InsuranceEligibility

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/elation-health/main/json-schema/elation-health-insurance-eligibility-schema.json",
  "title": "InsuranceEligibility",
  "x-generated": "2026-10-12",
  "x-method": "derived",
  "x-generator": "derive-json-schema.py",
  "x-source": "openapi/elation-health-insurance-eligibility-api-openapi.yml#/components/schemas/InsuranceEligibility",
  "properties": {
    "eligibility_check_timestamp": {
      "description": "Eligibility check timestamp in ISO format.",
      "format": "date-time",
      "type": "string"
    },
    "eligibility_details": {
      "$ref": "#/$defs/EligibilityDetails"
    },
    "eligibility_status": {
      "allOf": [
        {
          "$ref": "#/$defs/EligibilityStatusEnum"
        }
      ],
      "description": "Status of eligibility check.\n\n* `active` - active\n* `inactive` - inactive\n* `error` - error"
    },
    "patient_id": {
      "description": "Patient's id in Elation system.",
      "type": "integer"
    },
    "patient_insurance_id": {
      "description": "Patient's insurance id in Elation system.",
      "type": "integer"
    },
    "practice_id": {
      "description": "Practice's id in Elation system.",
      "type": "integer"
    }
  },
  "type": "object",
  "$defs": {
    "EligibilityDetails": {
      "properties": {
        "coinsurance": {
          "description": "Coinsurance percentage value as a decimal (e.g. 0.25).",
          "format": "decimal",
          "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
          "type": "string"
        },
        "coinsurance_ambiguous": {
          "type": "boolean"
        },
        "copay": {
          "description": "copayment amount in dollars.",
          "format": "double",
          "type": [
            "number",
            "null"
          ]
        },
        "copay_ambiguous": {
          "description": "If true, the given copay value may not be accurate and the full eligibility report will need to be referenced for better details.",
          "type": "boolean"
        },
        "deductible": {
          "description": "Deductible amount in dollars.",
          "format": "decimal",
          "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
          "type": "string"
        },
        "deductible_ambiguous": {
          "type": "boolean"
        },
        "deductible_remaining": {
          "description": "Remaining deductible amount in dollars.",
          "format": "decimal",
          "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
          "type": "string"
        },
        "deductible_remaining_ambiguous": {
          "type": "boolean"
        },
        "errors": {
          "description": "Error messages showing reason for failed eligibility check.",
          "items": {
            "additionalProperties": {},
            "type": "object"
          },
          "type": "array"
        }
      },
      "type": "object"
    },
    "EligibilityStatusEnum": {
      "description": "* `active` - active\n* `inactive` - inactive\n* `error` - error",
      "enum": [
        "active",
        "inactive",
        "error"
      ],
      "type": "string"
    }
  }
}