Stedi Coordination of benefits API
The Coordination of benefits API from Stedi — 1 operation(s) for coordination of benefits.
OpenAPI Specification
openapi: 3.0.3
info:
contact:
email: healthcare@stedi.com
license:
name: Proprietary
url: https://stedi.com
title: Stedi Healthcare Claims Claim acknowledgments Coordination of benefits API
version: '2025-03-07'
servers:
- description: Production
url: https://claims.us.stedi.com/2025-03-07
security:
- httpApiKeyAuth: []
tags:
- name: Coordination of benefits
paths:
/coordination-of-benefits:
post:
description: Submit a coordination of benefits (COB) check in JSON format
externalDocs:
description: Developer guide
url: https://www.stedi.com/docs/healthcare/coordination-of-benefits
operationId: CoordinationOfBenefits
requestBody:
content:
application/json:
examples:
CoordinationOfBenefits_example1:
description: ''
summary: COB check - dependent
value:
dependent:
dateOfBirth: '2002-12-31'
firstName: Jordan
lastName: Doe
encounter:
dateOfService: '2024-08-02'
serviceTypeCode: '30'
provider:
npi: '1999999984'
organizationName: ACME Health Services
subscriber:
dateOfBirth: '1985-05-27'
firstName: John
lastName: Doe
memberId: W000000000
tradingPartnerServiceId: SOMEID
schema:
$ref: '#/components/schemas/CoordinationOfBenefitsRequestContent'
required: true
responses:
'200':
content:
application/json:
examples:
CoordinationOfBenefits_example1:
description: ''
summary: COB check - dependent
value:
benefitsInformation:
- benefitsDateInformation:
benefitBegin: '2023-03-01'
code: '1'
name: Active Coverage
serviceTypeCodes:
- '1'
serviceTypes:
- Medical Care
subscriber:
dateOfBirth: '2002-02-27'
- benefitsDateInformation:
benefitBegin: '2023-03-01'
code: '1'
name: Active Coverage
serviceTypeCodes:
- '88'
serviceTypes:
- Pharmacy
subscriber:
dateOfBirth: '2002-02-27'
- benefitsDateInformation:
benefitBegin: '2023-03-01'
code: '1'
name: Active Coverage
serviceTypeCodes:
- AL
serviceTypes:
- Vision (Optometry)
subscriber:
dateOfBirth: '2002-02-27'
- benefitsDateInformation:
coordinationOfBenefits: '2024-07-01'
benefitsRelatedEntities:
- entityIdentification: PI
entityIdentificationValue: '1006'
entityIdentifier: Primary Payer
entityName: CIGNA
- entityFirstname: JOHN
entityIdentification: MI
entityIdentificationValue: '00000000000'
entityIdentifier: Insured or Subscriber
entityLastname: DOE
entityMiddlename: X
code: R
name: Other or Additional Payor
serviceTypeCodes:
- '1'
serviceTypes:
- Medical Care
subscriber:
dateOfBirth: '2002-12-31'
coordinationOfBenefits:
benefitOverlap: true
classification: CobInstanceExistsPrimacyDetermined
coverageOverlap: true
instanceExists: true
primacyDetermined: true
dependent:
address:
address1: 1 MAIN ST.
city: NEW YORK
postalCode: '10000'
state: NY
dateOfBirth: '2002-12-31'
firstName: JORDAN
gender: M
lastName: DOE
relationToSubscriber: Child
relationToSubscriberCode: '19'
errors: []
meta:
applicationMode: production
outboundTraceId: 01JDQFT4W3KTWZNTADEZ55BFFX
traceId: 01JDQFT4W3KTWZNTADEZ55BFFX
payer:
name: Aetna
payerIdentification: AETNA-USH
provider:
npi: '1999999984'
providerName: ACME Health Services
subscriber:
address:
address1: 1 MAIN ST.
