What does a typical Eligibility API response look like?
You may receive lengthy responses to our Medical Network APIs, due to the many data points that a payer or trading partner provides in the query response. It reflects the needs to inform the provider about the various financial components of the patient's insurance coverage - existence of copays and co-insurance payments; deductible amounts; possible dependents information; coverage levels and much more.
If the payer supports only a single category of inquiry in Eligibility requests, you'll see the value of 30, for Health Benefit Plan Coverage. Some payers typically will give a 30 code to positively affirm that the patient has active health insurance coverage.
Some payers will reply with shorter responses than others; the example we show is a briefer one that you can see by testing the tradingPartnerServiceId value of AETNA in the request.
The insuranceTypeCode denotes the type of insurance policy within a specific insurance program. Payers can support numerous types.
For a more in-depth breakdown of each JSON object in the Eligibility response, see this topic.