UnitedHealthcare · JSON Structure

Provider Benefit Check Response Structure

Patient benefit check response with cost-sharing details

Type: object Properties: 0
Health InsuranceHealthcareFHIRClaimsEligibility

UnitedHealthcare Benefit Check Response is a JSON Structure definition published by UnitedHealthcare. It conforms to the https://json-structure.org/meta/core/v0/# meta-schema.

Meta-schema: https://json-structure.org/meta/core/v0/#

JSON Structure

Raw ↑
{
  "$schema": "https://json-structure.org/meta/core/v0/#",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-structure/provider-benefit-check-response-structure.json",
  "name": "UnitedHealthcare Benefit Check Response",
  "type": "object",
  "description": "Patient benefit check response with cost-sharing details",
  "fields": [
    {
      "name": "coveredBenefit",
      "type": "boolean",
      "description": "Whether service is covered"
    },
    {
      "name": "authorizationRequired",
      "type": "boolean",
      "description": "Prior auth required"
    },
    {
      "name": "referralRequired",
      "type": "boolean",
      "description": "Referral required"
    },
    {
      "name": "estimatedPatientResponsibility",
      "type": "decimal",
      "description": "Estimated patient cost"
    },
    {
      "name": "estimatedPlanPayment",
      "type": "decimal",
      "description": "Estimated plan payment"
    },
    {
      "name": "costSharingDetails",
      "type": "object",
      "description": "Cost-sharing breakdown"
    }
  ]
}