city: NEW YORK
postalCode: '10000'
state: NY
firstName: JOHN
lastName: DOE
memberId: W000000000
schema:
$ref: '#/components/schemas/CoordinationOfBenefitsResponseContent'
description: CoordinationOfBenefits 200 response
'400':
content:
application/json:
schema:
$ref: '#/components/schemas/CoordinationOfBenefits400ErrorResponseContent'
description: CoordinationOfBenefits400Error 400 response
'403':
content:
application/json:
schema:
$ref: '#/components/schemas/AccessDeniedExceptionResponseContent'
description: AccessDeniedException 403 response
'404':
content:
application/json:
schema:
$ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent'
description: ResourceNotFoundException 404 response
'429':
content:
application/json:
schema:
$ref: '#/components/schemas/ThrottlingExceptionResponseContent'
description: ThrottlingException 429 response
'500':
content:
application/json:
schema:
$ref: '#/components/schemas/InternalFailureExceptionResponseContent'
description: InternalFailureException 500 response
'503':
content:
application/json:
schema:
$ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent'
description: ServiceUnavailableException 503 response
'504':
content:
application/json:
schema:
$ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent'
description: GatewayTimeoutException 504 response
tags:
- Coordination of benefits
components:
schemas:
EntityIdentificationCode:
description: Code identifying the type of `entityIdentificationValue`.
enum:
- MI
- PI
type: string
COBPayer:
properties:
name:
description: The payer's name, such as `CIGNA`.
type: string
payerIdentification:
description: The `tradingPartnerServiceId` (Payer ID) you used to identify the payer in the COB request.
type: string
type: object
COBResponseDependent:
description: Information about the dependent listed in the original COB request.
properties:
aaaErrors:
description: When a COB request fails, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions.
items:
$ref: '#/components/schemas/EligibilityCheckError'
type: array
address:
$ref: '#/components/schemas/Address'
description: The dependent's address.
birthSequenceNumber:
description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date.
type: string
dateOfBirth:
description: The dependent's date of birth.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
firstName:
description: The dependent's first name.
type: string
gender:
$ref: '#/components/schemas/GenderWithUnknown'
description: Code indicating the dependent's gender. Can be `F` - Female, `M` - Male, or `U` - Unknown.
groupNumber:
description: The group number associated with the subscriber's insurance policy.
type: string
lastName:
description: The dependent's last name.
type: string
memberId:
description: The member ID for the subscriber's insurance policy.
type: string
middleName:
description: The dependent's middle name or initial.
type: string
relationToSubscriber:
$ref: '#/components/schemas/RelationToSubscriberCodeName'
description: The name of the `relationToSubscriberCode`. For example, `Child` when the code is `19`.
relationToSubscriberCode:
$ref: '#/components/schemas/RelationToSubscriberCode'
description: For the dependent, this can be `01` - Spouse, `19` - Child, `20` Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship.
ssn:
description: The dependent's Social Security Number (SSN).
pattern: ^\d{9}$
type: string
type: object
COBEncounter:
description: 'Information about the encounter.
- You can submit COB checks with the `30` service type code for Health Benefit Plan Coverage. This is the broadest service type code that covers all medical services and subtypes included in the patient’s health plan.
- The service dates you provide **must** be within the past 2 years. COB checks don''t support requests with dates outside of this range.
- Don''t send service dates that are in the future. Future service dates typically result in errors from the payer.
- If you don''t specify a service date (either a single day or a range of dates), Stedi defaults to using the current date.'
properties:
beginningDateOfService:
description: The beginning date of service. If you include this value, you must also include the `endDateOfService`.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
dateOfService:
description: The date of service of the encounter.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
endDateOfService:
description: The end date of service. If you include this value, you must also include the `beginningDateOfService`.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
serviceTypeCode:
$ref: '#/components/schemas/COBServiceTypeCode'
type: object
COBBenefitsInformationName:
description: The full name of the benefits information code.
enum:
- Active Coverage
- Inactive
- Other or Additional Payor
- Cannot Process
type: string
COBResponseServiceTypeCode:
description: Code identifying the type of services included in a `benefitsInformation` object.
enum:
- '1'
- '30'
- '33'
- '35'
- '47'
- '52'
- '88'
- '98'
- AL
- MH
- UC
type: string
ValidationException:
description: 'A standard error for input validation failures.
