Why can't I create an estimate?

One possible reason is that the input fields in the request body do not pass validation. When this happens, the API will return Http status code 400 and details on the validation failure. Please see the example below:

{
    "title": "Request validation failed",
    "status": 400,
    "detail": "There were missing or invalid data or parameters in the request.",
    "errors": {
        "FCEST112": "Request.InsuranceInfo.DependentMemberInfo.DateOfBirth field is incorrectly formatted."
    }
}

If this status code is received, please refer to the description to fix the input format and then resend the request.

Another possible reason to cause the estimate failure is insufficient eligibility and benefit data. You might also see an API response with result “Failed” in outOfPocketEstimate part of the response. See the example below:

"outOfPocketEstimate": {
        "result": "Failed",
        "amount": 0

You can check the response to find what is missing in patient's eligibility and benefit information. For the example above, you can find the failure happens because there is no coinsurance in benefitInfo.

{
    "id": "0a1e68e9-70a8-4583-ba2f-5c9aeba7f08e",
    "expirationDate": "2022-03-08T04:34:00.5833477Z",
    "createdDate": "2022-03-01T10:34:00.5533502+00:00",
    "insuranceInfo": {
        "payer": {
            "id": "CNTCR",
            "idDomain": "TradingPartnerService"
        },
        "dependentMemberInfo": null,
        "policyHolderInfo": {
            "firstName": "johnOne",
            "lastName": "doeOne",
            "dateOfBirth": "1880-01-02",
            "memberId": "0000000000"
        },
        "plan": {
            "status": "Active Coverage",
            "statusCode": "1",
            "beginDate": null,
            "endDate": null
        }
    },
    "service": {
        "codes": [
            {
                "valueType": "ServiceTypeCode",
                "value": "98"
            }
        ],
        "provider": {
            "id": "Z3248882383",
            "idType": "Npi",
            "organizationName": "St. Agnes Hospital",
            "firstName": null,
            "lastName": null
        }
    },
    "benefitInfo": {
        "familyCoverage": {
            "outOfPocketMax": {
                "amount": null,
                "amountMet": null,
                "amountRemaining": 12680
            },
            "deductible": {
                "amount": null,
                "amountMet": null,
                "amountRemaining": null
            },
            "yearToDateSpending": null
        },
        "individualCoverage": {
            "outOfPocketMax": {
                "amount": null,
                "amountMet": null,
                "amountRemaining": 6330
            },
            "deductible": {
                "amount": null,
                "amountMet": null,
                "amountRemaining": null
            },
            "yearToDateSpending": null
        },
        "copayAmount": 20,
        "coinsurancePercent": null
    },
    "outOfPocketEstimate": {
        "result": "Failed",
        "amount": 0,
        "estimateDetails": null,
        "failureDetails": {
            "FCCALC109": "Either Remaining Individual Deductible or Maximum Individual Deductible are required to calculate an estimate."
        }
    }
}

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