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Candid Health

Candid Health Eligibility Checks API

The Eligibility Checks API from Candid Health — 9 operation(s) for eligibility checks.

Documentation Provider Profile APIs.io OpenAPI GitHub

Candid Health Eligibility Checks API is one of 53 APIs that Candid Health publishes on the APIs.io network, described by a machine-readable OpenAPI specification.

Tagged areas include Eligibility Checks. The published artifact set on APIs.io includes an OpenAPI specification, API documentation, and an API reference.

This API exposes 10 operations across 9 paths, and defines 77 schemas. It is described by OpenAPI 3.2.0, at version 1.0.0.

Requests are made against 10 base URLs: https://pre-api.joincandidhealth.com, https://pre-api-staging.joincandidhealth.com, https://sandbox-pre-api.joincandidhealth.com, https://staging-pre-api.joincandidhealth.com, http://localhost:4000, https://api.joincandidhealth.com, https://api-staging.joincandidhealth.com, https://sandbox-api.joincandidhealth.com, https://staging-api.joincandidhealth.com, http://localhost:5050.

10 operations 9 paths 77 schemas 4 GET5 POST1 PUT

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.2.0
API Version
1.0.0
Base URL
https://api.joincandidhealth.com
Authentication
HTTP Bearer
Resource Areas
1

Authentication & Security 1

Candid Health Eligibility Checks API declares 1 security scheme for authenticating requests. It accepts HTTP bearer tokens (OAuthScheme).

  • OAuthScheme — OAuth 2.0 authentication

Paths & Operations 10

Across 9 paths, the API surfaces 10 operations — 4 GET, 5 POST, 1 PUT. Each is listed below with its method, path, parameters, and response codes.

Eligibility Checks 10
POST
/eligibility-checks/v1
Post
post 1 param body → 200
POST
/eligibility-checks/v1/batch
Batch
batch 1 param body → 200
GET
/eligibility-checks/v1/batch/{batch_id}
Poll Batch
poll-batch 3 params → 200
GET
/eligibility-checks/v1/payer/search
Payer Search
payer-search 4 params → 200
GET
/eligibility-checks/v1/recommendation
Recommendation
recommendation 2 params → 200
POST
/eligibility-checks/v1/recommendation
Create Recommendation
create-recommendation 1 param body → 200
PUT
/eligibility-checks/v1/recommendation/{recommendation_id}/{version}/vote
Vote Recommendation
vote-recommendation 3 params body → 200404409
GET
/eligibility-checks/v1/get-multi/
Get Multi
get-multi 9 params → 200
POST
/eligibility-checks/v1/insurance-discovery
Insurance Discovery
insurance-discovery 1 param body → 200
POST
/eligibility-checks/v1/coordination-of-benefits
Coordination Of Benefits
coordination-of-benefits 1 param body → 200

Schemas 77

The contract defines 77 schemas that model the data the API accepts and returns. The most detailed are type_pre-encounter_eligibilityChecks_v1_CobResponseDependent (13 properties), type_pre-encounter_coverages_v1_PlanMetadata (11 properties), type_pre-encounter_eligibilityChecks_v1_EligibilityRecommendation (11 properties), type_pre-encounter_eligibilityChecks_v1_CobResponseSubscriber (11 properties). Each schema is shown below with its type and property counts.

