ informationStatusCode: type: string enum: - A - C - L - O - P - S - T employmentStatusCode: type: string enum: - AE - AO - AS - AT - AU - CC - DD - HD - IR - LX - PE - RE - RM - RR - RU governmentServiceAffiliationCode: type: string enum: - A - B - C - D - E - F - G - H - I - J - K - L - M - 'N' - O - Q - R - S - U - W description: type: string militaryServiceRankCode: type: string enum: - A1 - A2 - A3 - B1 - B2 - C1 - C2 - C3 - C4 - C5 - C6 - C7 - C8 - C9 - E1 - F1 - F2 - F3 - F4 - G1 - G4 - L1 - L2 - L3 - L4 - L5 - L6 - M1 - M2 - M3 - M4 - M5 - M6 - P1 - P2 - P3 - P4 - P5 - R1 - R2 - S1 - S2 - S3 - S4 - S5 - S6 - S7 - S8 - S9 - SA - SB - SC - T1 - V1 - W1 dateTimePeriodFormatQualifier: type: string enum: - D8 - RD8 dateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ startDateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ endDateTimePeriod: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ ssn: type: string pattern: ^\d{9}$ groupNumber: type: string planNumber: type: string planNetworkIdNumber: type: string groupDescription: type: string planDescription: type: string planNetworkDescription: type: string maintenanceTypeCode: type: string enum: - '001' maintenanceReasonCode: type: string enum: - '25' birthSequenceNumber: type: string address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false responseProvider: type: object properties: providerName: type: string providerFirstName: type: string providerOrgName: type: string middleName: type: string suffix: type: string entityIdentifier: type: string enum: - Provider - Third-Party Administrator - Employer - Hospital - Facility - Gateway Provider - Plan Sponsor - Payer entityType: type: string enum: - Person - Non-Person Entity npi: type: string pattern: ^\d{10}$ providerCode: type: string enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string ssn: type: string pattern: ^\d{9}$ federalTaxpayersIdNumber: type: string pattern: ^\d{9}$ payorIdentification: type: string pharmacyProcessorNumber: type: string serviceProviderNumber: type: string servicesPlanID: type: string address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false employersId: type: string aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '15' - '41' - '43' - '44' - '45' - '46' - '47' - '48' - '50' - '51' - '79' - '97' - T4 followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false entityIdentifier: type: string enum: - Dependent relationToSubscriber: type: string enum: - Spouse - Child - Employee - Unknown - Organ Donor - Cadaver Donor - Life Partner - Other Relationship relationToSubscriberCode: type: string enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 - Unknown insuredIndicator: type: string enum: - 'N' aaaErrors: type: array items: type: object properties: field: type: string description: type: string location: type: string possibleResolutions: type: string code: type: string enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '77' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA followupAction: type: string enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - >- Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - >- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly additionalProperties: false additionalProperties: false benefitsInformation: type: array items: type: object properties: code: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - A - B - C - CB - D - E - F - G - H - I - J - K - L - M - MC - 'N' - O - P - Q - R - S - T - U - V - W - X - 'Y' name: type: string enum: - Active Coverage - Active - Full Risk Capitation - Active - Services Capitated - >- Active - Services Capitated to Primary Care Physician - Active - Pending Investigation - Inactive - Inactive - Pending Eligibility Update - Inactive - Pending Investigation - Co-Insurance - Co-Payment - Deductible - Coverage Basis - Benefit Description - Exclusions - Limitations - Out of Pocket (Stop Loss) - Unlimited - Non-Covered - Cost Containment - Reserve - Primary Care Provider - Pre-existing Condition - Managed Care Coordinator - Services Restricted to Following Provider - Not Deemed a Medical Necessity - Benefit Disclaimer - Second Surgical Opinion Required - Other or Additional Payor - Prior Year(s) History - Card(s) Reported Lost/Stolen - >- Contact Following Entity for Eligibility or Benefit Information - Cannot Process - Other Source of Data - Health Care Facility - Spend Down coverageLevelCode: type: string enum: - CHD - DEP - ECH - EMP - ESP - FAM - IND - SPC - SPO coverageLevel: type: string enum: - Children Only - Dependents Only - Employee and Children - Employee Only - Employee and Spouse - Family - Individual - Spouse and Children - Spouse Only serviceTypeCodes: type: array items: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '30' - '32' - '33' - '34' - '35' - '36' - '37' - '38' - '39' - '40' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '83' - '84' - '85' - '86' - '87' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AC - AD - AE - AF - AG - AH - AI - AJ - AK - AL - AM - AN - AO - AQ - AR - B1 - B2 - B3 - BA - BB - BC - BD - BE - BF - BG - BH - BI - BJ - BK - BL - BM - BN - BP - BQ - BR - BS - BT - BU - BV - BW - BX - BY - BZ - C1 - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CO - CP - CQ - DG - DM - DS - GF - GN - GY - IC - MH - NI - 'ON' - PT - PU - RN - RT - TC - TN - UC serviceTypes: type: array items: type: string enum: - Medical Care - Surgical - Consultation - Diagnostic X-Ray - Diagnostic Lab - Radiation Therapy - Anesthesia - Surgical Assistance - Other Medical - Blood Charges - Used Durable Medical Equipment - Durable Medical Equipment Purchase - Ambulatory Service Center Facility - Renal Supplies in the Home - Alternate Method Dialysis - Chronic Renal Disease (CRD) Equipment - Pre-Admission Testing - Durable Medical Equipment Rental - Pneumonia Vaccine - Second Surgical Opinion - Third Surgical Opinion - Social Work - Diagnostic Dental - Periodontics - Restorative - Endodontics - Maxillofacial Prosthetics - Adjunctive Dental Services - Health Benefit Plan Coverage - Plan Waiting Period - Chiropractic - Chiropractic Office Visits - Dental Care - Dental Crowns - Dental Accident - Orthodontics - Prosthodontics - Oral Surgery - Routine (Preventive) Dental - Home Health Care - Home Health Prescriptions - Home Health Visits - Hospice - Respite Care - Hospital - Hospital - Inpatient - Hospital - Room and Board - Hospital - Outpatient - Hospital - Emergency Accident - Hospital - Emergency Medical - Hospital - Ambulatory Surgical - Long Term Care - Major Medical - Medically Related Transportation - Air Transportation - Cabulance - Licensed Ambulance - General Benefits - In-vitro Fertilization - MRI/CAT Scan - Donor Procedures - Acupuncture - Newborn Care - Pathology - Smoking Cessation - Well Baby Care - Maternity - Transplants - Audiology Exam - Inhalation Therapy - Diagnostic Medical - Private Duty Nursing - Prosthetic Device - Dialysis - Otological Exam - Chemotherapy - Allergy Testing - Immunizations - Routine Physical - Family Planning - Infertility - Abortion - AIDS - Emergency Services - Cancer - Pharmacy - Free Standing Prescription Drug - Mail Order Prescription Drug - Brand Name Prescription Drug - Generic Prescription Drug - Podiatry - Podiatry - Office Visits - Podiatry - Nursing Home Visits - Professional (Physician) - Anesthesiologist - Professional (Physician) Visit - Office - Professional (Physician) Visit - Inpatient - Professional (Physician) Visit - Outpatient - >- Professional (Physician) Visit - Nursing Home - >- Professional (Physician) Visit - Skilled Nursing Facility - Professional (Physician) Visit - Home - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Psychiatric - Inpatient - Psychiatric - Outpatient - Rehabilitation - Rehabilitation - Room and Board - Rehabilitation - Inpatient - Rehabilitation - Outpatient - Occupational Therapy - Physical Medicine - Speech Therapy - Skilled Nursing Care - Skilled Nursing Care - Room and Board - Substance Abuse - Alcoholism - Drug Addiction - Vision (Optometry) - Frames - Routine Exam - Lenses - Nonmedically Necessary Physical - Experimental Drug Therapy - Burn Care - Brand Name Prescription Drug - Formulary - Brand Name Prescription Drug - Non-Formulary - Independent Medical Evaluation - Partial Hospitalization (Psychiatric) - Day Care (Psychiatric) - Cognitive Therapy - Massage Therapy - Pulmonary Rehabilitation - Cardiac Rehabilitation - Pediatric - Nursery - Skin - Orthopedic - Cardiac - Lymphatic - Gastrointestinal - Endocrine - Neurology - Eye - Invasive Procedures - Gynecological - Obstetrical - Obstetrical/Gynecological - Mail Order Prescription Drug - Formulary - Mail Order Prescription Drug - Non-Formulary - 'Physician Visit - Office: Sick' - 'Physician Visit - Office: Well' - Coronary Care - Private Duty Nursing - Inpatient - Private Duty Nursing - Home - Surgical Benefits - Professional (Physician) - Surgical Benefits - Facility - Mental Health Provider- Inpatient - Mental Health Provider - Outpatient - Mental Health Facility - Inpatient - Mental Health Facility - Outpatient - Substance Abuse Facility - Inpatient - Substance Abuse Facility - Outpatient - Screening X-ray - Screening laboratory - Mammogram, High Risk Patient - Mammogram, Low Risk Patient - Flu Vaccination - Eyewear and Eyewear Accessories - Case Management - Dermatology - Durable Medical Equipment - Diabetic Supplies - Generic Prescription Drug - Formulary - Generic Prescription Drug - Non-Formulary - Allergy - Intensive Care - Mental Health - Neonatol Intensive Care - Oncology - Physical Therapy - Pulmonary - Renal - Residential Psychiatric Treatment - Transitional Care - Transitional Nursery Care - Urgent Care insuranceTypeCode: type: string enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' - AP - C1 - CO - CP - D - DB - EP - FF - GP - HM - HN - HS - IN - IP - LC - LD - LI - LT - MA - MB - MC - MH - MI - MP - OT - PE - PL - PP - PR - PS - QM - RP - SP - TF - WC - WU insuranceType: type: string enum: - >- Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan - >- Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan - >- Medicare Secondary, No-fault Insurance including Auto is Primary - Medicare Secondary Worker's Compensation - >- Medicare Secondary Public Health Service (PHS)or Other Federal Agency - Medicare Secondary Black Lung - Medicare Secondary Veteran's Administration - >- Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP) - >- Medicare Secondary, Other Liability Insurance is Primary - Auto Insurance Policy - Commercial - >- Consolidated Omnibus Budget Reconciliation Act (COBRA) - Medicare Conditionally Primary - Disability - Disability Benefits - Exclusive Provider Organization - Family or Friends - Group Policy - Health Maintenance Organization (HMO) - >- Health Maintenance Organization (HMO) - Medicare Risk - Special Low Income Medicare Beneficiary - Indemnity - Individual Policy - Long Term Care - Long Term Policy - Life Insurance - Litigation - Medicare Part A - Medicare Part B - Medicaid - Medigap Part A - Medigap Part B - Medicare Primary - Other - Property Insurance - Personal - Personal - Personal Payment (Cash - No Insurance) - Preferred Provider Organization (PPO) - Point of Service (POS) - Qualified Medicare Beneficiary - Property Insurance - Real - Supplemental Policy - Tax Equity Fiscal Responsibility Act (TEFRA) - Workers Compensation - Wrap Up Policy planCoverage: type: string timeQualifierCode: type: string enum: - '6' - '7' - '13' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' - '36' timeQualifier: type: string enum: - Hour - Day - 24 Hours - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week - Admission benefitAmount: type: string benefitPercent: type: string quantityQualifierCode: type: string enum: - 8H - '99' - CA - CE - D3 - DB - DY - HS - LA - LE - M2 - MN - P6 - QA - S7 - S8 - VS - YY quantityQualifier: type: string enum: - Minimum - Quantity Used - Covered - Actual - Covered - Estimated - Number of Co-insurance Days - Deductible Blood Units - Days - Hours - Life-time Reserve - Actual - Life-time Reserve - Estimated - Maximum - Month - Number of Services or Procedures - Quantity Approved - Age, High Value - Age, Low Value - Visits - Years benefitQuantity: type: string authOrCertIndicator: type: string enum: - 'N' - U - 'Y' inPlanNetworkIndicatorCode: type: string enum: - 'Y' - 'N' - U - W inPlanNetworkIndicator: type: string enum: - 'Yes' - 'No' - Unknown - Not Applicable headerLoopIdentifierCode: type: string trailerLoopIdentifierCode: type: string compositeMedicalProcedureIdentifier: type: object properties: productOrServiceIdQualifierCode: type: string productOrServiceIdQualifier: type: string procedureCode: type: string procedureModifiers: type: array items: type: string productOrServiceID: type: string diagnosisCodePointer: type: array items: type: string additionalProperties: false benefitsAdditionalInformation: type: object properties: planNumber: type: string policyNumber: type: string memberId: type: string familyUnitNumber: type: string groupNumber: type: string groupDescription: type: string planDescription: type: string planNetworkDescription: type: string referralNumber: type: string alternativeListId: type: string coverageListId: type: string hicNumber: type: string drugFormularyNumber: type: string priorAuthorizationNumber: type: string insurancePolicyNumber: type: string medicalAssistanceCategory: type: string planNetworkIdNumber: type: string medicaidRecepientIdNumber: type: string additionalProperties: false benefitsServiceDelivery: type: array items: type: object properties: quantityQualifierCode: type: string enum: - DY - FL - HS - MN - VS quantityQualifier: type: string enum: - Days - Units - Hours - Month - Visits quantity: type: string unitForMeasurementCode: type: string enum: - Days - Months - Visits - Week - Years unitForMeasurementQualifierCode: type: string enum: - DA - MO - VS - WK - YR unitForMeasurementQualifier: type: string enum: - Days - Months - Visits - Week - Years sampleSelectionModulus: type: string timePeriodQualifierCode: type: string enum: - '6' - '7' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' timePeriodQualifier: type: string enum: - Hour - Day - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week numOfPeriods: type: string deliveryOrCalendarPatternCode: type: string enum: - 1st Week of the Month - 2nd Week of the Month - 3rd Week of the Month - 4th Week of the Month - 5th Week of the Month - 1st & 3rd Week of the Month - 2nd & 4th Week of the Month - 1st Working Day of Period - Last Working Day of Period - Monday through Friday - Monday through Saturday - Monday through Sunday - Monday - Tuesday - Wednesday - Thursday - Friday - Saturday - Sunday - Monday through Thursday - Immediately - As Directed - Daily Mon. Through Fri. - 1/2 Mon. & 1/2 Tues. - 1/2 Tues. & 1/2 Thurs. - 1/2 Wed. & 1/2 Fri. - Once Anytime Mon. through Fri. - Tuesday through Friday - Monday, Tuesday and