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manager.json
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{
"openapi": "3.1.0",
"info": {
"title": "Stedi Manager",
"version": "2024-04-01",
"contact": {
"email": "healthcare@stedi.com"
},
"license": {
"name": "Proprietary",
"url": "https://stedi.com"
}
},
"paths": {
"/eligibility-manager/batch-eligibility": {
"post": {
"operationId": "BatchEligibilityChecks",
"requestBody": {
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/BatchEligibilityChecksRequestContent"
},
"examples": {
"BatchEligibilityChecks_example1": {
"summary": "Batch eligibility checks",
"description": "",
"value": {
"items": [
{
"submitterTransactionIdentifier": "ABC123456789",
"controlNumber": "000022222",
"tradingPartnerServiceId": "AHS",
"encounter": {
"serviceTypeCodes": [
"MH"
]
},
"provider": {
"organizationName": "ACME Health Services",
"npi": "1234567891"
},
"subscriber": {
"dateOfBirth": "19000101",
"firstName": "Jane",
"lastName": "Doe",
"memberId": "1234567890"
}
},
{
"submitterTransactionIdentifier": "DEF123456799",
"controlNumber": "333344444",
"tradingPartnerServiceId": "AHS",
"encounter": {
"serviceTypeCodes": [
"78"
]
},
"provider": {
"organizationName": "ACME Health Services",
"npi": "1234567891"
},
"subscriber": {
"dateOfBirth": "19001021",
"firstName": "John",
"lastName": "Doe",
"memberId": "1234567892"
}
}
]
}
}
}
}
},
"required": true
},
"responses": {
"200": {
"description": "BatchEligibilityChecks 200 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/BatchEligibilityChecksResponseContent"
},
"examples": {
"BatchEligibilityChecks_example1": {
"summary": "Batch eligibility checks",
"description": "",
"value": {
"batchId": "01928d19-df25-76c0-8d51-f5351260fa05",
"submittedAt": "2023-11-07T05:31:56Z"
}
}
}
}
}
},
"400": {
"description": "ValidationException 400 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/ValidationExceptionResponseContent"
}
}
}
},
"401": {
"description": "UnauthorizedException 401 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/UnauthorizedExceptionResponseContent"
}
}
}
},
"404": {
"description": "ResourceNotFoundException 404 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/ResourceNotFoundExceptionResponseContent"
}
}
}
},
"500": {
"description": "InternalFailureException 500 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/InternalFailureExceptionResponseContent"
}
}
}
}
}
}
},
"/eligibility-manager/polling/batch-eligibility": {
"get": {
"operationId": "BatchEligibilityPolling",
"parameters": [
{
"name": "pageSize",
"in": "query",
"description": "The maximum number of elements to return in a page. You can set this to a maximum of 10 elements. If not specified, the default is 10.",
"schema": {
"type": "number",
"maximum": 10,
"minimum": 1,
"description": "The maximum number of elements to return in a page. You can set this to a maximum of 10 elements. If not specified, the default is 10."
}
},
{
"name": "pageToken",
"in": "query",
"description": "A token returned by a previous call to this operation in the `nextPageToken` property. If not specified, Stedi returns the first page of results.",
"schema": {
"type": "string",
"maxLength": 1024,
"minLength": 1,
"description": "A token returned by a previous call to this operation in the `nextPageToken` property. If not specified, Stedi returns the first page of results."
}
},
{
"name": "batchId",
"in": "query",
"description": "An identifier for a batch of eligibility checks submitted through the [Batch Eligibility Check](https://www.stedi.com/docs/api-reference/healthcare/post-healthcare-batch-eligibility) endpoint. Use this to retrieve results for eligibility checks in the batch.",
"schema": {
"type": "string",
"description": "An identifier for a batch of eligibility checks submitted through the [Batch Eligibility Check](https://www.stedi.com/docs/api-reference/healthcare/post-healthcare-batch-eligibility) endpoint. Use this to retrieve results for eligibility checks in the batch."
