UnitedHealthcare · Schema
UnitedHealthcare Benefit Check Response
Patient benefit check response with cost-sharing details
Health InsuranceHealthcareFHIRClaimsEligibility
Properties
| Name | Type | Description |
|---|---|---|
| coveredBenefit | boolean | Whether service is covered |
| authorizationRequired | boolean | Prior auth required |
| referralRequired | boolean | Referral required |
| estimatedPatientResponsibility | number | Estimated patient cost |
| estimatedPlanPayment | number | Estimated plan payment |
| costSharingDetails | object | Cost-sharing breakdown |
JSON Schema
{
"$schema": "https://json-schema.org/draft/2020-12/schema",
"$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-schema/provider-benefit-check-response-schema.json",
"title": "UnitedHealthcare Benefit Check Response",
"description": "Patient benefit check response with cost-sharing details",
"type": "object",
"properties": {
"coveredBenefit": {
"type": "boolean",
"description": "Whether service is covered"
},
"authorizationRequired": {
"type": "boolean",
"description": "Prior auth required"
},
"referralRequired": {
"type": "boolean",
"description": "Referral required"
},
"estimatedPatientResponsibility": {
"type": "number",
"description": "Estimated patient cost"
},
"estimatedPlanPayment": {
"type": "number",
"description": "Estimated plan payment"
},
"costSharingDetails": {
"type": "object",
"description": "Cost-sharing breakdown",
"properties": {
"copay": {
"type": "number"
},
"coinsurance": {
"type": "number"
},
"deductibleApplies": {
"type": "boolean"
}
}
}
}
}
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