Availity · Schema

Benefit

HealthcareClearinghouseHIPAAX12 EDIEligibilityClaimsPrior AuthorizationRevenue Cycle ManagementPayersPrice Transparency

Properties

Name	Type	Description
code	string	X12 benefit information code
name	string
coverageLevel	string
benefitAmount	object
benefitPercent	number
inPlanNetworkIndicator	string
timeQualifier	string	Benefit period (e.g., Calendar Year, Plan Year, Lifetime)

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "#/components/schemas/Benefit",
  "title": "Benefit",
  "type": "object",
  "properties": {
    "code": {
      "type": "string",
      "description": "X12 benefit information code"
    },
    "name": {
      "type": "string"
    },
    "coverageLevel": {
      "type": "string",
      "enum": [
        "INDIVIDUAL",
        "FAMILY",
        "EMPLOYEE",
        "EMPLOYEE_AND_SPOUSE"
      ]
    },
    "benefitAmount": {
      "type": "object",
      "properties": {
        "value": {
          "type": "number"
        },
        "currency": {
          "type": "string"
        }
      }
    },
    "benefitPercent": {
      "type": "number",
      "minimum": 0,
      "maximum": 100
    },
    "inPlanNetworkIndicator": {
      "type": "string",
      "enum": [
        "Y",
        "N",
        "W"
      ]
    },
    "timeQualifier": {
      "type": "string",
      "description": "Benefit period (e.g., Calendar Year, Plan Year, Lifetime)"
    }
  }
}

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