type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryGender
string
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryDependent
object
Demographic information for the patient when they are a dependent on a health plan. If you only have the dependent's information, identify them in the subscrib…
7 properties 2 required
type_pre-encounter_eligibilityChecks_v1_CobDependent
object
A dependent for which you want to check coordination of benefits. If the dependent has their own member ID, include their information in the subscriber object…
4 properties 3 required
type_pre-encounter_eligibilityChecks_v1_EligibilityCheckErrorDetails
object
This object is our fern representation of Stedi's EligbilityCheckError object from their API.
6 properties
type_pre-encounter_eligibilityChecks_v1_IndividualProvider
object
3 properties 1 required
type_pre-encounter_eligibilityChecks_v1_CobEncounter
object
Information about the encounter for the COB check. Service dates must be within the past 2 years and must not be in the future.
3 properties
type_pre-encounter_eligibilityChecks_v1_CobResponseProvider
object
Information about the entity that submitted the original COB request.
5 properties
type_pre-encounter_coverages_v1_ExpandedMemberInfo
object
8 properties
type_pre-encounter_eligibilityChecks_v1_StediPayerItem
object
2 properties 2 required
type_pre-encounter_coverages_v1_NonCoveredDetail
object
6 properties 4 required
type_pre-encounter_coverages_v1_ServiceCoverage
object
5 properties 1 required
type_pre-encounter_eligibilityChecks_v1_CobPlanDateInformation
object
Dates associated with the patient's health plan coverage.
2 properties
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoverySubscriber
object
Demographic information for the patient when they are the health plan subscriber. Providing as much information as possible improves the probability of finding…
7 properties 2 required
type_pre-encounter_coverages_v1_ServiceTypeCode
string
Code identifying the type of service or benefit within a specific insurance policy (X12 008010 Element 1365)
type_pre-encounter_eligibilityChecks_v1_PostEligibilityRecommendationRequest
object
3 properties 3 required
type_pre-encounter_eligibilityChecks_v1_VoteValue
string
Possible vote values for recommendation quality
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryEncounter
object
The date range for the service. If not specified, Stedi defaults to the current date. You can specify either a single dateofservice or a beginningdateofservice…
3 properties
type_pre-encounter_eligibilityChecks_v1_EligibilityRequest
object
An object representing the data for an eligibility request.
10 properties 3 required
type_pre-encounter_common_FilterQueryString
string
A serialized list of filters separated by commas indicating filters to apply. Each filter is of the form 'path:operator:value'. Example: 'patient.mrn|eq|12345'…
type_pre-encounter_eligibilityChecks_v1_ParsedResponse
object
3 properties 1 required
type_pre-encounter_coverages_v1_CoverageBenefits
object
6 properties
type_pre-encounter_eligibilityChecks_v1_RequestCorrection
object
3 properties 3 required
type_pre-encounter_eligibilityChecks_v1_Encounter
object
2 properties
type_pre-encounter_eligibilityChecks_v1_CoordinationOfBenefitsRequest
object
An object representing the data for a coordination of benefits request.
5 properties 4 required
type_pre-encounter_eligibilityChecks_v1_EligibilityResponse
An object representing the data for an eligibility response.
type_pre-encounter_eligibilityChecks_v1_CobSubscriber
object
The primary policyholder for the insurance plan or a dependent with a unique member ID. You must provide at least one of memberid or ssn.
5 properties 3 required
type_pre-encounter_eligibilityChecks_v1_Cob
object
An overview of the COB response. Indicates whether there is a coverage overlap, whether that overlap creates a coordination of benefits instance, and whether S…
5 properties
type_pre-encounter_common_PageToken
string
A token that can be used to retrieve the next or previous page of results
type_pre-encounter_eligibilityChecks_v1_CobResponseSubscriber
object
Information about the primary policyholder for the insurance plan listed in the COB request.
11 properties
type_pre-encounter_coverages_v1_BenefitsRelatedEntity
object
5 properties
type_pre-encounter_eligibilityChecks_v1_CobProvider
object
Information about the entity requesting the COB check. Provide either organizationname (for organizations) or firstname and lastname (for individuals), plus np…
4 properties 1 required
type_pre-encounter_eligibilityChecks_v1_EligibilityCheckError
object
2 properties 2 required
type_pre-encounter_coverages_v1_BenefitType
string
type_pre-encounter_eligibilityChecks_v1_OrganizationProvider
object
2 properties 1 required
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryRequest
object
An object representing the data for an insurance discovery request.
4 properties 2 required
type_pre-encounter_eligibilityChecks_v1_StediPayer
object
10 properties 6 required
type_pre-encounter_coverages_v1_PlanDate
