UnitedHealthcare · JSON Structure

Provider Eligibility Request Structure

Request parameters for real-time eligibility and benefit verification

Type: object Properties: 0
Health InsuranceHealthcareFHIRClaimsEligibility

UnitedHealthcare Eligibility Request 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-eligibility-request-structure.json",
  "name": "UnitedHealthcare Eligibility Request",
  "type": "object",
  "description": "Request parameters for real-time eligibility and benefit verification",
  "fields": [
    {
      "name": "memberId",
      "type": "string",
      "description": "UnitedHealthcare member ID"
    },
    {
      "name": "dateOfBirth",
      "type": "date",
      "description": "Member date of birth"
    },
    {
      "name": "serviceType",
      "type": "string",
      "description": "X12 service type code"
    },
    {
      "name": "dateOfService",
      "type": "date",
      "description": "Requested date of service"
    },
    {
      "name": "npi",
      "type": "string",
      "description": "Rendering provider NPI"
    },
    {
      "name": "groupNumber",
      "type": "string",
      "description": "Insurance group number"
    }
  ]
}