Create Payor
Authorizations
Body
Request model for creating a payor (patient-insurance relationship)
Patient ID
Insurance ID
Relationship to subscriber
spouse, self, child, employee, unknown, organ_donor, cadaver_donor, life_partner, other_relationship Member ID
Group number for the insurance plan
Group description for the insurance plan
Primary, Secondary, Tertiary, or Quaternary
primary, secondary, tertiary, quaternary Coverage start date
Coverage end date
Provider network status
unknown, in_network, out_of_network Plan funding type
fully_funded, self_funded, unknown Plan name
Plan type (HMO, PPO, etc.)
01, 02, 03, 12, 13, 14, 15, 16, 17, 18, 19, 41, 42, 43, 47, 48, 49, AP, C1, CO, CP, D, DB, EP, FF, GP, HB, HD, HG, HM, HN, HP, HS, IN, IP, LC, LD, LI, LT, M, MA, MB, MC, MD, ME, MH, MI, MJ, MK, ML, MM, MN, MO, MP, MR, MT, OA, OT, PE, PL, PP, PR, PS, QM, RP, SA, SP, TF, WC, WU Plan renewal date type
calendar_year, service_year, contract Coordination of Benefits status
not_required, pending, complete Notes about COB
Last COB verification date
Whether patient has other active coverage
Whether plan covers out-of-state services
Notes about out-of-state coverage
Whether coverage is in grace period
Last premium payment date
Whether this is COBRA coverage
Whether deductible applies to out-of-pocket maximum
Eligibility check status
active, inactive, pending, failed Eligibility check comment
Eligibility check date
Eligibility version number
Individual deductible policy in network
Individual deductible policy out of network
Individual deductible remaining in network
Individual deductible remaining out of network
Family deductible policy in network
Family deductible policy out of network
Family deductible remaining in network
Family deductible remaining out of network
Individual OOP max policy in network
Individual OOP max policy out of network
Individual OOP max remaining in network
Individual OOP max remaining out of network
Family OOP max policy in network
Family OOP max policy out of network
Family OOP max remaining in network
Family OOP max remaining out of network
Benefits related entities from eligibility check
Subscriber information (creates new subscriber)
Existing subscriber ID (references existing subscriber)
Response
Successful Response
Payor resource.
Represents the relationship between a patient and their insurance coverage. Includes related insurance, subscriber, and service information.
Relationship to subscriber enum matching Prisma @map values
spouse, self, child, employee, unknown, organ_donor, cadaver_donor, life_partner, other_relationship Insurance tier enum matching Prisma
primary, secondary, tertiary, quaternary Provider network status enum matching Prisma @map values
unknown, in_network, out_of_network Plan funding type enum matching Prisma @map values
fully_funded, self_funded, unknown Insurance plan type enum matching Prisma - X12 standard codes
01, 02, 03, 12, 13, 14, 15, 16, 17, 18, 19, 41, 42, 43, 47, 48, 49, AP, C1, CO, CP, D, DB, EP, FF, GP, HB, HD, HG, HM, HN, HP, HS, IN, IP, LC, LD, LI, LT, M, MA, MB, MC, MD, ME, MH, MI, MJ, MK, ML, MM, MN, MO, MP, MR, MT, OA, OT, PE, PL, PP, PR, PS, QM, RP, SA, SP, TF, WC, WU Plan renewal date type enum matching Prisma @map values
calendar_year, service_year, contract COB status enum matching Prisma @map values
not_required, pending, complete Eligibility check status enum matching Prisma EligibilityStatus
active, inactive, pending, failed