Pre Encounter Coverages V 1 Get Eligibility

GET

/coverages/v1/:id/eligibility/:check_id

GET

/coverages/v1/:id/eligibility/:check_id

import requests
url = "https://api.taigabilling.com/coverages/v1/id/eligibility/check_id"
headers = {"Authorization": "Bearer <token>"}
response = requests.get(url, headers=headers)
print(response.json())

200Retrieved

{
  "metadata": {
    "check_id": "string",
    "service_code": "1",
    "status": "COMPLETED",
    "initiated_by": "string",
    "initiated_at": "2024-01-15T09:30:00Z"
  },
  "check": {
    "response": {
      "response": {
        "benefitsInformation": [
          {
            "additionalInformation": [
              {
                "description": "string"
              }
            ],
            "authOrCertIndicator": "string",
            "benefitAmount": "string",
            "benefitPercent": "string",
            "benefitQuantity": "string",
            "benefitsAdditionalInformation": {},
            "benefitsDateInformation": {},
            "benefitsRelatedEntities": [
              {}
            ],
            "benefitsRelatedEntity": {},
            "benefitsServiceDelivery": [
              {}
            ],
            "code": "string",
            "coverageLevel": "string",
            "coverageLevelCode": "string",
            "eligibilityAdditionalInformation": {},
            "eligibilityAdditionalInformationList": [
              {}
            ],
            "inPlanNetworkIndicator": "string",
            "inPlanNetworkIndicatorCode": "string",
            "insuranceType": "string",
            "insuranceTypeCode": "string",
            "name": "string",
            "planCoverage": "string",
            "quantityQualifier": "string",
            "quantityQualifierCode": "string",
            "serviceTypeCodes": [
              "string"
            ],
            "serviceTypes": [
              "string"
            ],
            "timeQualifier": "string",
            "timeQualifierCode": "string"
          }
        ],
        "controlNumber": "string",
        "dependents": [
          {}
        ],
        "eligibilitySearchId": "string",
        "errors": [
          {}
        ],
        "id": "string",
        "meta": {},
        "payer": {},
        "planDateInformation": {},
        "planInformation": {},
        "planStatus": [
          {}
        ],
        "provider": {},
        "reassociationKey": "string",
        "subscriber": {},
        "subscriberTraceNumbers": [
          {}
        ],
        "tradingPartnerServiceId": "string",
        "x12": "string"
      },
      "vendor": "string",
      "version": 1
    },
    "batch_id": "string",
    "errors": [
      {
        "source": "TAIGA",
        "errorDetails": {
          "field?": "string",
          "description?": "string",
          "location?": "string",
          "possibleResolutions?": "string",
          "code?": "string",
          "followupAction?": "string"
        }
      }
    ],
    "request": {
      "payer_id": "string",
      "provider": {
        "first_name": "string",
        "last_name": "string",
        "npi": "string"
      },
      "subscriber": {
        "first_name": "string",
        "last_name": "string",
        "member_id": "string",
        "date_of_birth": "2023-01-15"
      },
      "submitter_transaction_identifier": "string",
      "dependent": {
        "first_name": "string",
        "last_name": "string",
        "member_id": "string",
        "date_of_birth": "2023-01-15"
      },
      "encounter": {
        "date_of_service": "2023-01-15",
        "service_type_codes": [
          "string"
        ]
      },
      "get_existing_check_initiated_after": "2024-01-15T09:30:00Z",
      "source": "string",
      "portal_password": "string",
      "portal_username": "string"
    },
    "parsed_response": {
      "eligibility_status": "ACTIVE",
      "plan_metadata": {
        "payer_name": "string",
        "insurance_type": "string",
        "insurance_type_code": "string",
        "plan_name": "string",
        "member_id": "string",
        "group_number": "string",
        "start_date": "2023-01-15",
        "end_date": "2023-01-15",
        "plan_dates": [
          {
            "start_date": "2023-01-15",
            "field_name": "string",
            "end_date": "2023-01-15"
          }
        ],
        "subscriber": {
          "member_id": "string",
          "group_number": "string",
          "first_name": "string",
          "middle_name": "string",
          "last_name": "string",
          "date_of_birth": "string",
          "gender": "string",
          "address": {
            "address1": "string",
            "address2": "string",
            "city": "string",
            "state": "string",
            "postal_code": "string",
            "country_code": "string",
            "country_sub_division_code": "string"
          }
        },
        "dependent": {
          "member_id": "string",
          "group_number": "string",
          "first_name": "string",
          "middle_name": "string",
          "last_name": "string",