This should be thrown by services when a member of the input structure
falls outside of the modeled or documented constraints.'
properties:
fieldList:
description: 'A list of specific failures encountered while validating the input.
A member can appear in this list more than once if it failed to satisfy multiple constraints.'
items:
$ref: '#/components/schemas/ValidationExceptionField'
type: array
message:
description: A summary of the validation failure.
type: string
required:
- message
title: ValidationException
type: object
ServiceUnavailableExceptionResponseContent:
description: The server is temporarily unavailable.
properties:
code:
description: Classification of the exception type.
type: string
message:
description: Human readable exception message.
type: string
required:
- message
type: object
Address:
properties:
address1:
description: The first line of the address.
maxLength: 55
minLength: 1
type: string
address2:
description: The second line of the address.
maxLength: 55
minLength: 1
type: string
city:
description: The city.
maxLength: 30
minLength: 2
type: string
countryCode:
description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2).
maxLength: 2
minLength: 2
type: string
countrySubDivisionCode:
description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2).
maxLength: 3
minLength: 1
type: string
postalCode:
description: The United States or Canadian postal code, excluding punctuation and blanks.
maxLength: 9
minLength: 5
type: string
state:
$ref: '#/components/schemas/ResponseStateOrProvinceCode'
type: object
COBResponseBenefitsInformationSubscriber:
properties:
dateOfBirth:
description: The subscriber's date of birth.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
type: object
COBBenefitsDateInformation:
description: Dates associated with the benefits. Dates listed only apply to the `benefitsInformation` object in which this benefitsDateInformation is provided.
properties:
benefitBegin:
description: The date the benefits begin.
type: string
benefitEnd:
description: The date the benefits end.
type: string
coordinationOfBenefits:
description: Date or date range used for coordination of benefits instance.
type: string
periodEnd:
description: The end of the coverage overlap. Included when Stedi finds an instance of coverage overlap.
type: string
periodStart:
description: The start of the coverage overlap Included when Stedi finds an instance of coverage overlap.
type: string
planBegin:
description: Coverage start date. If multiple coverage start dates exist due to different start dates on various coverage/service types, this date applies to the medical coverage.
type: string
type: object
InternalFailureExceptionResponseContent:
description: The server response when an unexpected error occurred while processing request.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
AccessDeniedExceptionResponseContent:
description: The server response for authorization failure.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
CoordinationOfBenefitsRequestContent:
properties:
dependent:
$ref: '#/components/schemas/COBDependent'
encounter:
$ref: '#/components/schemas/COBEncounter'
provider:
$ref: '#/components/schemas/COBProvider'
description: An object containing information about the entity requesting the COB check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. You must provide the `organizationName` (if the entity is an organization) or `firstName` and `lastName` (if the provider is an individual). You must also provide the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier) (`npi`).
subscriber:
$ref: '#/components/schemas/COBSubscriber'
tradingPartnerServiceId:
description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list of supported payers for COB checks.\n - Each check **must** be for a participating health plan for which the patient has coverage. For example, if the patient has coverage from Cigna and UnitedHealthcare, a COB check to Aetna will return an error.\n - Medicare and Medicare Advantage plans aren't supported. If you submit a COB check for a Medicare or Medicare Advantage plan, the request will fail with an `AAA` = `75` error (Subscriber/Insured Not Found).\n - Ensure that you're sending the request to the correct payer entity. For example, Blue Cross Blue Shield (BCBS) has multiple entities that operate in different states. If you send a request to the wrong entity, the request will fail with an `AAA` = `75` error (Subscriber/Insured Not Found).\n - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`."
maxLength: 80
minLength: 1
type: string
required:
- encounter
- provider
- subscriber
- tradingPartnerServiceId
type: object
ResourceNotFoundExceptionResponseContent:
description: The server response when the specified resource cannot be found after an API request passes authentication and authorization.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
EligibilityCheckError:
description: When a payer rejects your eligibility check, the response contains one or more AAA errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors)
properties:
code:
$ref: '#/components/schemas/EligibilityCheckErrorCode'
description: 'The error code. Visit [Eligibility troubleshooting](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) for a complete list of all possible error codes and descriptions.
