Page Comparison

FirstName - first_name
LastName - last_name
DOB - dob
Gender - gender
Address - street_addr
City - city
State - state
ZipCode - zip

Relationship to Insured - insurance.respparty (e.g self, child, spouse, other)

// Primary Insurance Fields
Primary Insurance - insurance.primary_carrier_code (insurer_id)
Primary Insurance Group Number - insurance.primary_group_number
Primary Insurance Subscriber Number - insurance.primary_subscriber_num
Primary Insurance Card Front - insurance.primary_card_front
Primary Insurance Card Back - insurance.primary_card_back

// Secondary Insurance Fields
Secondary Insurance - insurance.secondary_carrier_code (insurer_id)
Secondary Insurance Group Number - insurance.secondary_group_number
Secondary Insurance Subscriber Number - insurance.secondary_subscriber_num
Secondary Insurance Card Front - insurance.secondary_card_front
Secondary Insurance Card Back - insurance.secondary_card_back

If Relationship to Insured is child, spouse, other:
Guarantor Name - insurance.guarantor_name
Guarantor DOB  - insurance.guarantor_dob
Guarantor Address1 - insurance.guarantor_address
Guarantor City - insurance.guarantor_city
Guarantor State - insurance.guarantor_state
Guarantor Zip -  - insurance.guarantor_zip

{
    "data": {
        "eligibility_id": "2505465",
        "carrier_code": "car7556"
    }
}

