The Insurance discovery API from Stedi — 2 operation(s) for insurance discovery.
components:
schemas:
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
AdditionalInformation:
properties:
description:
description: A free-form message containing additional information about the benefits in the response.
type: string
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
ApplicationModes:
description: 'The type of data in the request. This is either `production` when you send a request with a
standard API key or `test` when you send a request in test mode with a [test API key](https://www.stedi.com/docs/api-reference/index#api-key-types).
The `information` value is not currently used.
Payers may sometimes return other non-compliant values.'
enum:
- production
- test
- information
type: string
AuthOrCertIndicator:
description: 'Code indicating whether the benefit is subject to prior authorization or certification.
Payers may sometimes return other non-compliant values.'
enum:
- N
- U
- Y
type: string
BenefitRelatedEntityIdentification:
description: 'Code identifying the type of value provided in `entityIdentificationValue`. For example, `FI`
- Federal Taxpayer''s Identification Number.
Payers may sometimes return other non-compliant values.'
enum:
- '24'
- '34'
- '46'
- FA
- FI
- II
- MI
- NI
- PI
- PP
- SV
- XV
- XX
type: string
BenefitsAdditionalInformation:
description: Identifying information specific to this type of benefit.
properties:
alternativeListId:
description: The alternative list ID. This identifier allows the payer to specify a list of drugs and
its alternative drugs with the associated formulary status for the patient.
type: string
coverageListId:
description: The coverage list ID. This identifier allows the payer to specify the identifier of a list
of drugs that have coverage limitations for the associated patient.
type: string
drugFormularyNumber:
description: The drug formulary number.
type: string
familyUnitNumber:
description: The family unit number. This is returned when the payer is a pharmacy benefits manager (PBM)
and the patient has a suffix to their member ID number that is used in the NCPDP Telecom Standard Insurance
Segment, in field `303-C3` (Person Code). For all other uses, the family unit number (suffix) is considered
part of the patient's member ID number.
type: string
groupDescription:
description: Group name
type: string
groupNumber:
description: The group number for the patient's health insurance plan.
type: string
hicNumber:
description: The health insurance claim number (HICN). Note that CMS previously used the HICN to uniquely
identify Medicare beneficiaries. However, they have since transitioned to a new, randomized Medicare
Beneficiary Identifier (MBI) format. The HICN is no longer used for Medicare transactions but this property
is now used by some payers to return MBI. If you receive a value in this property that matches the format
specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis),
the number is likely an MBI and we recommend sending a follow-up eligibility check to CMS for additional
benefits data. This most commonly occurs with patients who are covered by both Medicare and Medicaid.
type: string
insurancePolicyNumber:
description: The insurance policy number.
type: string
medicaidRecepientIdNumber:
description: The Medicaid Recipient Identification number.
type: string
medicalAssistanceCategory:
description: The medical assistance category.
type: string
memberId:
description: The patient's member ID.
type: string
planDescription:
description: Plan name
type: string
planNetworkDescription:
description: Plan network name
type: string
planNetworkIdNumber:
description: The plan network identification number.
type: string
planNumber:
description: The insurance plan number.
type: string
policyNumber:
description: The patient's policy number.
type: string
priorAuthorizationNumber:
description: The prior authorization number.
type: string
referralNumber:
description: The referral number.
type: string
type: object
BenefitsDateInformation:
description: "Dates associated with the benefits.\n - This is where you can find benefit-specific eligibility\
\ dates, if provided. These dates override dates provided in `planDateInformation` for this benefit type.\n\
\ - This is where the payer may specify the last time the service was rendered (`latestVisitOrConsultation`),\
\ which you can use to determine whether the patient has already reached the allowed frequency, if applicable.\
\ For example, this object could contain the date when the patient received their last dental cleaning.\n\
\ - These dates only apply to the `benefitsInformation` object in which this `benefitsDateInformation`\
\ is provided."
properties:
added:
description: Added date. Payers may return this information in the case of retroactive eligibility.
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]))?$
type: string
admission:
description: The admission date or dates.
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]))?$
type: string
admissions:
description: The date(s) for admission.
items:
$ref: '#/components/schemas/DtpDate'
type: array
benefit:
description: The benefit date.
pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$
type: string
benefitBegin:
description: The date when the benefit begins.
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]))?$
type: string
benefitEnd:
description: The date when the benefit ends.