Payers may sometimes return other non-compliant values.'
description:
description: The error description.
type: string
field:
description: The error type, `AAA`.
type: string
followupAction:
$ref: '#/components/schemas/EligibilityCheckFollowupAction'
description: 'Recommended follow-up action based on the rejection reason code.
**Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately.
Payers may sometimes return other non-compliant values.'
location:
description: The location of the error within the original X12 EDI response.
type: string
possibleResolutions:
description: 'Information to help you correct the error.
We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**'
type: string
type: object
COBResponseBenefitsInformationCode:
description: The code indicating the type of benefits information. Can be `1` - Active Coverage, `6` - Inactive, `R` - Other or Additional Payor, or `V` - Cannot Process.
enum:
- '1'
- '6'
- R
- V
type: string
EligibilityCheckErrorCode:
description: 'This is a superset of all the possible codes in the sub-loops, as all errors are bubbled up to the top level of the response
Payers may sometimes return other non-compliant values.'
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
type: string
CoordinationOfBenefits400ErrorResponseContent:
oneOf:
- $ref: '#/components/schemas/BadRequestException'
- $ref: '#/components/schemas/ValidationException'
COBResponseSubscriber:
description: Information about the primary policyholder for the insurance plan listed in the COB request.
properties:
aaaErrors:
description: When a payer rejects your request, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions.
items:
$ref: '#/components/schemas/EligibilityCheckError'
type: array
address:
$ref: '#/components/schemas/Address'
description: The subscriber's address.
birthSequenceNumber:
description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date.
type: string
dateOfBirth:
description: The subscriber's date of birth.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
firstName:
description: The subscriber's first name.
type: string
gender:
$ref: '#/components/schemas/GenderWithUnknown'
description: Code indicating the subscriber's gender. Can be `F`- Female, `M` - Male, or `U` - Unknown.
groupNumber:
description: The group number associated with the subscriber's insurance policy.
type: string
lastName:
description: The subscriber's last name.
type: string
memberId:
description: The member ID for the subscriber's insurance policy.
type: string
middleName:
description: The subscriber's middle name or initial.
type: string
ssn:
description: The subscriber's Social Security Number (SSN).
pattern: ^\d{9}$
type: string
type: object
COBBenefitsInformation:
properties:
benefitsDateInformation:
$ref: '#/components/schemas/COBBenefitsDateInformation'
description: Dates associated with the benefits. All properties may either be expressed as a single date. Dates listed only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided.
benefitsRelatedEntities:
description: 'Contains either information about another payer with which the patient has coverage or information about the subscriber associated with the additional health plan.
For example, if you submit a COB check for a dependent to Cigna and Stedi finds additional coverage through Aetna, the `benefitsInformation[].benefitsRelatedEntities` instance would include subscriber details for the Aetna plan.'
items:
$ref: '#/components/schemas/COBBenefitsRelatedEntity'
type: array
code:
$ref: '#/components/schemas/COBResponseBenefitsInformationCode'
description: "The COB benefits information code. \n\nStedi returns entries with `benefitsInformation[].code` = `1` for every active coverage type for each health plan.\n\nStedi returns entries with `benefitsInformation[].code` = `R` when overlapping coverage exists within the date of service provided in the COB check."
name:
$ref: '#/components/schemas/COBBenefitsInformationName'
description: The name of the benefit information code.
serviceTypeCodes:
description: Code identifying the type of services.
items:
$ref: '#/components/schemas/COBResponseServiceTypeCode'
type: array
serviceTypes:
description: The full names of the service type codes.
items:
$ref: '#/components/schemas/COBResponseServiceTypeCodeName'
type: array
subscriber:
$ref: '#/components/schemas/COBResponseBenefitsInformationSubscriber'
description: Information about the primary policyholder for the insurance plan related to this `benefitsInformation` instance.
type: object
EntityIdentifierName:
description: Identifies the type of `benefitsInformation[].benefitsRelatedEntities`.
enum:
- Insured or Subscriber
- Payer
- Primary Payer
- Secondary Payer
- Tertiary Payer
type: string
COBMetaData:
properties:
applicationMode:
description: The type of data in the request. Stedi uses `production` to identify transactions processed in our live clearinghouse environment.
