Stedi Insurance discovery API
The Insurance discovery API from Stedi — 2 operation(s) for insurance discovery.
Stedi Insurance discovery API is one of 25 APIs that Stedi publishes on the APIs.io network, described by a machine-readable OpenAPI specification.
Tagged areas include Insurance Discovery. The published artifact set on APIs.io includes an OpenAPI specification, API documentation, and an API reference.
This API exposes 2 operations across 2 paths, and defines 101 schemas. It is described by OpenAPI 3.2.0, at version 2024-04-01.
Requests are made against 2 base URLs: https://healthcare.us.stedi.com/2024-04-01, https://healthcare.us.stedi.com/2026-06-01.
2 operations
2 paths
101 schemas
1 GET1 POST
Metadata
The identity and technical contract details declared by the specification.
Authentication & Security 1
Stedi Insurance discovery API declares
1 security scheme
for authenticating requests.
An API key is passed in the header as Authorization (httpApiKeyAuth).
By default, every request must be authenticated.
httpApiKeyAuth— A [Stedi API Key](https://portal.stedi.com/app/settings/api-keys) for authentication.
Paths & Operations 2
Across 2 paths, the API surfaces 2 operations — 1 GET, 1 POST. Each is listed below with its method, path, parameters, and response codes.
Insurance discovery 2
POST
/insurance-discovery/check/v1
Submit an insurance discovery check in JSON format
GET
/insurance-discovery/check/v1/{discoveryId}
Retrieve insurance discovery check results by discoveryId
Schemas 101
The contract defines 101 schemas that model the data the API accepts and returns. The most detailed are PlanInformation (41 properties), DiscoveryResponseSubscriber (35 properties), DiscoveryResponseDependent (35 properties), BenefitsDateInformation (34 properties). Each schema is shown below with its type and property counts.
BenefitsRelatedEntity
object
Identify another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. This array is…
12 properties
DeliveryOrCalendarPatternQualifierCode
string
Code that specifies the routine shipments, deliveries, or calendar pattern. For example 9 - Last Working Day of Period. Visit [Eligibility code lists](https://…
ApplicationModes
string
The type of data in the request. This is either production when you send a request with a standard API key or test when you send a request in test mode with a…
Contacts
object
Contacts
2 properties
InsuranceDiscoveryCheckResponseContent
object
7 properties
Confidence
object
2 properties
Gender
string
InformationStatusCode
string
Payers may sometimes return other non-compliant values.
CodeListQualifierCode
string
Payers may sometimes return other non-compliant values.
InsuranceTypeCode
string
Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values.
BenefitsDateInformation
object
Dates associated with the benefits. - This is where you can find benefit-specific eligibility dates, if provided. These dates override dates provided in planDa…
34 properties
InsuranceDiscoveryProvider
object
Information about the provider requesting the insurance discovery check.
1 property
1 required
ServiceUnavailableExceptionResponseContent
object
The server is temporarily unavailable.
2 properties
1 required
EligibilityCheckErrorCode
string
This is a superset of all the possible codes in the sub-loops, as all errors are bubbled up to the top level of the response Payers may sometimes return other…
BenefitRelatedEntityIdentification
string
Code identifying the type of value provided in entityIdentificationValue. For example, FI - Federal Taxpayer's Identification Number. Payers may sometimes retu…
ContactInformation
object
2 properties
DiscoveryResponseDependent
object
Common fields shared between subscriber and dependent structures in the eligibility response.
35 properties
InPlanNetworkIndicatorCode
string
Code indicating whether the benefit is in-network or out-of-network. Can be Y - Yes, N - No, U - Unknown, or W - Not Applicable Code U indicates that it is unk…
GenderWithUnknown
string
EligibilityCheckProviderErrorCode
string
Payers may sometimes return other non-compliant values.
EntityTypeQualifier
string
The type of entity. Payers may sometimes return other non-compliant values.
BenefitsAdditionalInformation
object
Identifying information specific to this type of benefit.
19 properties
CommunicationMode
string
Payers may sometimes return other non-compliant values.
ResourceNotFoundExceptionResponseContent
object
The server response when the specified resource cannot be found after an API request passes authentication and authorization.
