Insurance Discovery Check

Submit an insurance discovery check in JSON format

Insurance discovery checks search for a patient’s active coverage using only their demographic data.

1. Call this endpoint with as much patient demographic information as possible.
2. Stedi searches for active coverage for the patient.
3. The endpoint returns an array of potential active coverages along with subscriber details and benefits information.

We recommend using insurance discovery checks as a backup when eligibility checks fail or aren’t possible. Because of their limitations, you shouldn’t rely on them as your primary method for verifying patient coverage.

Visit Insurance discovery checks for a full how-to guide.

Authorizations

Authorization · string · header · required

A Stedi API Key for authentication.

Body

application/json

provider · object · required

Information about the provider requesting the insurance discovery check.

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subscriber · object · required

Demographic information for the patient when they are the health plan subscriber. We strongly recommend providing as much information as possible to improve the probability of finding matching coverage.

We especially recommend providing the subscriber's Social Security Number and their address - particularly their zip code.

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dependent · object

Demographic information for the patient when they are a dependent on a health plan.

• We strongly recommend providing as much information as possible to improve the probability of finding matching coverage. We especially recommend providing the dependent's Social Security Number and their address - particularly their zip code.
• You should provide information for both the subscriber and the dependent in the request when possible.
• If you only have the dependent's information, you should identify them in the subscriber object instead and leave this object empty. Note that some payers require information about both the dependent and the subscriber, so providing only the dependent's information limits Stedi's ability to return coverage matches for those payers.

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encounter · object

The date range for the service being requested. If you don't specify a service date (either a single day or a range of dates), Stedi defaults to the current date.

You can specify either a single dateOfService or a beginningDateOfService and endDateOfService.

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Response

200

application/json

InsuranceDiscoveryCheck 200 response

meta · object

Metadata about the response. Stedi uses this data for tracking and troubleshooting.

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discoveryId · string

A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the Insurance Discovery Check Results endpoint.

status · enum<string>

The status of the discovery check. This is either PENDING or COMPLETE. - If the status is COMPLETE, the items array will contain any potential coverage matches Stedi found for the patient. - If the status is PENDING, the check is still in progress. You can immediately begin polling the Insurance Discovery Check Results endpoint to retrieve the results asynchronously.

Available options:

PENDING,

COMPLETE

items · object[]

An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check status is COMPLETE. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information.

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coveragesFound · number

The number of potential coverage matches for the patient. This will be 0 if Stedi didn't find any matching coverage.

errors · object[]

When a payer rejects your eligibility check, the response contains one or more AAA errors that specify the reasons for the rejection and any recommended follow-up actions.

Any errors that occur at the payer, provider, subscriber, or dependents levels are also included in this array, allowing you to review all errors in a central location. If there are no AAA errors, this array will be empty.

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