POST
/
coordination-of-benefits
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/coordination-of-benefits \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "tradingPartnerServiceId": "SOMEID",
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "firstName": "John",
    "lastName": "Doe",
    "dateOfBirth": "1985-05-27",
    "memberId": "W000000000"
  },
  "dependent": {
    "firstName": "Jordan",
    "lastName": "Doe",
    "dateOfBirth": "2002-12-31"
  },
  "encounter": {
    "dateOfService": "2024-08-02",
    "serviceTypeCode": "30"
  }
}'
{
  "benefitsInformation": [
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "1"
      ],
      "serviceTypes": [
        "Medical Care"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "88"
      ],
      "serviceTypes": [
        "Pharmacy"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "AL"
      ],
      "serviceTypes": [
        "Vision (Optometry)"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "R",
      "name": "Other or Additional Payor",
      "serviceTypeCodes": [
        "1"
      ],
      "serviceTypes": [
        "Medical Care"
      ],
      "benefitsDateInformation": {
        "coordinationOfBenefits": "2024-07-01"
      },
      "benefitsRelatedEntities": [
        {
          "entityIdentifier": "Primary Payer",
          "entityName": "CIGNA",
          "entityIdentification": "PI",
          "entityIdentificationValue": "1006"
        },
        {
          "entityIdentifier": "Insured or Subscriber",
          "entityFirstName": "JOHN",
          "entityMiddleName": "X",
          "entityIdentification": "MI",
          "entityIdentificationValue": "00000000000",
          "entityLastName": "DOE"
        }
      ],
      "subscriber": {
        "dateOfBirth": "2002-12-31"
      }
    }
  ],
  "coordinationOfBenefits": {
    "classification": "CobInstanceExistsPrimacyDetermined",
    "instanceExists": true,
    "primacyDetermined": true,
    "coverageOverlap": true,
    "benefitOverlap": true
  },
  "dependent": {
    "firstName": "JORDAN",
    "lastName": "DOE",
    "gender": "M",
    "dateOfBirth": "2002-12-31",
    "relationToSubscriber": "Child",
    "relationToSubscriberCode": "19",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  },
  "errors": [],
  "meta": {
    "applicationMode": "production",
    "traceId": "01JDQFT4W3KTWZNTADEZ55BFFX",
    "outboundTraceId": "01JDQFT4W3KTWZNTADEZ55BFFX"
  },
  "payer": {
    "name": "Aetna",
    "identification": "AETNA-USH"
  },
  "provider": {
    "providerName": "ACME Health Services",
    "entityType": "Non-Person Entity",
    "npi": "1999999984"
  },
  "subscriber": {
    "memberId": "W000000000",
    "firstName": "JOHN",
    "lastName": "DOE",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  }
}

This endpoint submits a real-time coordination of benefits (COB) check request for a patient. When a patient has active coverage through multiple health plans, COB checks can help ensure that you submit claims to the correct payer and avoid claim denials.

  • Call this endpoint with a JSON payload. Each check must be for a Stedi-supported payer with which the patient has coverage. For example, if the patient has coverage from Cigna and UnitedHealthcare, a COB check to Aetna will return an error.
  • Stedi searches a national database containing 245+ million patient coverage records from 45+ health plans, ASOs, TPAs, and others, including participation from the vast majority of national commercial health plans. Data is updated weekly to ensure accuracy.
  • Stedi returns information about the patient’s active health plans, the responsibility sequence number for each payer if available (such as primary or secondary), and whether coordination of benefits is required.

We recommend performing COB checks for all new patients who have coverage through one of Stedi’s supported payers. When Stedi identifies overlapping coverage, we strongly recommend performing follow-up eligibility checks with each payer to verify coverage status and retrieve the patient’s complete and current benefits information before you submit claims.

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Supported payers

Medicare and Medicare Advantage plans aren’t supported. Visit the Payer Network for a complete list of supported payers.

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Accurate patient data

COB checks are significantly more sensitive to data accuracy than eligibility checks. To perform successful COB checks, the patient information you provide in the check must match the payer’s data exactly.

For example, if a payer has a patient’s name stored as “Jonathan Doe”, they may return benefits information when you submit an eligibility check for “Jon Doe”, as long as they can identify the patient through the other information provided. However, a COB request for “Jon Doe” will fail because the name doesn’t match the payer’s records exactly.

To avoid unnecessary COB check failures, we strongly recommend that you first submit an eligibility check request for the patient. Then use the following data from the successful payer benefit response to build the COB request: firstName, lastName, dateOfBirth, memberId.

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COB response

The COB response includes information about the patient’s active health plans, subscriber information, and coordination of benefits.

Unlike standard eligibility checks, the COB response shape is standardized across all supported payers. There are no payer-specific variations in what information is included or how the response is structured.

Visit Interpret COB response for information and examples for using the COB response to inform claim submissions, including how to determine payer primacy.

Authorizations

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Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json

Response

200
application/json
CoordinationOfBenefits 200 response

The response is of type object.