2 properties
1 required
DependentInsuredIndicator
string
Indicates the status of the insured. For the dependent, this is always N.
ResponseProvider
object
Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or ano…
19 properties
DiscoveryResponseProvider
object
17 properties
Warning
object
2 properties
InPlanNetworkIndicatorName
string
The name of the in-plan network indicator code. Payers may sometimes return other non-compliant values.
DeliveryPatternTimeQualifierCode
string
A code specifying the time for routine shipments or deliveries. Payers may sometimes return other non-compliant values.
EligibilityCheckFollowupAction
string
Payers may sometimes return other non-compliant values.
InsuranceDiscoverySubscriber
object
Demographic information for the patient when they are the health plan subscriber. We strongly recommend providing as much information as possible to improve th…
7 properties
2 required
ResponseSubscriberEntityIdentifier
string
The entity identifier for the subscriber.
DiscoveryBenefitsInformation
object
28 properties
QuantityQualifierCode
string
Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values.
MaintenanceReasonCode
string
Code identifying the reason for the changes to subscriber identifying information, such as name, date of birth, or address. This is always 25 Payers may someti…
InsuranceDiscoveryResponseFields
object
8 properties
EligibilityCheckProviderAndMemberFollowupAction
string
Payers may sometimes return other non-compliant values.
DiscoveryPlanDateInformation
object
23 properties
BenefitsRelatedEntityRelationshipCode
string
Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values.
InternalFailureExceptionResponseContent
object
The server response when an unexpected error occurred while processing request.
2 properties
1 required
InsuranceTypeName
string
The full name of the insurance type code. Payers may sometimes return other non-compliant values.
DtpDate
object
3 properties
ResponseDependentEntityIdentifier
string
The entity identifier for the dependent.
ResponseProviderCode
string
A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-listsprovider-codes) for a comple…
DeliveryOrCalendarPatternQualifier
string
The name of the deliveryOrCalendarPatternCode. For example, Last Working Day of Period. Payers may sometimes return other non-compliant values.
DeliveryPatternTimeQualifier
string
The name of the deliveryPatternTimeCode. Payers may sometimes return other non-compliant values.
DependentRelationshipCode
string
For the dependent, this can be 01 - Spouse, 19 - Child, 20 Employee, 21 - Unknown, 39 - Organ Donor, 40 - Cadaver Donor, 53 - Life Partner, or G8 - Other Relat…
DiscoveryStatus
string
TimeQualifierCode
string
Code indicating the time period for the benefit information. Payers may sometimes return other non-compliant values.
InsuranceDiscoveryEncounter
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 da…
3 properties
PlanInformation
object
Additional identification for the subscriber's healthcare plan.
41 properties
BenefitsInformationCoverageLevelName
string
The full name of the coverage level code. Payers may sometimes return other non-compliant values.
BenefitsInformationName
string
The full name of the benefits information code. Payers may sometimes return other non-compliant values.
BenefitsServiceDeliveryQuantityQualifierCode
string
Code specifying the type of quantity. Payers may sometimes return other non-compliant values.
SubscriberRelationship
string
The name of the relationToSubscriberCode. For the subscriber, this is always Self.
TimePeriodQualifierCode
string
Code specifying the time period for the benefit information. Payers may sometimes return other non-compliant values.
DiscoveryPayer
object
14 properties
DateTimePeriodFormatQualifier
string
Payers may sometimes return other non-compliant values.
TimePeriodQualifier
string
The name of the timePeriodQualifierCode. For example, Calendar Year. Payers may sometimes return other non-compliant values.
CompositeMedicalProcedureIdentifier
object
Identifies relevant medical procedures by their standard codes and modifiers (if applicable).
6 properties
MaintenanceTypeCode
string
The maintenance type code. Used to acknowledge a change in the identifying elements for the subscriber from those submitted in the original eligibility check r…
HealthCareDiagnosisCode
object
Information about the patient's healthcare diagnosis.
2 properties
GatewayTimeoutExceptionResponseContent
object
The server response for a gateway timeout error.
2 properties
1 required
SubscriberInsuredIndicator
string
Indicates the status of the insured. For the subscriber, this is always Y.
