The Insurance Eligibility Object

The Insurance Eligibility Object represents the eligibility information for a patient's insurance.

The response includes eligibility details such as co-pay, coinsurance, deductible, and remaining deductible.

Object Definition

{
    "eligibility_details": {
        "copay": null,
        "copay_ambiguous": true,
        "coinsurance": "0",
        "coinsurance_ambiguous": false,
        "deductible": "2000",
        "deductible_ambiguous": false,
        "deductible_remaining": "1827.12",
        "deductible_remaining_ambiguous": false,
        "errors": []
    },
    "eligibility_check_timestamp": "2022-05-05T19:39:26+00:00",
    "eligibility_status": "active",
    "patient_id": 140658474356545,
    "patient_insurance_id": 130754515763059,
    "practice_id": 6558432
}

Attribute

Type

Possible Values

Description

eligibility_details.copay

decimal

copayment amount in dollars

eligibility_details.copay_ambiguous

boolean

true, false

If true, the given copay value may not be accurate and the full eligibility report will need to be referenced for better details.

eligibility_details.coinsurance

string

0.00 to 1.00

Coinsurance percentage value as a decimal

e.g. 0.25

eligibility_details.coinsurance_ambiguous

boolean

true, false

eligibility_details.deductible

string

Deductible amount in dollars

eligibility_details.deductible_ambiguous

boolean

true, false

eligibility_details.deductible_remaining

string

Remaining deductible amount in dollars

eligibility_details.deductible_remaining_ambiguous

boolean

true, false

eligibility_details.errors

array of objects

Error messages showing reason for failed eligibility check

eligibility_check_timestamp

string

Eligibility check timestamp in ISO format

eligibility_status

string

"active", "inactive", "error"

Status of eligibility check

patient_id

integer

Patient's id in Elation system

patient_insurance_id

integer

Patient's insurance id in Elation system

practice_id

integer

Practice's id in Elation system