Stedi Real-time eligibility check API
The Real-time eligibility check API from Stedi — 2 operation(s) for real-time eligibility check.
Stedi Real-time eligibility check API is one of 25 APIs that Stedi publishes on the APIs.io network, described by a machine-readable OpenAPI specification.
Tagged areas include Real-time eligibility check. 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 133 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
133 schemas
2 POST
Metadata
The identity and technical contract details declared by the specification.
Authentication & Security 1
Stedi Real-time eligibility check 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 — 2 POST. Each is listed below with its method, path, parameters, and response codes.
Real-time eligibility check 2
POST
/change/medicalnetwork/eligibility/v3
Submit a real-time 270/271 eligibility check in JSON format
POST
/change/medicalnetwork/eligibility/v3/raw-x12
Submit a real-time 270/271 eligibility check in raw X12 EDI format
Schemas 133
The contract defines 133 schemas that model the data the API accepts and returns. The most detailed are PlanInformation (41 properties), ResponseDependent (36 properties), ResponseSubscriber (36 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://…
ProviderType
string
Identify the type of provider.
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
Gender
string
InformationStatusCode
string
Payers may sometimes return other non-compliant values.
CodeListQualifierCode
string
Payers may sometimes return other non-compliant values.
EligibilityRawX12Check400ErrorResponseContent
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
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…
EncounterProductOrServiceIDQualifier
string
Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, CJ - Current Procedural Terminology (CPT) Co…
RequestDependentAddress
object
Address information for the dependent. When providing address information, we recommend including state for member identification in addition to the required a…
7 properties
2 required
EligibilityCheckRequestContent
object
13 properties
3 required
EligibilityCheckDependentError
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
ContactInformation
object
2 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…
EligibilityCheckOutputValidationErrors
object
18 properties
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.
RequestSubscriberReferenceIdentificationQualifier
string
Use this for providers that are not requesting the eligibility check. This is the type of providerIdentifier you are providing. - Set to HPI when the National…
PlanDateInformation
object
Contains the dates associated with the subscriber and dependents' (if applicable) insurance plan. This information is used to determine their eligibility for b…
32 properties
RequestSubscriberAddress
object
Address information for the subscriber. When providing address information: - The address1 and city properties are required for standard eligibility checks and…
7 properties
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
EligibilityMetaDataJSON
object
Metadata about the response. Stedi uses this data for tracking and troubleshooting.
6 properties
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
DependentInsuredIndicator
string
Indicates the status of the insured. For the dependent, this is always N.
RequestProviderAddress
object
Address information for the provider. - Only include when specifically instructed by a payer, such as when the provider has multiple locations and you need to…
7 properties
2 required
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.
DiagnosisTypeCode
string
The type of diagnosis code you are providing. You can set to BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis…
EligibilityCheckFollowupAction
string
Payers may sometimes return other non-compliant values.
EligibilityCheckResponseContent
object
21 properties
EligibilityCheckDependentErrorCode
string
Payers may sometimes return other non-compliant values.
ResponseSubscriberEntityIdentifier
string
The entity identifier for the subscriber.
BenefitsInformation
object
30 properties
QuantityQualifierCode
string
Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values.
AdditionalIdentificationDependent
object
Use this object when you need to provide an additional identification number for the dependent. This is rarely required for standard eligibility checks.
11 properties
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…
RequestDependentReferenceIdentificationQualifier
string
The type of providerIdentifier you are using. Use for providers that are not requesting the eligibility check, such as the referring provider. - Set to HPI whe…
EligibilityCheckProviderAndMemberFollowupAction
string
Payers may sometimes return other non-compliant values.
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.
RequestStateOrProvinceCode
string
The US state or Canadian province code. For example, TN for Tennessee or NB for New Brunswick.
AdditionalIdentificationSubscriber
object
Use this object when you need to provide an identification number other than or in addition to the subscriber's member ID. For example, you may provide the pat…
11 properties
DtpDate
object
3 properties
ResponseDependentEntityIdentifier
string
The entity identifier for the dependent.
