Patient Insurance Eligibility Information

The Patient Insurance Eligibility Information feature allows the user to perform an eligibility check and receive eligibility information on specific patient insurances.

The POST will trigger athena’s eligibility service to send a 270 eligibility request to the given/specified payer. 

The GET will retrieve the most recent 271 eligibility response that athena has received from that payer.

Please note that this feature will not work in Preview environments for testing because athena’s eligibility service is only live in our Production environment. Therefore, nothing will be sent even if you retrieve a success with your preview credentials.
 

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Endpoints

Get patient's insurance benefit-details
GET
/v1/{practiceid}/patients/{patientid}/insurances/{insuranceid}/benefitdetails

Retrieves eligibility information for a specific insurance

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Input Parameters

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❙ required

practiceid integer practiceid
patientid integer patientid
insuranceid integer insuranceid
servicetypecode string STC Code for which we are checking the eligibility
dateofservice string Fetches the eligibility on that specific date.

Output Parameters

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ansi271 string 271 data from the payer.
dateofservice string Date on which eligibility was checked.
lastcheckdate string The last time we did an eligibilty check for this patient.
Example Code
Create patient's insurance benefit-details
POST
/v1/{practiceid}/patients/{patientid}/insurances/{insuranceid}/benefitdetails

Send eligibility check for a specific insurance

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Input Parameters

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❙ required

practiceid integer practiceid
patientid integer patientid
insuranceid integer insuranceid
Content-Type string Content type of the payload

❙ Request Body

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dateofservice string Checks the eligibility on that specific date.
servicetypecode string STC Code for which we are checking the eligibility

Output Parameters

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message string If success/error message with more detail.
success string True if operation was sucessful, false otherwise.
Example Code