object
3 properties 2 required
type_pre-encounter_eligibilityChecks_v1_EligibilityRecommendationPatientInfo
object
An object representing patient information for an eligibility recommendation. This is used to find recommendations. Each field helps us find the right correspo…
7 properties
type_pre-encounter_common_ErrorBase4xx
object
2 properties 1 required
type_pre-encounter_common_OrganizationId
string
The unique identifier for an Organization in the database
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryResponse
object
An object representing the data for an insurance discovery response.
5 properties
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryAddress
object
The patient's address. Providing a zip code improves the probability of finding matching coverage.
6 properties
type_pre-encounter_eligibilityChecks_v1_CopayEstimationRecommendationPayload
object
Payload for MD visit copay estimation from AI analysis
2 properties 1 required
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryProvider
object
Information about the provider requesting the insurance discovery check.
1 property 1 required
type_pre-encounter_eligibilityChecks_v1_Provider
type_pre-encounter_eligibilityChecks_v1_EligibilityRecommendationPayload
type_pre-encounter_eligibilityChecks_v1_PayerSearchResponse
object
5 properties 3 required
type_pre-encounter_eligibilityChecks_v1_InsuranceDiscoveryStatus
string
The status of the insurance discovery check.
type_pre-encounter_eligibilityChecks_v1_EligibilityCheck
object
6 properties 1 required
type_pre-encounter_coverages_v1_Address
object
7 properties
type_pre-encounter_coverages_v1_PlanMetadata
object
11 properties
type_pre-encounter_eligibilityChecks_v1_Vote
object
User feedback on a recommendation
2 properties 2 required
type_pre-encounter_eligibilityChecks_v1_EligibilityRecommendation
object
An eligibility recommendation object that contains an EligibilityRecommendationType and a payload of data denoting the recommendation.
11 properties 9 required
type_pre-encounter_common_VersionConflictErrorBody
object
3 properties 1 required
type_pre-encounter_eligibilityChecks_v1_CobAddress
object
A patient's address as returned in a coordination of benefits response.
7 properties
type_pre-encounter_common_CoverageId
string
The unique identifier for a Coverage in the database
type_pre-encounter_eligibilityChecks_v1_CobResponseDependent
object
Information about the dependent listed in the original COB request.
13 properties
type_pre-encounter_coverages_v1_CoverageDetails
object
5 properties 4 required
type_pre-encounter_eligibilityChecks_v1_EligibilityStatus
string
enum to represent the status of a patient's coverage
type_pre-encounter_coverages_v1_ServiceCoverageDetails
object
5 properties
type_pre-encounter_eligibilityChecks_v1_CobPayer
object
Information about the payer listed in the COB request.
2 properties
type_pre-encounter_coverages_v1_CoverageValueUnit
string
type_pre-encounter_coverages_v1_RelatedEntityContact
object
2 properties
type_pre-encounter_coverages_v1_CoverageValue
object
4 properties
type_pre-encounter_coverages_v1_PlanCoverage
object
4 properties
type_pre-encounter_coverages_v1_PlanCoverageDetails
object
9 properties
type_pre-encounter_common_UserId
string
The unique identifier for a User in the database
type_pre-encounter_eligibilityChecks_v1_UserConfiguredPromptsRecommendationPayload
object
Payload for user-configured prompt recommendations from AI analysis
1 property 1 required
type_pre-encounter_eligibilityChecks_v1_UserConfiguredPromptsResult
object
Individual result from a single user-configured prompt execution
4 properties 4 required
type_pre-encounter_eligibilityChecks_v1_BatchEligibilityResponse
object
An object representing the data for a batch eligibility response.
2 properties 2 required
type_pre-encounter_coverages_v1_MemberInfo
object
4 properties 2 required
type_pre-encounter_eligibilityChecks_v1_EligibilityCheckErrorSource
string
enum to represent the source of an error in an eligibility check
type_pre-encounter_eligibilityChecks_v1_CoordinationOfBenefitsResponse
object
An object representing the data for a coordination of benefits response.
8 properties
type_pre-encounter_eligibilityChecks_v1_EligibilityCheckPage
object
4 properties 2 required
type_pre-encounter_common_PatientId
string
The unique identifier for a Patient
type_pre-encounter_eligibilityChecks_v1_MedicareAdvantageRecommendationPayload
object
An object representing the payload for a Medicare Advantage recommendation.
4 properties
type_pre-encounter_coverages_v1_CoverageLevel
string

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

candid-health-eligibility-checks-api-openapi.yml Raw ↑

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#Eligibility Checks
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API Details
ID
candid-health:candid-health-eligibility-checks-api
Base URL
https://api.joincandidhealth.com
Docs
https://docs.joincandidhealth.com/api-reference/patient-collections
Provider
Candid Health
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