Stedi Real-time eligibility check API
The Real-time eligibility check API from Stedi — 2 operation(s) for real-time eligibility check.
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 Real-time eligibility check API
version: '2025-03-07'
servers:
- description: Production
url: https://claims.us.stedi.com/2025-03-07
security:
- httpApiKeyAuth: []
tags:
- name: Real-time eligibility check
paths:
/change/medicalnetwork/eligibility/v3:
post:
description: Submit a real-time 270/271 eligibility check in JSON format
externalDocs:
description: Developer guide
url: https://www.stedi.com/docs/healthcare/send-eligibility-checks
operationId: EligibilityCheck
parameters:
- in: header
name: X-Forwarded-For
schema:
description: '**(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request''s point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS.
When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States.
Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples.'
type: string
requestBody:
content:
application/json:
examples:
EligibilityCheck_example1:
description: ''
summary: Eligibility check
value:
encounter:
serviceTypeCodes:
- MH
externalPatientId: UAA111222333
provider:
npi: '1999999984'
organizationName: ACME Health Services
subscriber:
dateOfBirth: '19000101'
firstName: Jane
lastName: Doe
memberId: '123456789'
tradingPartnerServiceId: AHS
EligibilityCheck_example2:
description: ''
summary: Invalid provider name
value:
provider:
npi: '1447848577'
organizationName: SIMPSON
subscriber:
dateOfBirth: '20240606'
firstName: Abe
lastName: Stedi
tradingPartnerServiceId: BS001
schema:
$ref: '#/components/schemas/EligibilityCheckRequestContent'
required: true
responses:
'200':
content:
application/json:
examples:
EligibilityCheck_example1:
description: ''
summary: Eligibility check
value:
benefitsInformation:
- additionalInformation:
- description: Complete Care Management
code: '1'
name: Active Coverage
planCoverage: Open Access Plus
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
- additionalInformation:
- description: Includes services provided by Client Specific Network
- description: Coinsurance does apply to member's out-of-pocket maximum
- description: Copay does apply to member's out-of-pocket maximum
- description: Deductible does apply to member's out-of-pocket maximum
benefitAmount: '6000'
code: G
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Out of Pocket (Stop Loss)
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- additionalInformation:
- description: Includes services provided by Client Specific Network
benefitAmount: '500'
code: C
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- additionalInformation:
- description: Includes services provided by Client Specific Network
- description: Copay does apply to member's out-of-pocket maximum
- description: Coinsurance does apply to member's out-of-pocket maximum
- description: Deductible does apply to member's out-of-pocket maximum
benefitAmount: '3000'
code: G
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Out of Pocket (Stop Loss)
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- additionalInformation:
- description: Includes services provided by Client Specific Network
benefitAmount: '250'
code: C
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- benefitAmount: '15000'
code: C
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Deductible
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- additionalInformation:
- description: Coinsurance does apply to member's out-of-pocket maximum
- description: Deductible does apply to member's out-of-pocket maximum
benefitAmount: '30000'
code: G
coverageLevel: Family
coverageLevelCode: FAM
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Out of Pocket (Stop Loss)
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- benefitPercent: '0.1'
code: A
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
- benefitAmount: '7500'
code: C
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Deductible
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- additionalInformation:
- description: Deductible does apply to member's out-of-pocket maximum
- description: Coinsurance does apply to member's out-of-pocket maximum
benefitAmount: '15000'
code: G
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Out of Pocket (Stop Loss)
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
timeQualifier: Calendar Year
timeQualifierCode: '23'
- benefitPercent: '0.5'
code: A
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'No'
inPlanNetworkIndicatorCode: N
name: Co-Insurance
serviceTypeCodes:
- '30'
serviceTypes:
- Health Benefit Plan Coverage
- code: '1'
inPlanNetworkIndicator: Not Applicable
inPlanNetworkIndicatorCode: W
name: Active Coverage
serviceTypeCodes:
- A7
- BC
- A8
- A4
- A5
- A6
- '7'
- '4'
- BB
- '22'
serviceTypes:
- Psychiatric - Inpatient
- Day Care (Psychiatric)
- Psychiatric - Outpatient
- Psychiatric
- Psychiatric - Room and Board
- Psychotherapy
- Anesthesia
- Diagnostic X-Ray
- Partial Hospitalization (Psychiatric)
- Social Work
- additionalInformation:
- description: Includes services provided by Client Specific Network
authOrCertIndicator: N
benefitAmount: '0'
code: C
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- BC
- A4
- A6
- '4'
- '22'
serviceTypes:
- Day Care (Psychiatric)
- Psychiatric
- Psychotherapy
- Diagnostic X-Ray
- Social Work
- additionalInformation:
- description: Includes services provided by Client Specific Network
authOrCertIndicator: N
benefitAmount: '0'
code: C
coverageLevel: Individual
coverageLevelCode: IND
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- A8
serviceTypes:
- Psychiatric - Outpatient
- additionalInformation:
- description: Includes services provided by Client Specific Network
authOrCertIndicator: N
benefitAmount: '0'
code: C
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- A4
- A6
- '4'
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Diagnostic X-Ray
- Social Work
- additionalInformation:
- description: Includes services provided by Client Specific Network
authOrCertIndicator: N
benefitAmount: '0'
code: C
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
- authOrCertIndicator: N
benefitAmount: '20'
code: B
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
timeQualifier: Visit
timeQualifierCode: '27'
- authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- A4
- A6
- '4'
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Diagnostic X-Ray
- Social Work
- additionalInformation:
- description: Included For Specific Services
authOrCertIndicator: N
benefitAmount: '20'
code: B
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Included For Specific Services
authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- A4
- A6
- '4'
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Diagnostic X-Ray
- Social Work
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: N
benefitAmount: '20'
code: B
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Telehealth Provided Other than in Patient’s Home
industryCode: '02'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: N
benefitAmount: '20'
code: B
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Payment
serviceTypeCodes:
- A4
- A6
- '22'
serviceTypes:
- Psychiatric
- Psychotherapy
- Social Work
timeQualifier: Visit
timeQualifierCode: '27'
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: Y
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- '7'
serviceTypes:
- Anesthesia
- authOrCertIndicator: Y
code: CB
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Coverage Basis
serviceTypeCodes:
- '7'
- BB
serviceTypes:
- Anesthesia
- Partial Hospitalization (Psychiatric)
- additionalInformation:
- description: Includes services provided by Client Specific Network
authOrCertIndicator: Y
benefitAmount: '0'
code: C
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Deductible
serviceTypeCodes:
- '7'
serviceTypes:
- Anesthesia
- authOrCertIndicator: Y
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Office
industryCode: '11'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- '7'
serviceTypes:
- Anesthesia
- authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
inPlanNetworkIndicator: 'Yes'
inPlanNetworkIndicatorCode: Y
name: Co-Insurance
serviceTypeCodes:
- '4'
serviceTypes:
- Diagnostic X-Ray
- additionalInformation:
- description: Services rendered thru Client Specific Network
authOrCertIndicator: N
benefitPercent: '0'
code: A
coverageLevel: Individual
coverageLevelCode: IND
eligibilityAdditionalInformation:
codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
eligibilityAdditionalInformationList:
- codeListQualifier: Mutually Defined
codeListQualifierCode: ZZ
industry: Outpatient Hospital
industryCode: '22'
inPlanNetworkIndica
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