EligibilityCheckError
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…
6 properties
EligibilityCheckProviderError
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…
6 properties
PayerEntityIdentifier
string
The entity identifier code for the payer. Payers may sometimes return other non-compliant values.
BenefitsServiceDeliveryQuantityQualifier
string
The name of the quantityQualifierCode. For example, Days. Payers may sometimes return other non-compliant values.
TimeQualifierName
string
The name of the time period qualifier code. Note that for the patient's deductible, Calendar Year indicates the patient's total deductible amount for the year,…
Address
object
7 properties
ThrottlingExceptionResponseContent
object
The server response when usage plan or account-level throttling limits exceeded.
2 properties
1 required
RelatedEntityIdentifierName
string
Code identifying an organizational entity, a physical location, property or an individual. - PPO is used to identify a PPO by name or identification number, an…
BenefitsServiceDelivery
object
The delivery or usage pattern for the benefits.
16 properties
EmploymentStatusCode
string
Payers may sometimes return other non-compliant values.
ResponseEligibilityServiceType
string
The name of a Service Type Code listed in the serviceTypeCodes array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checkss…
ConfidenceLevel
string
ProviderInformation
object
2 properties
AccessDeniedExceptionResponseContent
object
The server response for authorization failure.
2 properties
1 required
BenefitsInformationCode
string
The code indicating the type of benefits information. Visit [Eligibility and benefit codes](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-b…
QuantityQualifierName
string
The name of the quantity qualifier code. Payers may sometimes return other non-compliant values.
AdditionalInformation
object
1 property
AuthOrCertIndicator
string
Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values.
ResponseProviderEntityIdentifier
string
A code identifying the type of provider. Payers may sometimes return other non-compliant values.
DiscoveryResponseSubscriber
object
Common fields shared between subscriber and dependent structures in the eligibility response.
35 properties
InsuranceDiscoveryCheckRequestContent
object
4 properties
2 required
UnitForMeasurementCode
string
Code specifying the unit of measurement for the quantity. Payers may sometimes return other non-compliant values.
ValidationExceptionResponseContent
object
A standard error for input validation failures. Thrown when a member of the input structure falls outside of the modeled or documented constraints.
2 properties
1 required
GetInsuranceDiscoveryCheckResponseContent
object
7 properties
EligibilityAdditionalInformation
object
6 properties
DependentRelationship
string
The name of the relationToSubscriberCode. For example, Child when the code is 19.
ResponseEligibilityServiceTypeCode
string
A code identifying a type of service. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checksservice-type-codes) for a complet…
MilitaryServiceRankCode
string
Payers may sometimes return other non-compliant values.
UnitForMeasurement
string
The name of the unitForMeasurementQualifierCode. For example, Days. Payers may sometimes return other non-compliant values.
ResponseStateOrProvinceCode
string
The US state or Canadian province code with unknown option. For example, TN for Tennessee or NB for New Brunswick. Payers may sometimes return other non-compli…
GovernmentServiceAffiliationCode
string
Payers may sometimes return other non-compliant values.
InjuryCodeCategory
string
Payers may sometimes return other non-compliant values.
InsuranceDiscoveryDependent
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 improv…
7 properties
2 required
InsuranceDiscoveryMetadata
object
Metadata about the response. Stedi uses this data for tracking and troubleshooting.
2 properties
BenefitsInformationCoverageLevelCode
string
Code indicating the level of coverage for the patient. This will either be CHD - Children Only, DEP - Dependents Only, ECH - Employee and Children, EMP - Emplo…
SubscriberRelationshipCode
string
For the subscriber, this is always 18 for Self.
Specification
The full machine-readable OpenAPI contract behind this narrative.
Source
More from Stedi 12
Other APIs Stedi publishes across the network.
Stedi Claim acknowledgments API
Stedi Claim Attachments API
Stedi Claim submission API
Stedi Coordination of benefits API
Stedi Documents API
Stedi Enrollments API
Stedi Events API
Stedi Executions API
Stedi Fragments API
Stedi Partnerships API
Stedi Payer API
Stedi Payers API
#Insurance Discovery
Where this information came from
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