{
    "data": {
        "id": "132407",
        "code": "edward+001.vclinic@vseelab.com",
        "first_name": "Edward",
        "last_name": "VSee",
        "full_name": "Edward VSee",
        "username": "edward+001.vclinic@vseelab.com",
        "vseeid": "ccpreview+6258012d656449b8b5e73ad964457b1f",
        "dob": "1986-01-01",
        "email": "edward+001.vclinic@vseelab.com",
        "gender": 1,
        "active": true,
        "tos": false,
        "status": 20,
        "subtype": "",
        "street_addr": "2868 Tully Street",
        "state": "Detroit",
        "city": "MI",
        "zip": "48226",
        "timezone": "America/Los_Angeles",
        "email_verified": true,
        "insurance": {
            "primary": {
                "carrier_code": "car7556",
                "subscriber_num": "234234",
                "insurance_order": 1,
                "insurance_coverage_id": "3708039",
                "eligibility_id": "2505465",
                "last_checked": 1649950742,
                "eligibility_response": "No response received by clearinghouse",
                "eligibility_text": "The payer response contains invalid or non compliant data.(70002)",
                "raw_response": {
                    "?xml": {
                        "@version": "1.0",
                        "@encoding": "ISO-8859-1"
                    },
                    "PPMDResults": {
                        "@s": "PRDAPI1WFEYU1PO",
                        "@lst": "4/14/2022 8:39:02 AM",
                        "Results": {
                            "@eligibilityid": "2505465",
                            "@eligibilitystatusid": "1",
                            "@eligibilitycreatedat": "04/14/2022  8:38AM",
                            "@eligibilitychangedat": "04/14/2022  8:38AM",
                            "@eligibilityresponsedate": "04/14/2022  8:38AM",
                            "@patientname": "VSEE,EDWARD",
                            "@address2": "2868 TULLY STREET",
                            "@city": "MI",
                            "@state": "DET",
                            "@zipcode": "48226     ",
                            "@dob": "1986-01-01T00:00:00",
                            "@subscriberid": "234234",
                            "@eligibilitystc": "30",
                            "Edi271": {
                                "@xmlns:xsi": "http://www.w3.org/2001/XMLSchema-instance",
                                "@xmlns:xsd": "http://www.w3.org/2001/XMLSchema",
                                "InterchangeControlHeader": {
                                    "@ISA01_AuthorizationInformationQualifier": "00",
                                    "@ISA02_AuthorizationInformation": "          ",
                                    "@ISA03_SecurityInformationQualifier": "00",
                                    "@ISA04_SecurityInformation": "          ",
                                    "@ISA05_SenderInterchangeIdQualifier": "ZZ",
                                    "@ISA06_SendersInterchangeId": "MCKESSON_TSH   ",
                                    "@ISA07_ReceiverInterchangeIdQualifier": "ZZ",
                                    "@ISA08_ReceiversInterchangeId": "007454         ",
                                    "@ISA09_Date": "220414",
                                    "@ISA10_Time": "1038",
                                    "@ISA11_InterchangeStandardsIdentifier": "|",
                                    "@ISA12_InterchangeVersionId": "00501",
                                    "@ISA13_InterchangeControlNumber": "000000001",
                                    "@ISA14_AcknowledgementRequested": "0",
                                    "@ISA15_TestIndicator": "P",
                                    "@ISA16_SubElementDelimeter": ":"
                                },
                                "FunctionalGroupHeader": {
                                    "@GS01_FunctionalIdentifierCode": "HB",
                                    "@GS02_ApplicationSendersCode": "ZZDEMO",
                                    "@GS03_ApplicationReceiversCode": "025924AMD",
                                    "@GS04_Date": "20220414",
                                    "@GS05_Time": "103848",
                                    "@GS06_GroupControlNumber": "314159265",
                                    "@GS07_ResponsibleAgencyCode": "X",
                                    "@GS08_VersionIdentificationCode": "005010X279A1"
                                },
                                "TransactionSets": {
                                    "TransactionSet": {
                                        "Header": {
                                            "STSegment": {
                                                "@ST01_TransactionSetIdentifierCode": "271",
                                                "@ST02_TransactionSetControlNumber": "000000001",
                                                "@ST03_ImplementationConventionReference": "005010X279A1"
                                            },
                                            "BHTSegment": {
                                                "@BHT01_HierarchicalStructuralCode": "0022",
                                                "@BHT02_TransactionSetPurposeCode": "11",
                                                "@BHT03_ReferenceIdentification": "Prod9917412505465",
                                                "@BHT04_Date": "20220414",
                                                "@BHT05_Time": "103848"
                                            }
                                        },
                                        "InformationSourceDetail": {
                                            "InformationSourceLevel": {
                                                "InformationSourceLevel": {
                                                    "@HL01_HierarchicalIdNumber": "1",
                                                    "@HL03_HierarchicalLevelCode": "20",
                                                    "@HL04_HierarchicaChildCode": "1"
                                                }
                                            },
                                            "InformationSourceName": {
                                                "InformationSourceName": {
                                                    "@NM101_EntityIdentifierCode": "PR",
                                                    "@NM102_EntityTypeQualifier": "2",
                                                    "@NM103_LastOrOrganizationalName": "HEALTH CHOICE ARIZONA",
                                                    "@NM108_IdentificationCodeQualifier": "PI",
                                                    "@NM109_IdentificationCode": "ZZDEMO"
                                                },
                                                "RequestValidations": {
                                                    "AAASegment": {
                                                        "@AAA01_ConditionOrResponseCode": "N",
                                                        "@AAA03_RejectReasonCode": "80",
                                                        "@AAA04_FollowUpActionCode": "R"
                                                    }
                                                }
                                            }
                                        },
                                        "InformationReceiverDetail": {
                                            "InformationReceiverLevel": {
                                                "ReceiverLevel": {
                                                    "@HL01_HierarchicalIdNumber": "2",
                                                    "@HL02_HierarchicalParentIdNumber": "1",
                                                    "@HL03_HierarchicalLevelCode": "21",
                                                    "@HL04_HierarchicaChildCode": "1"
                                                }
                                            },
                                            "InformationReceiverName": {
                                                "ReceiverName": {
                                                    "@NM101_EntityIdentifierCode": "1P",
                                                    "@NM102_EntityTypeQualifier": "1",
                                                    "@NM103_LastOrOrganizationalName": "JONES",
                                                    "@NM104_FirstName": "CAMERON",
                                                    "@NM108_IdentificationCodeQualifier": "XX",
                                                    "@NM109_IdentificationCode": "2133321234"
                                                }
                                            }
                                        },
                                        "SubscriberDetail": {
                                            "HierarchicalLevel": {
                                                "@HL01_HierarchicalIdNumber": "3",
                                                "@HL02_HierarchicalParentIdNumber": "2",
                                                "@HL03_HierarchicalLevelCode": "22",
                                                "@HL04_HierarchicaChildCode": "0"
                                            },
                                            "Name": {
                                                "Name": {
                                                    "@NM101_EntityIdentifierCode": "IL",
                                                    "@NM102_EntityTypeQualifier": "1",
                                                    "@NM103_LastOrOrganizationalName": "VSEE",
                                                    "@NM104_FirstName": "EDWARD",
                                                    "@NM108_IdentificationCodeQualifier": "MI",
                                                    "@NM109_IdentificationCode": "234234"
                                                },
                                                "EligibilityOrBenefitInformation": {
                                                    "EligibilityOrBenefitInformation": {
                                                        "EligibilityOrBenefitInformation": {
                                                            "@EB01_EligibilityOrBenefitInformationCode": "V"
                                                        },
                                                        "MessageTexts": {
                                                            "MSGSegment": {
                                                                "@MSG01_FreeFormMessageText": "The payer response contains invalid or non compliant data.(70002)"
                                                            }
                                                        }
                                                    }
                                                }
                                            }
                                        }
                                    }
                                },
                                "FunctionalGroupTrailer": {
                                    "@GE01_NumberOfTransactionSets": "1",
                                    "@GE02_GroupControlNumber": "314159265"
                                },
                                "InterchangeControlTrailer": {
                                    "@IEA01_NumberOfFunctionalGroups": "1",
                                    "@IEA02_InterchangeControlReference": "000000001"
                                }
                            }
                        }
                    }
                }
            },
            "secondary": {
                "carrier_code": "car11406",
                "group_number": "asdasd",
                "subscriber_num": "aaaaa",
                "insurance_order": 2
            },
            "patient": {
                "respparty": "self",
                "member_id": "5991794",
                "response_party_id": "6858376"
            }
        },
        "account_code": "vclinic",
        "clinics": [
            "vclinic"
        ],
        "created": 1649934637
    }
}

