API ReferencePre EncounterEligibility ChecksV1
Create eligibility check
Sends real-time eligibility checks to payers through Stedi.
Authorization
BearerAuth AuthorizationBearer <token>
Send your Taiga API key as a Bearer token. Create and manage keys in the Taiga developer portal.
In: header
Request Body
application/json
TypeScript Definitions
Use the request body type in TypeScript.
An object representing the data for an eligibility request.
Response Body
application/json
curl -X POST "https://example.com/eligibility-checks/v1" \ -H "Content-Type: application/json" \ -d '{ "payer_id": "string", "provider": { "npi": "string" }, "subscriber": { "first_name": "string", "last_name": "string" } }'{ "batch_id": "string", "errors": [ { "source": "TAIGA", "errorDetails": { "field?": "string", "description?": "string", "location?": "string", "possibleResolutions?": "string", "code?": "string", "followupAction?": "string" } } ], "request": { "submitter_transaction_identifier": "string", "payer_id": "string", "provider": { "first_name": "string", "last_name": "string", "npi": "string" }, "subscriber": { "member_id": "string", "first_name": "string", "last_name": "string", "date_of_birth": "2019-08-24" }, "dependent": { "member_id": "string", "first_name": "string", "last_name": "string", "date_of_birth": "2019-08-24" }, "encounter": { "date_of_service": "2019-08-24", "service_type_codes": [ "string" ] }, "get_existing_check_initiated_after": "2019-08-24T14:15:22Z", "source": "string", "portal_password": "string", "portal_username": "string" }, "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" }, "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": "2019-08-24", "end_date": "2019-08-24", "plan_dates": [ { "start_date": "2019-08-24", "end_date": "2019-08-24", "field_name": "string" } ], "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" } } }, "benefits": { "plan_coverage": { "in_network": { "deductible": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_contract": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_year_to_date": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_contract": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_year_to_date": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "additional_notes": "string" }, "in_network_flat": [ { "type": "DEDUCTIBLE", "coverageLevel": "EMPLOYEE_AND_CHILDREN", "unit": "PERCENT", "value": 0.1, "additional_notes": "string" } ], "out_of_network": { "deductible": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_contract": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "deductible_year_to_date": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_contract": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "oop_max_year_to_date": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "additional_notes": "string" }, "out_of_network_flat": [ { "type": "DEDUCTIBLE", "coverageLevel": "EMPLOYEE_AND_CHILDREN", "unit": "PERCENT", "value": 0.1, "additional_notes": "string" } ] }, "service_specific_coverage": [ { "service_code": "1", "in_network": { "copay": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "coinsurance": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "visits": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "visits_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "additional_notes": "string" }, "in_network_flat": [ { "type": "DEDUCTIBLE", "coverageLevel": "EMPLOYEE_AND_CHILDREN", "unit": "PERCENT", "value": 0.1, "additional_notes": "string" } ], "out_of_network": { "copay": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "coinsurance": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "visits": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "visits_remaining": { "family": 0, "individual": 0, "employeeAndSpouse": 0, "employeeAndChildren": 0 }, "additional_notes": "string" }, "out_of_network_flat": [ { "type": "DEDUCTIBLE", "coverageLevel": "EMPLOYEE_AND_CHILDREN", "unit": "PERCENT", "value": 0.1, "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": 0.1, "additional_notes": "string", "service_type_codes": [ "1" ] } ], "notes": "string", "autoUpdatedEligibilityCheckId": "string" } }, "request_corrections": [ { "property": "string", "request_value": "string", "corrected_value": "string" } ]}Update coverage PUT
Updates a Coverage. The path must contain the next version number to prevent race conditions. For example, if the current version of the coverage is n, you will need to send a request to this endpoint with `/{id}/n+1` to update the coverage. Updating historic versions is not supported.
Create eligibility check batch POST
Sends a batch of eligibility checks to payers through Stedi.