},
"examples": {
"BatchEligibilityPolling_example1": {
"summary": "Poll batch eligibility checks",
"description": "",
"value": "01932c61-2d4f-7d22-85fa-c7db2e13e771"
}
}
},
{
"name": "startDateTime",
"in": "query",
"description": "An ISO 8601 formatted string. For example `2023-08-28T00:00:00Z`. Stedi returns asychronous eligibility checks processed after this time.",
"schema": {
"type": "string",
"description": "An ISO 8601 formatted string. For example `2023-08-28T00:00:00Z`. Stedi returns asychronous eligibility checks processed after this time.",
"format": "date-time"
}
}
],
"responses": {
"200": {
"description": "BatchEligibilityPolling 200 response",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/BatchEligibilityPollingResponseContent"
},
"examples": {
"BatchEligibilityPolling_example1": {
"summary": "Poll batch eligibility checks",
"description": "",
"value": {
"nextPageToken": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"items": [
{
"controlNumber": "000022222",
"eligibilitySearchId": "01932c61-2d4f-7d22-85fa-c7bbd267392c",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"status": "ERROR",
"meta": {
"outboundTraceId": "01JCP62EYY1N6PZABF9Q45EN5Y"
},
"errors": [
{
"followupAction": "Please Correct and Resubmit",
"possibleResolutions": "Payer TEST is not configured. Please check our published payer list or contact Stedi support to resolve.",
"code": "79",
"description": "Invalid Participant Identification",
"location": "2100A"
}
],
"tradingPartnerServiceId": "TEST",
"submitterTransactionIdentifier": "ABC123456789"
},
{
"controlNumber": "333344444",
"eligibilitySearchId": "01932c61-2d4f-7d22-85fa-c7ca69c814a5",
"batchId": "01932c61-2d4f-7d22-85fa-c7db2e13e771",
"submitterTransactionIdentifier": "DEF123456799",
"status": "SUCCESS",
"meta": {
"senderId": "030240928",
"submitterId": "117151744",
"applicationMode": "production",
"traceId": "01J2VZA127GH93JT74HJU",
"outboundTraceId": "01J2VZA127GH93JT74HJU"
},
"reassociationKey": "123456789",
"tradingPartnerServiceId": "123456789",
"provider": {
"providerName": "ACME HEALTH SERVICES",
"entityIdentifier": "Provider",
"entityType": "Non-Person Entity",
"npi": "1234567890"
},
"subscriber": {
"memberId": "1234567892",
"firstName": "JANE",
"lastName": "DOE",
"middleName": "A",
"gender": "F",
"entityIdentifier": "Insured or Subscriber",
"entityType": "Person",
"dateOfBirth": "19000101",
"groupNumber": "123456789",
"address": {
"address1": "1234 FIRST ST",
"city": "NEW YORK",
"state": "WV",
"postalCode": "123451111"
}
},
"payer": {
"entityIdentifier": "Payer",
"entityType": "Non-Person Entity",
"lastName": "ABCDE",
"name": "ABCDE",
"federalTaxpayersIdNumber": "123412345",
"contactInformation": {
"contacts": [
{
"communicationMode": "Telephone",
"communicationNumber": "1234567890"
},
{
"communicationMode": "UR",
"communicationNumber": "website.company.com"
}
]
}
},
"planInformation": {
"groupNumber": "12341234",
"groupDescription": "ABCDE",
"priorIdNumber": "1234567890"
},
"planDateInformation": {
"planBegin": "20240101",
"planEnd": "20241231",
"eligibilityBegin": "20220102"
},
"planStatus": [
{
"statusCode": "1",
"status": "Active Coverage",
"planDetails": "Open Access Plus",
"serviceTypeCodes": [
"30"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
]
},
{
"statusCode": "1",
"status": "Active Coverage",
"serviceTypeCodes": [
"MH"
]
}
],
"benefitsInformation": [
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"planCoverage": "Open Access Plus",
"additionalInformation": [
{
"description": "Complete Care Management"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "6000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "500",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "3000",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "250",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes",
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
]
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "FAM",
"coverageLevel": "Family",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "30000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.1",
"inPlanNetworkIndicatorCode": "Y",
"inPlanNetworkIndicator": "Yes"
},
{
"code": "C",
"name": "Deductible",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "7500",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "G",
"name": "Out of Pocket (Stop Loss)",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifierCode": "23",
"timeQualifier": "Calendar Year",
"benefitAmount": "15000",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No",
"additionalInformation": [
{
"description": "Deductible does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
}
]
},
{
"code": "A",
"name": "Co-Insurance",
"coverageLevelCode": "IND",
"coverageLevel": "Individual",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"benefitPercent": "0.5",
"inPlanNetworkIndicatorCode": "N",
"inPlanNetworkIndicator": "No"
},
{
"code": "1",
"name": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
],
"serviceTypes": [
"Psychiatric - Inpatient",
"Day Care (Psychiatric)",
"Psychiatric - Outpatient",
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],
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{
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{
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"22"
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},
{
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},
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],
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{
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]
},
{
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"description": "Services rendered thru Client Specific Network"
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],
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},
"eligibilityAdditionalInformationList": [
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]
},
{
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],
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