The Real-time eligibility check API from Stedi — 2 operation(s) for real-time eligibility check.
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
AdditionalIdentificationDependent:
description: Use this object when you need to provide an additional identification number for the dependent.
This is rarely required for standard eligibility checks.
properties:
agencyClaimNumber:
description: The Property and Casualty Claim Number associated with the patient. You should only submit
this value when when you are submitting an eligibility request to a property and casualty payer.
maxLength: 50
minLength: 1
type: string
contractNumber:
description: The contract number for an existing contract between the payer and the provider requesting
the eligibility check.
maxLength: 50
minLength: 1
type: string
healthInsuranceClaimNumber:
description: This property is never used in practice.
maxLength: 50
minLength: 1
type: string
identificationCardSerialNumber:
description: The identification card serial number. You can include this when the ID card has a number
in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card
when multiple cards have been or will be issued to a member, such as a replacement card.
maxLength: 50
minLength: 1
type: string
insurancePolicyNumber:
description: The insurance policy number.
maxLength: 50
minLength: 1
type: string
medicalRecordIdentificationNumber:
description: The medical record identification number.
maxLength: 50
minLength: 1
type: string
memberIdentificationNumber:
description: 'Not intended for most use cases. Only set this when the property and casualty patient identifier
is a member ID that would be used in an 837 claim submission.
If the patient has their own member ID for the health plan, you should identify them in the `subscriber`
object. If the patient doesn''t have their own member ID, don''t set this property.'
maxLength: 50
minLength: 1
type: string
patientAccountNumber:
description: The patient account number.
maxLength: 50
minLength: 1
type: string
planNetworkIdentificationNumber:
description: The plan network identification number.
maxLength: 50
minLength: 1
type: string
planNumber:
description: The insurance plan number.
maxLength: 50
minLength: 1
type: string
policyNumber:
description: The insurance group or policy number.
maxLength: 50
minLength: 1
type: string
type: object
AdditionalIdentificationSubscriber:
description: 'Use this object when you need to provide an identification number other than or in addition
to the subscriber''s member ID. For example, you may provide the patient account number.
Don''t include the health insurance claim number or the medicaid recipient ID number here unless they are
different from the member ID.'
properties:
agencyClaimNumber:
description: The Property and Casualty Claim Number associated with the patient. You should only submit
this value when when you are submitting an eligibility request to a property and casualty payer.
maxLength: 50
minLength: 1
type: string
contractNumber:
description: The contract number for an existing contract between the payer and the provider requesting
the eligibility check.
maxLength: 50
minLength: 1
type: string
healthInsuranceClaimNumber:
description: The health insurance claim number.
maxLength: 50
minLength: 1
type: string
identificationCardSerialNumber:
description: The identification card serial number. You can include this when the ID card has a number
in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card
when multiple cards have been or will be issued to a member, such as a replacement card.
maxLength: 50
minLength: 1
type: string
insurancePolicyNumber:
description: The insurance policy number.
maxLength: 50
minLength: 1
type: string
medicalRecordIdentificationNumber:
description: The medical record identification number.
maxLength: 50
minLength: 1
type: string
memberIdentificationNumber:
description: This property is never used in practice. Supply the subscriber's member ID in `subscriber.memberId`.
maxLength: 50
minLength: 1
type: string
patientAccountNumber:
description: The patient account number.
maxLength: 50
minLength: 1
type: string
planNetworkIdentificationNumber:
description: The plan network identification number.
maxLength: 50
minLength: 1
type: string
planNumber:
description: The insurance plan number.
maxLength: 50
minLength: 1
type: string
policyNumber:
description: The insurance group or policy number.
maxLength: 50
minLength: 1
type: string
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
BenefitsInformation:
properties:
additionalInformation:
description: A free-form message containing additional information about the benefits in the response.
items:
$ref: '#/components/schemas/AdditionalInformation'
type: array
authOrCertIndicator:
$ref: '#/components/schemas/AuthOrCertIndicator'
description: "Code indicating whether the benefit is subject to prior authorization or certification.\
\ Can be `Y` - Yes, `N` - No, or `U` - Unknown.\n - When this property is set to `U`, it means the\
\ payer can't determine in real time whether prior authorization is required for the service. They may\
\ require additional details, like diagnosis or place of service to make a determination. Check the\
\ `additionalInformation[].description` property for any additional clarification. You can also contact\
\ the payer directly or use their provider portal to get more information.\n - Some payers may send\
\ additional notes about prior authorization rules in the `additionalInformation[].description` property.\
\ Payers may also send prior authorization notes in a separate `benefitsInformation` object with a code\
\ of `1` (Active coverage), `CB` (Coverage Benefit), or `D` (Benefit Description).\n\nVisit our [patient\
\ benefits docs](https://www.stedi.com/docs/healthcare/eligibility-network-status-authorization-referrals#is-prior-authorization-required)\
\ to learn more about prior authorization.\n\nPayers may sometimes return other non-compliant values."
benefitAmount:
description: "The monetary benefit amount, such as a patient's co-pay or deductible. This value is expressed\
\ as a decimal, such as 100.00. \n \n The payer will always send a value in this property when the `benefitsInformation[].code`\
\ = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or\
\ `Y` - Spend Down. For those codes, this value represents the patient's portion of responsibility.\
\ \n \n The payer will **never** send this value when `benefitsInformation[].code` = `A` - Co-Insurance.\
\ This property can contain zero when the patient has no responsibility. \n \n Learn more about [patient\
\ costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)."