type: string
outboundTraceId:
description: The value provided in the `submitterTransactionIdentifier` property in the original COB request.
type: string
traceId:
description: A unique ID Stedi assigns to the COB request.
type: string
type: object
RelationToSubscriberCodeName:
description: The name of the `relationToSubscriberCode`.
enum:
- Spouse
- Child
- Employee
- Unknown
- Organ Donor
- Cadaver Donor
- Life Partner
- Other Relationship
type: string
GenderWithUnknown:
enum:
- M
- F
- U
type: string
COBBenefitsRelatedEntity:
properties:
entityFirstname:
description: The entity's first name, when the entity is a subscriber.
type: string
entityIdentification:
$ref: '#/components/schemas/EntityIdentificationCode'
description: Code identifying the type of `entityIdentificationValue`. This can be either `MI` - Member ID or `PI` - Payer ID.
entityIdentificationValue:
description: The identification number for the entity, qualified by the code in `entityIdentification`. The ID returned in this property is proprietary to our COB check product, so you can't use it as the Payer ID for eligibility checks or other API requests to Stedi. It likely doesn't match the Payer IDs listed in the [Payer Network](https://www.stedi.com/healthcare/network).
type: string
entityIdentifier:
$ref: '#/components/schemas/EntityIdentifierName'
description: 'Identifies the type of entity. This can either be a type of payer or the subscriber associated with the COB coverage.
Note that Stedi uses `Payer` either when there is no COB instance or when Stedi is unable to determine primacy.'
entityLastname:
description: The entity's last name, when the entity is a subscriber.
type: string
entityMiddlename:
description: The entity's middle name or initial, when the entity is a subscriber.
type: string
entityName:
description: The payer's business name, when the entity is a payer.
type: string
type: object
GatewayTimeoutExceptionResponseContent:
description: The server response for a gateway timeout error.
properties:
code:
description: Classification of the exception type.
type: string
message:
description: Human readable exception message.
type: string
required:
- message
type: object
ValidationExceptionField:
description: Describes one specific validation failure for an input member.
properties:
message:
description: A detailed description of the validation failure.
type: string
path:
description: A JSONPointer expression to the structure member whose value failed to satisfy the modeled constraints.
type: string
required:
- message
- path
type: object
COBSubscriber:
description: "The primary policyholder for the insurance plan _or_ a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave `dependent` empty.\n\n\n\nThe demographic information you provide **must** match the payer's data exactly. For example, if the payer has the subscriber's name as `Jonathan Doe`, a COB request for `Jon Doe` will fail because the name doesn't match the payer's records. Also note that:\n - Any prefix on the member's card is considered part of the `memberID` used for the search.\n - Mismatches in the `memberId` are one of the most common causes of `Member Not Found` errors. We strongly recommend first performing an [Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) and using the `memberId` in the response to populate your COB check.\n - We recommend including the `ssn` property in addition to the `memberId` if possible. This allows Stedi to do an additional search for the patient when the `memberId` doesn't return a match.\n - Stedi can identify coverage overlap for the same payer if the member ID differs between the two coverages."
properties:
dateOfBirth:
description: The subscriber's date of birth.
pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$
type: string
firstName:
description: The patient's first name.
maxLength: 35
minLength: 1
type: string
lastName:
description: The patient's last name.
maxLength: 60
minLength: 1
type: string
memberId:
description: "The member ID for the subscriber's insurance policy. \n\nYou must provide at least one of the `memberId` or `ssn` properties in the request. However, we recommend including both if possible. This allows Stedi to do an additional search for patient information when the `memberId` doesn't return a match."
maxLength: 80
minLength: 1
pattern: ^[A-Za-z0-9-]+$
type: string
ssn:
description: "The subscriber's Social Security Number (SSN). \n\nYou must provide at least one of the `memberId` or `ssn` properties
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# Full source: https://raw.githubusercontent.com/api-evangelist/stedi/refs/heads/main/openapi/stedi-coordination-of-benefits-api-openapi.yml