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]))?$
type: string
certification:
deprecated: true
description: The certification date.
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]))?$
type: string
cobraBegin:
deprecated: true
description: The date when COBRA coverage begins.
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]))?$
type: string
cobraEnd:
deprecated: true
description: The date when COBRA coverage ends.
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]))?$
type: string
completion:
description: The completion date.
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]))?$
type: string
coordinationOfBenefits:
description: The coordination of benefits date.
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]))?$
type: string
dateOfDeath:
description: The date of death.
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]))?$
type: string
dateOfLastUpdate:
description: The date when the plan information was last updated.
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]))?$
type: string
discharge:
description: The discharge date.
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]))?$
type: string
discharges:
description: The date(s) when the patient was discharged.
items:
$ref: '#/components/schemas/DtpDate'
type: array
effectiveDateOfChange:
deprecated: true
description: The effective date of change.
pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$
type: string
eligibility:
description: Plan eligibility dates.
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]))?$
type: string
eligibilityBegin:
description: The date when the patient is first eligible for benefits under the plan.
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]))?$
type: string
eligibilityEnd:
description: The date when the patient is no longer eligible for benefits under the plan.
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]))?$
type: string
enrollment:
deprecated: true
description: The date when the patient is enrolled in the plan.
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]))?$
type: string
issue:
deprecated: true
description: The issue date.
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]))?$
type: string
latestVisitOrConsultation:
description: The latest visit or consultation date. This date may be used to determine whether the patient
has already reached the allowed frequency for a specific benefit.
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]))?$
type: string
periodEnd:
description: The end of a period.
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]))?$
type: string
periodStart:
description: The start of a period.
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]))?$
type: string
plan:
description: Only included when multiple plans apply to the patient or multiple plan periods apply.
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]))?$
type: string
planBegin:
description: Only included when multiple plans apply to the patient or multiple plan periods apply.
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]))?$
type: string
planEnd:
deprecated: true
description: The date coverage from the plan ends.
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]))?$
type: string
policyEffective:
deprecated: true
description: The date when the policy becomes effective.
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]))?$
type: string
policyExpiration:
deprecated: true
description: The date when the policy expires.
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]))?$
type: string
premiumPaidToDateEnd:
deprecated: true
description: The end of period when the plan premium payments are up-to-date.
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]))?$
type: string
premiumPaidtoDateBegin:
deprecated: true
description: The start of the period when the plan premium was paid in full.
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]))?$
type: string
primaryCareProvider:
description: The primary care provider date.
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]))?$
type: string
service:
description: The service date or dates.
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]))?$
type: string
status:
description: The status date.
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]))?$
type: string
type: object
BenefitsInformationCode:
description: 'The code indicating the type of benefits information. Visit [Eligibility and benefit codes](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#benefit-type-codes)
for more information.
Payers may sometimes return other non-compliant values.'
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
type: string
BenefitsInformationCoverageLevelCode:
description: "Code indicating the level of coverage for the patient. \n\nThis will either be `CHD` - Children\
\ Only, `DEP` - Dependents Only, `ECH` - Employee and Children, `EMP` - Employee Only, `ESP` - Employee\
\ and Spouse, `FAM` - Family, `IND` - Individual, `SPC` - Spouse and Children, `SPO` - Spouse Only, or `Unknown`.\n\
\nPayers may sometimes return other non-compliant values."
enum:
- CHD
- DEP
- ECH
- EMP
- ESP
- FAM
- IND
- SPC
- SPO
type: string
BenefitsInformationCoverageLevelName:
description: 'The full name of the coverage level code.
Payers may sometimes return other non-compliant values.'
enum:
- Children Only
- Dependents Only
- Employee and Children
- Employee Only
- Employee and Spouse
- Family
- Individual
- Spouse and Children
- Spouse Only
type: string
BenefitsInformationName:
description: 'The full name of the benefits information code.
Payers may sometimes return other non-compliant values.'
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
type: string
BenefitsRelatedEntity:
description: 'Identify another entity associated with the eligibility or benefits. This could be a provider,
an individual, an organization, or another payer.
This array is commonly used to designate the patient''s primary care provider (PCP), another organization
that handles a specific carveout benefit type, or another health plan for the patient (coordination of benefits
scenarios).
