Pre Encounter Eligibility Checks V 1 Post

POST

/eligibility-checks/v1

POST

/eligibility-checks/v1

import requests
url = "https://api.taigabilling.com/eligibility-checks/v1"
payload = {
    "payer_id": "supported-payer-id",
    "provider": {
        "first_name": "Jane",
        "last_name": "Smith",
        "npi": "1999999984"
    },
    "subscriber": {
        "first_name": "John",
        "last_name": "Doe",
        "member_id": "EXAMPLE123",
        "date_of_birth": "1985-05-27"
    },
    "encounter": {
        "date_of_service": "2026-08-26",
        "service_type_codes": ["AL"]
    }
}
headers = {
    "Authorization": "Bearer <token>",
    "Content-Type": "application/json"
}
response = requests.post(url, json=payload, headers=headers)
print(response.json())

200Vision / optometry (AL)

{
  "response": {
    "response": {
      "benefitsInformation": [
        {
          "benefitsDateInformation": {
            "benefitBegin": "2026-01-01"
          },
          "code": "1",
          "name": "Active Coverage",
          "serviceTypeCodes": [
            "AL"
          ],
          "serviceTypes": [
            "Vision (Optometry)"
          ]
        },
        {
          "benefitAmount": "20",
          "code": "B",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Co-Payment",
          "serviceTypeCodes": [
            "AL"
          ],
          "serviceTypes": [
            "Vision (Optometry)"
          ],
          "timeQualifier": "Visit",
          "timeQualifierCode": "27"
        },
        {
          "additionalInformation": [
            {
              "description": "One visit per calendar year"
            }
          ],
          "benefitQuantity": "1",
          "code": "F",
          "coverageLevel": "Individual",
          "coverageLevelCode": "IND",
          "inPlanNetworkIndicator": "Yes",
          "inPlanNetworkIndicatorCode": "Y",
          "name": "Limitations",
          "quantityQualifier": "Visits",
          "quantityQualifierCode": "VS",
          "serviceTypeCodes": [
            "AL"
          ],
          "serviceTypes": [
            "Vision (Optometry)"
          ],
          "timeQualifier": "Calendar Year",
          "timeQualifierCode": "23"
        }
      ],
      "planDateInformation": {
        "plan": {
          "begin": "2026-01-01",
          "end": "2026-12-31"
        }
      },
      "planStatus": [
        {
          "serviceTypeCodes": [
            "AL"
          ],
          "serviceTypes": [
            "Vision (Optometry)"
          ],
          "status": "Active Coverage",
          "statusCode": "1"
        }
      ]
    },
    "vendor": "stedi",
    "version": 1
  },
  "parsed_response": {
    "eligibility_status": "ACTIVE",
    "plan_metadata": {
      "plan_name": "Example Vision Plan",
      "start_date": "2026-01-01",
      "end_date": "2026-12-31"
    },
    "benefits": {
      "service_specific_coverage": [
        {
          "service_code": "AL",
          "in_network": {
            "copay": {
              "individual": 20
            },
            "visits": {
              "individual": 1
            },
            "additional_notes": "Routine eye exam"
          },
          "in_network_flat": [
            {
              "type": "COPAY",
              "coverageLevel": "INDIVIDUAL",
              "unit": "CURRENCY",
              "value": 20
            },
            {
              "type": "LIMITATION",
              "coverageLevel": "INDIVIDUAL",
              "unit": "COUNT",
              "value": 1,
              "additional_notes": "One visit per calendar year"
            }
          ],
          "out_of_network_flat": []
        }
      ],
      "benefits_related_entities": [],
      "non_covered_details": []
    }
  },
  "request_corrections": []
}

Sends real-time eligibility checks to payers through Stedi.

Authentication

AuthorizationBearer

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

Request

This endpoint expects an object.

payer_idstringRequired

Supported payer ID values can be found here.

providerobjectRequired

subscriberobjectRequired

The primary policyholder for the insurance plan or a dependent with a unique member ID.

If a dependent has a unique member ID, include their information here and leave dependent undefined.

submitter_transaction_identifierstring or nullOptional

A unique identifier for the eligibility check within the batch. Taiga returns this identifier in the response for the /batch/{batch_id} polling endpoint so you can correlate benefit responses with the original eligibility check.

dependentobject or nullOptional

If a dependent has a unique member ID, include their information as subscriber and leave this field undefined.

encounterobject or nullOptional

get_existing_check_initiated_afterdatetime or nullOptional

If not provided, this endpoint will run a fresh eligibility check. If provided, it will return an existing successful eligibility check if one exists that was initiated after provided date with the same parameters (Date of Service, Payer ID, Provider, Subscriber, Dependent, and Encounter).

sourcestring or nullOptional

portal_passwordstring or nullOptional

The password that the provider uses to log in to the payer's portal. This is not commonly used.

portal_usernamestring or nullOptional

The username that the provider uses to log in to the payer's portal. This is not commonly used.

Response

responseobject

Eligibility vendor metadata plus the parsed clearinghouse response. Read the benefit detail from this envelope’s response.benefitsInformation, which is response.response.benefitsInformation on the eligibility check.

batch_idstring or nullOptional

errorslist of objects or nullOptional

requestobject or nullOptional

An object representing the data for an eligibility request.

parsed_responseobject or nullOptional

request_correctionslist of objects or nullOptional