type: string
benefitPercent:
description: "The percentage of the benefit, such as co-insurance. This property can contain zero when\
\ the patient has no responsibility. \n \n The payer will always send a value in this property when\
\ `benefitsInformation[].code` = `A` - Co-Insurance. For this code, this value represents the patient's\
\ portion of the responsibility. The percentage is expressed as a decimal, such as `0.80` represents\
\ 80%. \n \n The payer will **never** send a value in this property when `benefitsInformation[].code`\
\ = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment, or\
\ `Y` - Spend Down. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)."
type: string
benefitQuantity:
description: The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For
example, `10` when the `quantityQualifier` is `Visits`.
type: string
benefitsAdditionalInformation:
$ref: '#/components/schemas/BenefitsAdditionalInformation'
benefitsDateInformation:
$ref: '#/components/schemas/BenefitsDateInformation'
benefitsRelatedEntities:
description: 'Other entities associated with the eligibility or benefits. This could be a provider, an
individual, an organization, or another payer. When present, this array typically contains information
about the patient''s primary care provider (PCP), another organization that handles a specific benefit
type (such as telehealth mental health services), 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.
- For Blue Cross Blue Shield (BCBS) payers, Stedi returns an entry containing information about the
patient''s home plan - the plan that actually verified the coverage. In this object, the `entityIdentifier`
property is set to `Party Performing Verification`. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#bcbs-home-plan)'
items:
$ref: '#/components/schemas/BenefitsRelatedEntity'
type: array
benefitsRelatedEntity:
$ref: '#/components/schemas/BenefitsRelatedEntity'
deprecated: true
description: Please use `benefitsInformation[].benefitsRelatedEntities` instead.
benefitsServiceDelivery:
items:
$ref: '#/components/schemas/BenefitsServiceDelivery'
type: array
code:
$ref: '#/components/schemas/BenefitsInformationCode'
compositeMedicalProcedureIdentifier:
$ref: '#/components/schemas/CompositeMedicalProcedureIdentifier'
coverageLevel:
$ref: '#/components/schemas/BenefitsInformationCoverageLevelName'
coverageLevelCode:
$ref: '#/components/schemas/BenefitsInformationCoverageLevelCode'
eligibilityAdditionalInformation:
$ref: '#/components/schemas/EligibilityAdditionalInformation'
deprecated: true
description: Please use `benefitsInformation[].eligibilityAdditionalInformationList` instead.
eligibilityAdditionalInformationList:
description: Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in
the response.
items:
$ref: '#/components/schemas/EligibilityAdditionalInformation'
type: array
headerLoopIdentifierCode:
description: The loop header identifier number in the `LS` segment of the original X12 EDI transaction.
type: string
inPlanNetworkIndicator:
$ref: '#/components/schemas/InPlanNetworkIndicatorName'
inPlanNetworkIndicatorCode:
$ref: '#/components/schemas/InPlanNetworkIndicatorCode'
insuranceType:
$ref: '#/components/schemas/InsuranceTypeName'
insuranceTypeCode:
$ref: '#/components/schemas/InsuranceTypeCode'
description: 'Code identifying the type of insurance policy. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#insurance-type-codes)
for a complete list.
Payers may sometimes return other non-compliant values.'
name:
$ref: '#/components/schemas/BenefitsInformationName'
planCoverage:
description: 'The specific product name or special program name for an insurance plan. For example `Gold
1-2-3`.
Payers are normally required to send the plan name when `benefitsInformation[].code` is set to values
`1` - `8` and the `benefitsInformation[].serviceTypeCodes` contains `30` (Health Benefit Plan Coverage).
However, behavior may vary by payer, so don''t rely on this information being present in the response.
Note that the plan name returned in this property may not exactly match the name the payer uses in official
plan documents or marketing literature.
Visit [What''s the plan name?](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#what’s-the-plan-name%3F)
in the benefits response documentation for more details.'
type: string
quantityQualifier:
$ref: '#/components/schemas/QuantityQualifierName'
description: 'The name of the `quantityQualifierCode`.
Payers may sometimes return other non-compliant values.'
quantityQualifierCode:
$ref: '#/components/schemas/QuantityQualifierCode'
description: 'Code indicating the type of quantity for the benefit. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#quantity-qualifier-codes)
for a complete list.
Payers may sometimes return other non-compliant values.'
serviceTypeCodes:
description: 'Service Type Codes (STCs) related to the benefit type. For example, `7` - Anesthesia. Visit
[Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes)
for a complete list.
This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It
differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which
applies to X12 versions later than 005010.
Payers may sometimes return other non-compliant values.'
items:
$ref: '#/components/schemas/ResponseEligibilityServiceTypeCode'
type: array
serviceTypes:
description: 'The names of the Service Type Codes listed in the `serviceTypeCodes` array. Visit [Service
Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a
complete list of codes and their names.
The word physician in service type codes refers to any healthcare provider, including physician assistants,
nurse practitioners, and other types of healthcare professionals.
Payers may sometimes return other non-compliant values.'
items:
$ref: '#/components/schemas/ResponseEligibilityServiceType'
type: array
timeQualifier:
$ref: '#/components/schemas/TimeQualifierName'
description: 'The name of the `timeQualifierCode`.
Payers may sometimes return other non-compliant values.'
timeQualifierCode:
$ref: '#/components/schemas/TimeQualifierCode'
description: 'Code indicating 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.'
trailerLoopIdentifierCode:
description: The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction.
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 O
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# Full source: https://raw.githubusercontent.com/api-evangelist/stedi/refs/heads/main/openapi/stedi-real-time-eligibility-check-api-openapi.yml