This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable
to the patient and the payer supports it.'
properties:
address:
$ref: '#/components/schemas/Address'
description: The address of the entity, such as a provider or organization.
contactInformation:
$ref: '#/components/schemas/ContactInformation'
description: The contact information for the entity, such as a phone number or email address.
entityFirstname:
description: The first name of the entity, if the entity is a person.
type: string
entityIdentification:
$ref: '#/components/schemas/BenefitRelatedEntityIdentification'
description: 'Code identifying the type of identifier in the `entityIdentificationValue` property. Visit
[Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#identification-code-qualifiers)
for a complete list.
Payers may sometimes return other non-compliant values.'
entityIdentificationValue:
description: The identification number for the entity, qualified by the code in `entityIdentification`.
type: string
entityIdentifier:
$ref: '#/components/schemas/RelatedEntityIdentifierName'
description: 'Code identifying an organizational entity, a physical location, property, or individual.
When set to `Party Performing Verification` for a BCBS payer, this is the patient''s home plan.
Payers may sometimes return other non-compliant values.'
entityMiddlename:
description: The middle name or initial of the entity, if the entity is a person.
type: string
entityName:
description: The last name (if the entity is a person) or the business name (if the entity is an organization).
type: string
entityRelationship:
$ref: '#/components/schemas/BenefitsRelatedEntityRelationshipCode'
description: 'Code specifying the relationship between the entity and the patient. Can be `01` - Parent,
`02` - Child, `27` - Domestic Partner, `41` - Spouse, `48` - Employee, `65` - Other, or `72` - Unknown.
Payers may sometimes return other non-compliant values.'
entitySuffix:
description: The name suffix, such as Sr. Jr. or III.
type: string
entityType:
$ref: '#/components/schemas/EntityTypeQualifier'
providerInformation:
$ref: '#/components/schemas/ProviderInformation'
type: object
BenefitsRelatedEntityRelationshipCode:
description: 'Code specifying the relationship between the entity and the patient.
Payers may sometimes return other non-compliant values.'
enum:
- '01'
- '02'
- '27'
- '41'
- '48'
- '65'
- '72'
type: string
BenefitsServiceDelivery:
description: The delivery or usage pattern for the benefits.
properties:
deliveryOrCalendarPatternCode:
$ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier'
deliveryOrCalendarPatternQualifier:
$ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier'
deliveryOrCalendarPatternQualifierCode:
$ref: '#/components/schemas/DeliveryOrCalendarPatternQualifierCode'
deliveryPatternTimeCode:
$ref: '#/components/schemas/DeliveryPatternTimeQualifier'
deliveryPatternTimeQualifier:
$ref: '#/components/schemas/DeliveryPatternTimeQualifier'
deliveryPatternTimeQualifierCode:
$ref: '#/components/schemas/DeliveryPatternTimeQualifierCode'
description: 'Code specifying the time for routine shipments or deliveries. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-pattern-time-codes)
for a complete list.
Payers may sometimes return other non-compliant values.'
numOfPeriods:
description: The number of periods in the time period. For example, `12` when the `timePeriodQualifier`
is `Hour`.
type: string
quantity:
description: The quantity of the benefit. For example, `10` when the `quantityQualifier` is `Visits`.
type: string
quantityQualifier:
$ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifier'
description: 'The name of the `quantityQualifierCode`. For example, `Days`.
Payers may sometimes return other non-compliant values.'
quantityQualifierCode:
$ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifierCode'
description: 'Code specifying the type of quantity for the benefit. Can be `DY` - Days, `FL` - Units,
`HS` - Hours, `MN` - Month, and `VS` - Visits.
Payers may sometimes return other non-compliant values.'
sampleSelectionModulus:
description: Specifies the sampling frequency, based on the unit of measure. For example `every 2 months`
or `once per calendar year`.
type: string
timePeriodQualifier:
$ref: '#/components/schemas/TimePeriodQualifier'
description: 'The name of the `timePeriodQualifierCode`. For example, `Calendar Year`.
Payers may sometimes return other non-compliant values.'
timePeriodQualifierCode:
$ref: '#/components/schemas/TimePeriodQualifierCode'
description: 'Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes)
for a complete list.
Payers may sometimes return other non-compliant values.'
unitForMeasurementCode:
$ref: '#/components/schemas/UnitForMeasurement'
deprecated: true
unitForMeasurementQualifier:
$ref: '#/components/schemas/UnitForMeasurement'
description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`.