          "date_of_birth": "string",
          "gender": "string",
          "address": {
            "address1": "string",
            "address2": "string",
            "city": "string",
            "state": "string",
            "postal_code": "string",
            "country_code": "string",
            "country_sub_division_code": "string"
          }
        },
        "trading_partner": "string"
      },
      "benefits": {
        "plan_coverage": {
          "in_network": {
            "deductible": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_contract": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_remaining": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_year_to_date": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_contract": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_remaining": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_year_to_date": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "additional_notes": "string"
          },
          "in_network_flat": [
            {
              "type": "DEDUCTIBLE",
              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
              "unit": "PERCENT",
              "value": 1.1,
              "additional_notes": "string"
            }
          ],
          "out_of_network": {
            "deductible": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_contract": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_remaining": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "deductible_year_to_date": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_contract": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_remaining": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "oop_max_year_to_date": {
              "family": 1.1,
              "individual": 1.1,
              "employeeAndSpouse": 1.1,
              "employeeAndChildren": 1.1
            },
            "additional_notes": "string"
          },
          "out_of_network_flat": [
            {
              "type": "DEDUCTIBLE",
              "coverageLevel": "EMPLOYEE_AND_CHILDREN",
              "unit": "PERCENT",
              "value": 1.1,
              "additional_notes": "string"
            }
          ]
        },
        "service_specific_coverage": [
          {
            "service_code": "1",
            "in_network": {
              "copay": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "coinsurance": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "visits": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "visits_remaining": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "additional_notes": "string"
            },
            "in_network_flat": [
              {
                "type": "DEDUCTIBLE",
                "coverageLevel": "EMPLOYEE_AND_CHILDREN",
                "unit": "PERCENT",
                "value": 1.1,
                "additional_notes": "string"
              }
            ],
            "out_of_network": {
              "copay": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "coinsurance": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "visits": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "visits_remaining": {
                "family": 1.1,
                "individual": 1.1,
                "employeeAndSpouse": 1.1,
                "employeeAndChildren": 1.1
              },
              "additional_notes": "string"
            },
            "out_of_network_flat": [
              {
                "type": "DEDUCTIBLE",
                "coverageLevel": "EMPLOYEE_AND_CHILDREN",
                "unit": "PERCENT",
                "value": 1.1,
                "additional_notes": "string"
              }
            ]
          }
        ],
        "benefits_related_entities": [
          {
            "entityIdentifier": "string",
            "entityType": "string",
            "entityName": "string",
            "contactInformation": [
              {
                "mode": "string",
                "value": "string"
              }
            ],
            "serviceTypeCodes": [
              "1"
            ]
          }
        ],
        "non_covered_details": [
          {
            "type": "DEDUCTIBLE",
            "coverageLevel": "EMPLOYEE_AND_CHILDREN",
            "unit": "PERCENT",
            "value": 1.1,
            "additional_notes": "string",
            "service_type_codes": [
              "1"
            ]
          }
        ],
        "notes": "string",
        "autoUpdatedEligibilityCheckId": "string"
      }
    },
    "request_corrections": [
      {
        "property": "string",
        "request_value": "string",
        "corrected_value": "string"
      }
    ]
  }
}

Gets the eligibility of a patient for a specific coverage if successful.

Authentication

AuthorizationBearer

Send your Taiga API key as a Bearer token. Create and manage keys in the Taiga developer portal.

Path parameters

idstringRequiredformat: "uuid"

The unique identifier for a Coverage in the database

check_idstringRequired

Response

metadataobject

checkobject or nullOptional