The Insurance discovery API from Stedi — 2 operation(s) for insurance discovery.
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openapi: 3.2.0
info:
contact:
email: healthcare@stedi.com
license:
name: Proprietary
url: https://stedi.com
title: Stedi Healthcare Insurance discovery API
version: '2024-04-01'
servers:
- description: Production
url: https://healthcare.us.stedi.com/2024-04-01
- description: Production (2026-06-01)
url: https://healthcare.us.stedi.com/2026-06-01
security:
- httpApiKeyAuth: []
tags:
- name: Insurance discovery
paths:
/insurance-discovery/check/v1:
post:
description: Submit an insurance discovery check in JSON format
externalDocs:
description: Developer guide
url: https://www.stedi.com/docs/healthcare/insurance-discovery
operationId: InsuranceDiscoveryCheck
requestBody:
content:
application/json:
examples:
InsuranceDiscoveryCheck_example1:
description: ''
summary: Insurance discovery check
value:
encounter:
beginningDateOfService: '20240326'
endDateOfService: '20240326'
provider:
npi: '1999999984'
subscriber:
address:
address1: 123 Main St
city: Springfield
postalCode: '62701'
state: IL
dateOfBirth: '19800101'
firstName: John
gender: M
lastName: Smith
middleName: Robert
ssn: '123456789'
schema:
$ref: '#/components/schemas/InsuranceDiscoveryCheckRequestContent'
required: true
responses:
'200':
content:
application/json:
examples:
InsuranceDiscoveryCheck_example1:
description: ''
summary: Insurance discovery check
value:
discoveryId: 12345678-abcd-4321-efgh-987654321abc
items:
- benefitsInformation:
- additionalInformation:
- description: To determine if a prior authorization is required, please check the health plan's website.
benefitsRelatedEntities:
- entityFirstname: Jane
entityIdentification: XX
entityIdentificationValue: '1234567890'
entityIdentifier: Primary Care Provider
entityName: Dough
entityType: Person
code: '1'
inPlanNetworkIndicator: Not Applicable
inPlanNetworkIndicatorCode: W
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
- code: '1'
inPlanNetworkIndicator: Not Applicable
inPlanNetworkIndicatorCode: W
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '1'
serviceTypes:
- Medical Care
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '4'
serviceTypes:
- Diagnostic X-Ray
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '4'
serviceTypes:
- Diagnostic X-Ray
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '4'
serviceTypes:
- Diagnostic X-Ray
- code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '5'
serviceTypes:
- Diagnostic Lab
- additionalInformation:
- description: per visit
benefitAmount: '20'
code: B
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
planCoverage: Gold Plan
serviceTypeCodes:
- '5'
serviceTypes:
- Diagnostic Lab
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '5'
serviceTypes:
- Diagnostic Lab
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '12'
serviceTypes:
- Durable Medical Equipment Purchase
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '12'
serviceTypes:
- Durable Medical Equipment Purchase
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '12'
serviceTypes:
- Durable Medical Equipment Purchase
- code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '13'
serviceTypes:
- Ambulatory Service Center Facility
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '13'
serviceTypes:
- Ambulatory Service Center Facility
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '13'
serviceTypes:
- Ambulatory Service Center Facility
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '18'
serviceTypes:
- Durable Medical Equipment Rental
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '18'
serviceTypes:
- Durable Medical Equipment Rental
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '18'
serviceTypes:
- Durable Medical Equipment Rental
- additionalInformation:
- description: Limited to 26 visits per year (visits in excess of 26 require prior authorization).
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '33'
serviceTypes:
- Chiropractic
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '33'
serviceTypes:
- Chiropractic
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '33'
serviceTypes:
- Chiropractic
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '48'
serviceTypes:
- Hospital - Inpatient
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '48'
serviceTypes:
- Hospital - Inpatient
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '48'
serviceTypes:
- Hospital - Inpatient
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '50'
serviceTypes:
- Hospital - Outpatient
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '50'
serviceTypes:
- Hospital - Outpatient
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '50'
serviceTypes:
- Hospital - Outpatient
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '51'
serviceTypes:
- Hospital - Emergency Accident
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '51'
serviceTypes:
- Hospital - Emergency Accident
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '51'
serviceTypes:
- Hospital - Emergency Accident
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '51'
serviceTypes:
- Hospital - Emergency Accident
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '52'
serviceTypes:
- Hospital - Emergency Medical
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '52'
serviceTypes:
- Hospital - Emergency Medical
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '52'
serviceTypes:
- Hospital - Emergency Medical
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '52'
serviceTypes:
- Hospital - Emergency Medical
timeQualifier: Visit
timeQualifierCode: '27'
- code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '53'
serviceTypes:
- Hospital - Ambulatory Surgical
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '53'
serviceTypes:
- Hospital - Ambulatory Surgical
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '53'
serviceTypes:
- Hospital - Ambulatory Surgical
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '62'
serviceTypes:
- MRI/CAT Scan
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '62'
serviceTypes:
- MRI/CAT Scan
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '62'
serviceTypes:
- MRI/CAT Scan
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '65'
serviceTypes:
- Newborn Care
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '65'
serviceTypes:
- Newborn Care
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '65'
serviceTypes:
- Newborn Care
- additionalInformation:
- description: Covered in accordance with ACA guidelines.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '68'
serviceTypes:
- Well Baby Care
- benefitAmount: '0'
code: B
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
planCoverage: Gold Plan
serviceTypeCodes:
- '68'
serviceTypes:
- Well Baby Care
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '68'
serviceTypes:
- Well Baby Care
- additionalInformation:
- description: Prior authorization may be required. Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '69'
serviceTypes:
- Maternity
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '69'
serviceTypes:
- Maternity
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '69'
serviceTypes:
- Maternity
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '86'
serviceTypes:
- Emergency Services
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '86'
serviceTypes:
- Emergency Services
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Covered No Limit.
code: '1'
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '86'
serviceTypes:
- Emergency Services
- benefitPercent: '0.5'
code: A
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Co-Insurance
planCoverage: Gold Plan
serviceTypeCodes:
- '86'
serviceTypes:
- Emergency Services
timeQualifier: Visit
timeQualifierCode: '27'
- code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '88'
serviceTypes:
- Pharmacy
- additionalInformation:
- description: per prescription
benefitAmount: '10'
code: B
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
planCoverage: Gold Plan
serviceTypeCodes:
- '88'
serviceTypes:
- Pharmacy
timeQualifier: Visit
timeQualifierCode: '27'
- code: I
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Non-Covered
planCoverage: Gold Plan
serviceTypeCodes:
- '88'
serviceTypes:
- Pharmacy
- additionalInformation:
- description: PCP
code: '1'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Active Coverage
planCoverage: Gold Plan
serviceTypeCodes:
- '98'
serviceTypes:
- Professional (Physician) Visit - Office
- additionalInformation:
- description: per visit
- description: PCP
benefitAmount: '15'
code: B
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
planCoverage: Gold Plan
serviceTypeCodes:
- '98'
serviceTypes:
- Professional (Physician) Visit - Office
timeQualifier: Visit
timeQualifierCode: '27'
- additionalI
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# Full source: https://raw.githubusercontent.com/api-evangelist/stedi/refs/heads/main/openapi/stedi-insurance-discovery-api-openapi.yml