Payers may sometimes return other non-compliant values.'
unitForMeasurementQualifierCode:
$ref: '#/components/schemas/UnitForMeasurementCode'
description: 'Code specifying the unit of measurement. For example, `DA` - Days, `MO` - Months, `VS` -
Visits, `WK` - Week, and `YR` - Years.
Payers may sometimes return other non-compliant values.'
type: object
BenefitsServiceDeliveryQuantityQualifier:
description: 'The name of the `quantityQualifierCode`. For example, `Days`.
Payers may sometimes return other non-compliant values.'
enum:
- Days
- Units
- Hours
- Month
- Visits
type: string
BenefitsServiceDeliveryQuantityQualifierCode:
description: 'Code specifying the type of quantity.
Payers may sometimes return other non-compliant values.'
enum:
- DY
- FL
- HS
- MN
- VS
type: string
CodeListQualifierCode:
description: Payers may sometimes return other non-compliant values.
enum:
- GR
- NI
- ZZ
type: string
CommunicationMode:
description: Payers may sometimes return other non-compliant values.
enum:
- Electronic Data Interchange Access Number
- Electronic Mail
- Facsimile
- Telephone
- Uniform Resource Locator (URL)
- Telephone Extension
- Work Phone Number
type: string
CompositeMedicalProcedureIdentifier:
description: Identifies relevant medical procedures by their standard codes and modifiers (if applicable).
properties:
diagnosisCodePointer:
description: The diagnosis code pointer.
items:
type: string
type: array
procedureCode:
description: The procedure code. Many payers do not support eligibility checks for specific procedure
codes. If the payer does not support procedure codes, they return a generic benefits response for the
service type code `30`.
type: string
procedureModifiers:
description: Procedure modifiers that provides additional information related to the performance of the
service.
items:
type: string
type: array
productOrServiceID:
description: The product or service ID. This value represents the end of the range of applicable procedure
codes. The beginning of the range is listed in `procedureCode`.
type: string
productOrServiceIDQualifier:
description: The name of the `productOrServiceIDQualifierCode`. For example, `American Dental Association`.
type: string
productOrServiceIDQualifierCode:
description: Identifies the external code list used to provide the specified procedure or service codes.
Can be `AD` - American Dental Association, `CJ` - Current Procedural Terminology (CPT) codes, `HC` -
Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International
Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion
EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually
Defined
type: string
type: object
Confidence:
properties:
level:
$ref: '#/components/schemas/ConfidenceLevel'
description: The confidence level for the match.
reason:
description: A reason for the confidence level. For example, `This record was identified as a low confidence
match due to a DOB partial match`.
type: string
type: object
ConfidenceLevel:
enum:
- REVIEW_NEEDED
- HIGH
type: string
ContactInformation:
properties:
contacts:
description: The contact information.
items:
$ref: '#/components/schemas/Contacts'
type: array
name:
description: The name of the contact person.
type: string
type: object
Contacts:
description: Contacts
properties:
communicationMode:
$ref: '#/components/schemas/CommunicationMode'
description: 'The type of communication number provided.
Payers may sometimes return other non-compliant values.'
communicationNumber:
description: "The communication number referenced in `communicationMode`. It includes the country or area\
\ code when applicable. \n \n Note that phone numbers are formatted as AAABBBCCCC, where AAA represents\
\ the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number.\
\ Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345`\
\ for `555-112-3345`."
type: string
type: object
DateTimePeriodFormatQualifier:
description: Payers may sometimes return other non-compliant values.
enum:
- D8
- RD8
type: string
DeliveryOrCalendarPatternQualifier:
description: 'The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`.
Payers may sometimes return other non-compliant values.'
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)
type: string
DeliveryOrCalendarPatternQualifierCode:
description: 'Code that specifies the routine shipments, deliveries, or calendar pattern. For example `9`
- Last Working Day of Period. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-frequency-codes)
for a complete list.
Payers may sometimes return other non-compliant values.'
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
type: string
DeliveryPatternTimeQualifier:
description: 'The name of the `deliveryPatternTimeCode`.
Payers may sometimes return other non-compliant values.'
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)
type: string
DeliveryPatternTimeQualifierCode:
description: 'A code specifying the time for routine shipments or deliveries.
Payers may sometimes return other non-compliant values.'
enum:
- A
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# Full source: https://raw.githubusercontent.com/api-evangelist/stedi/refs/heads/main/openapi/stedi-insurance-discovery-api-openapi.yml