Thursday - Monday, Tuesday and Friday - Wednesday and Thursday - Monday, Wednesday and Thursday - Tuesday, Thursday and Friday - 1/2 Tues. & 1/2 Fri. - 1/2 Mon. & 1/2 Wed. - 1/3 Mon., 1/3 Wed., 1/3 Fri. - Whenever Necessary - 1/2 By Wed. Bal. By Fri. - >- None (Also Used to Cancel or Override a Previous Pattern) deliveryOrCalendarPatternQualifierCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - A - B - C - D - E - F - G - H - J - K - L - M - 'N' - O - P - Q - R - S - SG - SL - SP - SX - SY - SZ - T - U - V - W - X - 'Y' deliveryOrCalendarPatternQualifier: type: string enum: - 1st Week of the Month - 2nd Week of the Month - 3rd Week of the Month - 4th Week of the Month - 5th Week of the Month - 1st & 3rd Week of the Month - 2nd & 4th Week of the Month - 1st Working Day of Period - Last Working Day of Period - Monday through Friday - Monday through Saturday - Monday through Sunday - Monday - Tuesday - Wednesday - Thursday - Friday - Saturday - Sunday - Monday through Thursday - Immediately - As Directed - Daily Mon. Through Fri. - 1/2 Mon. & 1/2 Tues. - 1/2 Tues. & 1/2 Thurs. - 1/2 Wed. & 1/2 Fri. - Once Anytime Mon. through Fri. - Tuesday through Friday - Monday, Tuesday and Thursday - Monday, Tuesday and Friday - Wednesday and Thursday - Monday, Wednesday and Thursday - Tuesday, Thursday and Friday - 1/2 Tues. & 1/2 Fri. - 1/2 Mon. & 1/2 Wed. - 1/3 Mon., 1/3 Wed., 1/3 Fri. - Whenever Necessary - 1/2 By Wed. Bal. By Fri. - >- None (Also Used to Cancel or Override a Previous Pattern) deliveryPatternTimeCode: type: string enum: - 1st Shift (Normal Working Hours) - 2nd Shift - 3rd Shift - A.M. - P.M. - As Directed - Any Shift - >- None (Also Used to Cancel or Override a Previous Pattern) deliveryPatternTimeQualifierCode: type: string enum: - A - B - C - D - E - F - G - 'Y' deliveryPatternTimeQualifier: type: string enum: - 1st Shift (Normal Working Hours) - 2nd Shift - 3rd Shift - A.M. - P.M. - As Directed - Any Shift - >- None (Also Used to Cancel or Override a Previous Pattern) additionalProperties: false additionalInformation: type: array items: type: object properties: description: type: string additionalProperties: false eligibilityAdditionalInformationList: type: array items: type: object properties: codeListQualifierCode: type: string enum: - GR - NI - ZZ codeListQualifier: type: string industryCode: type: string industry: type: string codeCategory: type: string enum: - '44' injuredBodyPartName: type: string additionalProperties: false benefitsRelatedEntities: type: array items: type: object properties: entityIdentifier: type: string enum: - Contracted Service Provider - Preferred Provider Organization (PPO) - Provider - Third-Party Administrator - Employer - Other Physician - Facility - Gateway Provider - Group - Independent Physicians Association (IPA) - Insured or Subscriber - Legal Representative - Origin Carrier - Primary Care Provider - Prior Insurance Carrier - Plan Sponsor - Payer - Primary Payer - Secondary Payer - Tertiary Payer - Party Performing Verification - Vendor - >- Organization Completing Configuration Change - Utilization Management Organization - Managed Care Organization entityType: type: string enum: - Person - Non-Person Entity entityName: type: string entityFirstname: type: string entityMiddlename: type: string entitySuffix: type: string entityIdentification: type: string enum: - '24' - '34' - '46' - FA - FI - II - MI - NI - PI - PP - SV - XV - XX entityIdentificationValue: type: string entityRelationship: type: string enum: - '01' - '02' - '27' - '41' - '48' - '65' - '72' address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false contactInformation: type: object properties: name: type: string contacts: type: array items: type: object properties: communicationMode: type: string enum: - >- Electronic Data Interchange Access Number - Electronic Mail - Facsimile - Telephone - Uniform Resource Locator (URL) communicationNumber: type: string additionalProperties: false additionalProperties: false providerInformation: type: object properties: providerCode: type: string enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string additionalProperties: false additionalProperties: false benefitsDateInformation: type: object properties: discharges: type: array items: type: object properties: date: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ startDate: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ endDate: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ additionalProperties: false issue: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ effectiveDateOfChange: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ periodStart: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ periodEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ completion: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ coordinationOfBenefits: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ plan: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ benefit: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ primaryCareProvider: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ latestVisitOrConsultation: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ eligibility: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ added: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ cobraBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ cobraEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ premiumPaidtoDateBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ premiumPaidToDateEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ planBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ planEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ benefitBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ benefitEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ eligibilityBegin: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ eligibilityEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ enrollment: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ admissions: type: array items: type: object properties: date: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ startDate: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ endDate: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ additionalProperties: false dateOfDeath: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ certification: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ service: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ policyEffective: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ policyExpiration: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ dateOfLastUpdate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ status: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ discharge: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ admission: type: string pattern: >- ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ additionalProperties: false benefitsRelatedEntity: type: object properties: entityIdentifier: type: string enum: - Contracted Service Provider - Preferred Provider Organization (PPO) - Provider - Third-Party Administrator - Employer - Other Physician - Facility - Gateway Provider - Group - Independent Physicians Association (IPA) - Insured or Subscriber - Legal Representative - Origin Carrier - Primary Care Provider - Prior Insurance Carrier - Plan Sponsor - Payer - Primary Payer - Secondary Payer - Tertiary Payer - Party Performing Verification - Vendor - >- Organization Completing Configuration Change - Utilization Management Organization - Managed Care Organization entityType: type: string enum: - Person - Non-Person Entity entityName: type: string entityFirstname: type: string entityMiddlename: type: string entitySuffix: type: string entityIdentification: type: string enum: - '24' - '34' - '46' - FA - FI - II - MI - NI - PI - PP - SV - XV - XX entityIdentificationValue: type: string entityRelationship: type: string enum: - '01' - '02' - '27' - '41' - '48' - '65' - '72' address: type: object properties: address1: type: string minLength: 1 maxLength: 55 address2: type: string minLength: 1 maxLength: 55 city: type: string minLength: 2 maxLength: 30 state: type: string enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY postalCode: type: string minLength: 5 maxLength: 9 countryCode: type: string minLength: 2 maxLength: 2 countrySubDivisionCode: type: string minLength: 1 maxLength: 3 additionalProperties: false contactInformation: type: object properties: name: type: string contacts: type: array items: type: object properties: communicationMode: type: string enum: - >- Electronic Data Interchange Access Number - Electronic Mail - Facsimile - Telephone - Uniform Resource Locator (URL) communicationNumber: type: string additionalProperties: false additionalProperties: false providerInformation: type: object properties: providerCode: type: string enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU referenceIdentification: type: string additionalProperties: false additionalProperties: false eligibilityAdditionalInformation: type: object properties: codeListQualifierCode: type: string enum: - GR - NI - ZZ codeListQualifier: type: string industryCode: type: string industry: type: string codeCategory: type: string enum: - '44' injuredBodyPartName: type: string additionalProperties: false additionalProperties: false inNetwork: type: boolean required: - inNetwork additionalProperties: false description: >- The eligibility responses that the patient has in order of preference (primary, secondary, etc.). lineItems: type: array items: type: object properties: id: type: string cptCode: type: string serviceDate: type: string serviceAmount: type: number required: - id - cptCode - serviceDate - serviceAmount additionalProperties: false description: The line items you are estimating the patient cost for required: - eligibilityResponses - lineItems additionalProperties: false required: true responses: '200': description: Default Response ````