Match Check
Eligibility Checks
Match Check
Creates or updates a patient from eligibility check demographics and creates insurance records.
POST
Match Check
Authorizations
Path Parameters
Body
application/json
Request schema for matching eligibility check to patient/insurance
Required insurance ID to update with eligibility data
Optional patient ID. If provided, use this patient; otherwise search/create by demographics.
Insurance tier. Defaults to primary.
Available options:
primary, secondary, tertiary, quaternary Service types to copy from existing payor. If not provided, all existing services are copied.
X12 Service Type — human-readable enum values stored in the database. See app/utils/service_type_mapping.py for code-to-type mappings.
Available options:
medical_care, surgical, consultation, diagnostic_x_ray, diagnostic_lab, radiation_therapy, anesthesia, surgical_assistance, other_medical, blood_charges, used_durable_medical_equipment, durable_medical_equipment_purchase, ambulatory_service_center_facility, renal_supplies_in_home, alternate_method_dialysis, chronic_renal_disease_equipment, pre_admission_testing, durable_medical_equipment_rental, pneumonia_vaccine, second_surgical_opinion, third_surgical_opinion, social_work, diagnostic_dental, periodontics, restorative, endodontics, maxillofacial_prosthetics, adjunctive_dental_services, health_benefit_plan_coverage, plan_waiting_period, chiropractic, chiropractic_office_visits, dental_care, dental_crowns, dental_accident, orthodontics, prosthodontics, oral_surgery, routine_preventive_dental, home_health_care, home_health_prescriptions, home_health_visits, hospice, respite_care, hospital, hospital_inpatient, hospital_room_and_board, hospital_outpatient, hospital_emergency_accident, hospital_emergency_medical, hospital_ambulatory_surgical, long_term_care, major_medical, medically_related_transportation, air_transportation, cabulance, licensed_ambulance, general_benefits, in_vitro_fertilization, mri_cat_scan, donor_procedures, acupuncture, newborn_care, pathology, smoking_cessation, well_baby_care, maternity, transplants, audiology_exam, inhalation_therapy, diagnostic_medical, private_duty_nursing, prosthetic_device, dialysis, otological_exam, chemotherapy, allergy_testing, immunizations, routine_physical, family_planning, infertility, abortion, aids, emergency_services, cancer, pharmacy, free_standing_prescription_drug, mail_order_prescription_drug, brand_name_prescription_drug, generic_prescription_drug, podiatry, podiatry_office_visits, podiatry_nursing_home_visits, professional_physician, anesthesiologist, professional_visit_office, professional_visit_inpatient, professional_visit_outpatient, professional_visit_nursing_home, professional_visit_skilled_nursing_facility, professional_visit_home, psychiatric, psychiatric_room_and_board, psychotherapy, psychiatric_inpatient, psychiatric_outpatient, rehabilitation, rehabilitation_room_and_board, rehabilitation_inpatient, rehabilitation_outpatient, occupational_therapy, physical_medicine, speech_therapy, skilled_nursing_care, skilled_nursing_care_room_and_board, substance_abuse, alcoholism, drug_addiction, vision_optometry, frames, routine_exam, lenses, nonmedically_necessary_physical, experimental_drug_therapy, burn_care, brand_name_prescription_drug_formulary, brand_name_prescription_drug_non_formulary, independent_medical_evaluation, partial_hospitalization_psychiatric, day_care_psychiatric, cognitive_therapy, massage_therapy, pulmonary_rehabilitation, cardiac_rehabilitation, pediatric, nursery, skin, orthopedic, cardiac, lymphatic, gastrointestinal, endocrine, neurology, eye, invasive_procedures, gynecological, obstetrical, obstetrical_gynecological, mail_order_prescription_drug_brand_name, mail_order_prescription_drug_generic, physician_visit_office_sick, physician_visit_office_well, coronary_care, private_duty_nursing_inpatient, private_duty_nursing_home, surgical_benefits_professional, surgical_benefits_facility, mental_health_provider_inpatient, mental_health_provider_outpatient, mental_health_facility_inpatient, mental_health_facility_outpatient, substance_abuse_facility_inpatient, substance_abuse_facility_outpatient, screening_x_ray, screening_laboratory, mammogram_high_risk_patient, mammogram_low_risk_patient, flu_vaccination, eyewear_and_accessories, case_management, dermatology, durable_medical_equipment, diabetic_supplies, generic_prescription_drug_formulary, generic_prescription_drug_non_formulary, allergy, intensive_care, mental_health, neonatal_intensive_care, oncology, physical_therapy, pulmonary, renal, residential_psychiatric_treatment, transitional_care, transitional_nursery_care, urgent_care Service types to create from this eligibility check. If not provided, all service types from the check are created.