ValidationException
object
A standard error for input validation failures. This should be thrown by services when a member of the input structure falls outside of the modeled or document…
2 properties
1 required
HealthCareInformation
object
2 properties
2 required
IndividualRelationshipCode
string
The dependent's relationship to the subscriber. You can set this to 01 - Spouse, 19 - Child, 34 - Other Adult.
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…
ValidationExceptionField
object
Describes one specific validation failure for an input member.
2 properties
2 required
RequestProviderCode
string
ResponseSubscriber
object
Information about the primary policyholder for the insurance plan listed in the original eligibility check request. The response will always include either the…
36 properties
RequestDependentProviderCode
string
Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital ma…
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.
RequestEligibilityServiceTypeCode
string
Payer
object
Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer…
16 properties
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…
TimeQualifierCode
string
Code indicating the time period for the benefit information. Payers may sometimes return other non-compliant values.
EligibilityRawX12CheckRequestContent
object
3 properties
1 required
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.
DateTimePeriodFormatQualifier
string
Payers may sometimes return other non-compliant values.
TimePeriodQualifierCode
string
Code specifying the time period for the benefit information. 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
Encounter
object
Details about the eligibility or benefit information you are requesting for the patient. - If you don't specify either serviceTypeCodes or a procedureCode and…
12 properties
RequestSubscriber
object
The primary policyholder for the insurance plan or a dependent with a unique member ID. If a dependent has a unique member ID, include their information here a…
28 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
EligibilityCheckSubscriberError
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
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
Provider
object
Information about the entity requesting the eligibility check. This may be an individual practitioner, a medical group, a hospital, or another type of healthca…
27 properties
IndustryCode
string
The type of facility where the service was provided. You can set this to one of the [place of service codes](https://www.cms.gov/medicare/coding-billing/place-…
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
MedicalProcedureProductOrServiceIDQualifier
string
Code identifying the type/source of the procedureCode. You can set this to AD - American Dental Association Codes, CJ - Current Procedural Terminology (CPT) Co…
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
PlanStatus
object
4 properties
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
MedicalProcedure
object
4 properties
2 required
EmploymentStatusCode
string
Payers may sometimes return other non-compliant values.
EligibilityMetaDataRawX12
object
Metadata about the response. Stedi uses this data for tracking and troubleshooting.
6 properties
EligibilityRawX12CheckResponseContent
object
21 properties
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…
EligibilityCheckSubscriberErrorCode
string
Payers may sometimes return other non-compliant values.
ProviderInformation
object
2 properties
AccessDeniedExceptionResponseContent
object
The server response for authorization failure.
2 properties
1 required
SubscriberTraceNumber
object
5 properties
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.
RawEligibilityResponseValidationErrors
object
21 properties
EligibilityCheckPayerErrorCode
string
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.
UnitForMeasurementCode
string
Code specifying the unit of measurement for the quantity. Payers may sometimes return other non-compliant values.
EligibilityAdditionalInformation
object
6 properties
RequestSubscriberProviderCode
string
Use this for providers that are not requesting the eligibility check - the requestor is specified in the provider object. For example, if you are a hospital ma…
DependentRelationship
string
The name of the relationToSubscriberCode. For example, Child when the code is 19.
RequestDependent
object
26 properties
EncounterReferenceIdentificationQualifier
string
The type of information you provided in the priorAuthorizationOrReferralNumber property. You can set this to 9F - Referral Number or G1 - Prior Authorization N…
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.
EligibilityCheck400ErrorResponseContent
InjuryCodeCategory
string
Payers may sometimes return other non-compliant values.
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.
InformationReceiverName
object
16 properties
ResponseDependent
object
Information about the dependent listed in the original eligibility check request. Note that a dependent submitted in the request may be returned in the subscri…
36 properties
EligibilityCheckPayerError
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
Specification
The full machine-readable OpenAPI contract behind this narrative.
Source
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#Real-time eligibility check
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