Candid Health Eligibility API

openapi: 3.0.1
info:
  title: Candid Health Auth Eligibility API
  description: REST API for Candid Health, an autonomous medical-billing and revenue-cycle management platform. Submit encounters and claims, run eligibility checks, capture charges, look up payers and fee schedules, retrieve insurance adjudications (ERAs / remits), and scan billing lifecycle events. All requests are authenticated with an OAuth bearer token obtained from the auth token endpoint.
  termsOfService: https://www.joincandidhealth.com
  contact:
    name: Candid Health Support
    url: https://docs.joincandidhealth.com/additional-resources/support
  version: '1.0'
servers:
- url: https://api.joincandidhealth.com/api
  description: Candid Health production API
security:
- bearerAuth: []
tags:
- name: Eligibility
  description: Real-time and batch insurance eligibility checks.
paths:
  /eligibility/v2:
    post:
      operationId: submitEligibilityCheck
      tags:
      - Eligibility
      summary: Submit an encounter eligibility check.
      description: Runs a real-time eligibility check against a payer to confirm active coverage and surface patient benefit detail.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/EligibilityCheckRequest'
      responses:
        '200':
          description: Eligibility result (270/271 response detail).
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityCheckResponse'
  /pre-encounter/coverages/v1/check_eligibility:
    post:
      operationId: checkCoverageEligibility
      tags:
      - Eligibility
      summary: Check eligibility for a stored coverage.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/EligibilityCheckRequest'
      responses:
        '200':
          description: Eligibility result.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityCheckResponse'
components:
  schemas:
    Address:
      type: object
      properties:
        address1:
          type: string
        address2:
          type: string
          nullable: true
        city:
          type: string
        state:
          type: string
        zip_code:
          type: string
    BillingProvider:
      type: object
      properties:
        organization_name:
          type: string
        npi:
          type: string
        tax_id:
          type: string
        address:
          $ref: '#/components/schemas/Address'
    Patient:
      type: object
      properties:
        external_id:
          type: string
        first_name:
          type: string
        last_name:
          type: string
        date_of_birth:
          type: string
          format: date
        gender:
          type: string
        address:
          $ref: '#/components/schemas/Address'
    EligibilityCheckResponse:
      type: object
      properties:
        eligibility_check_id:
          type: string
          format: uuid
        active_coverage:
          type: boolean
        benefits:
          type: array
          items:
            type: object
            properties:
              name:
                type: string
              coverage_level:
                type: string
              amount_cents:
                type: integer
        raw_271:
          type: object
          description: Raw 271 eligibility response payload.
    EligibilityCheckRequest:
      type: object
      properties:
        payer_id:
          type: string
        provider:
          $ref: '#/components/schemas/BillingProvider'
        subscriber:
          $ref: '#/components/schemas/Patient'
        service_type_codes:
          type: array
          items:
            type: string
        date_of_service:
          type: string
          format: date
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
      description: 'OAuth bearer token obtained from POST /auth/v2/token. Send as `Authorization: Bearer <access_token>`.'