X12 Service Type — human-readable enum values stored in the database. See app/utils/service_type_mapping.py for code-to-type mappings.
Available options:
medical_care, surgical, consultation, diagnostic_x_ray, diagnostic_lab, radiation_therapy, anesthesia, surgical_assistance, other_medical, blood_charges, used_durable_medical_equipment, durable_medical_equipment_purchase, ambulatory_service_center_facility, renal_supplies_in_home, alternate_method_dialysis, chronic_renal_disease_equipment, pre_admission_testing, durable_medical_equipment_rental, pneumonia_vaccine, second_surgical_opinion, third_surgical_opinion, social_work, diagnostic_dental, periodontics, restorative, endodontics, maxillofacial_prosthetics, adjunctive_dental_services, health_benefit_plan_coverage, plan_waiting_period, chiropractic, chiropractic_office_visits, dental_care, dental_crowns, dental_accident, orthodontics, prosthodontics, oral_surgery, routine_preventive_dental, home_health_care, home_health_prescriptions, home_health_visits, hospice, respite_care, hospital, hospital_inpatient, hospital_room_and_board, hospital_outpatient, hospital_emergency_accident, hospital_emergency_medical, hospital_ambulatory_surgical, long_term_care, major_medical, medically_related_transportation, air_transportation, cabulance, licensed_ambulance, general_benefits, in_vitro_fertilization, mri_cat_scan, donor_procedures, acupuncture, newborn_care, pathology, smoking_cessation, well_baby_care, maternity, transplants, audiology_exam, inhalation_therapy, diagnostic_medical, private_duty_nursing, prosthetic_device, dialysis, otological_exam, chemotherapy, allergy_testing, immunizations, routine_physical, family_planning, infertility, abortion, aids, emergency_services, cancer, pharmacy, free_standing_prescription_drug, mail_order_prescription_drug, brand_name_prescription_drug, generic_prescription_drug, podiatry, podiatry_office_visits, podiatry_nursing_home_visits, professional_physician, anesthesiologist, professional_visit_office, professional_visit_inpatient, professional_visit_outpatient, professional_visit_nursing_home, professional_visit_skilled_nursing_facility, professional_visit_home, psychiatric, psychiatric_room_and_board, psychotherapy, psychiatric_inpatient, psychiatric_outpatient, rehabilitation, rehabilitation_room_and_board, rehabilitation_inpatient, rehabilitation_outpatient, occupational_therapy, physical_medicine, speech_therapy, skilled_nursing_care, skilled_nursing_care_room_and_board, substance_abuse, alcoholism, drug_addiction, vision_optometry, frames, routine_exam, lenses, nonmedically_necessary_physical, experimental_drug_therapy, burn_care, brand_name_prescription_drug_formulary, brand_name_prescription_drug_non_formulary, independent_medical_evaluation, partial_hospitalization_psychiatric, day_care_psychiatric, cognitive_therapy, massage_therapy, pulmonary_rehabilitation, cardiac_rehabilitation, pediatric, nursery, skin, orthopedic, cardiac, lymphatic, gastrointestinal, endocrine, neurology, eye, invasive_procedures, gynecological, obstetrical, obstetrical_gynecological, mail_order_prescription_drug_brand_name, mail_order_prescription_drug_generic, physician_visit_office_sick, physician_visit_office_well, coronary_care, private_duty_nursing_inpatient, private_duty_nursing_home, surgical_benefits_professional, surgical_benefits_facility, mental_health_provider_inpatient, mental_health_provider_outpatient, mental_health_facility_inpatient, mental_health_facility_outpatient, substance_abuse_facility_inpatient, substance_abuse_facility_outpatient, screening_x_ray, screening_laboratory, mammogram_high_risk_patient, mammogram_low_risk_patient, flu_vaccination, eyewear_and_accessories, case_management, dermatology, durable_medical_equipment, diabetic_supplies, generic_prescription_drug_formulary, generic_prescription_drug_non_formulary, allergy, intensive_care, mental_health, neonatal_intensive_care, oncology, physical_therapy, pulmonary, renal, residential_psychiatric_treatment, transitional_care, transitional_nursery_care, urgent_care Response
Successful Response
Response for eligibility check match operation
The patient ID (created or found)
The insurance ID that was updated
The payor ID that was created/updated
The subscriber ID that was created
Whether a new patient was created
Whether an existing patient was updated
Human-readable result message