{
  "id": "62583ab3-8cfc-4a47-b6c9-272850e631f8",
  "type": "eligibility.checked",
  "created": 1649949363,
  "account_code": "vclinic",
  "data": {
    "eligibility_id": "2505464",
    "member_id": "132407",
    "eligibility_response": "No response received by clearinghouse",
    "external_member_id": "5991794"
  }
}

Success / Reject reason not found
Authorized quantity exceeded
Required application data missing
Input Errors
Out of Network
Authorization/Access restrictions
Unable to respond at current time.
Invalid/Missing provider information
Invalid/Missing provider name
Invalid/Missing provider speciality
Invalid/Missing provider phone number
Invalid/Missing provider state
Invalid/Missing referring provider identification number
Provider is not primary care physician
Provider ineligible for inquiries
Provider not on file
Service dates not within provider plan enrollment
Inquired benefit inconsistent with provider type
Inappropriate date
Invalid/Missing dates of service
Invalid/Missing date of birth
Date of birth follows date of service
Date of death preceeds dates of service
Date of service not within allowable inquiry period
Date of service in future
Invalid/Missing patient ID
Invalid/Missing patient name
Invalid/Missing patient gender code
Patient not found
Inconsistent with patient age.
Inconsistent with patient gender.
Patient birth date does not match that for the patient in the
Invalid/Missing subscriber/insured ID
Invalid/Missing subscriber/insured name
Invalid/Missing subscriber/insured gender code
Subscriber/Insured not found
Duplicate Subscriber/Insured ID number
Subscriber found, patient not found
Subscriber/Insured not in Group/Plan identified
Invalid participant identification
invalid or missing provider address
Payer name or identifier missing
Certification Information Missing
No response received by clearinghouse
Expiremental service or procedure.
Authorization number not found.
Requires primary care physician authorization.
Invalid/Missing diagnosis codes.
Invalid/Missing procedure codes.
Additional patient condition information required.
Certification information does not match patient.
Requires medical review.
Invalid authorization number format.
Missing authorization number.

'04' => 'Authorized quantity exceeded',
'15' => 'Required application data missing',
'33' => 'Input Errors',
'35' => 'Out of Network',
'41' => 'Authorization/Access restrictions',
'42' => 'Unable to respond at current time.',
'43' => 'Invalid/Missing provider information',
'44' => 'Invalid/Missing provider name',
'45' => 'Invalid/Missing provider speciality',
'46' => 'Invalid/Missing provider phone number',
'47' => 'Invalid/Missing provider state',
'48' => 'Invalid/Missing referring provider identification number',
'49' => 'Provider is not primary care physician',
'50' => 'Provider ineligible for inquiries',
'51' => 'Provider not on file',
'52' => 'Service dates not within provider plan enrollment',
'53' => 'Inquired benefit inconsistent with provider type
Inappropriate date
 type',
'56' => 'Inappropriate date',
'57' => 'Invalid/Missing dates of service',
'58' => 'Invalid/Missing date of birth',
'60' => 'Date of birth follows date of service',
'61' => 'Date of death preceeds dates of service',
'62' => 'Date of service not within allowable inquiry period',
'63' => 'Date of service in future',
'64' => 'Invalid/Missing patient ID',
'65' => 'Invalid/Missing patient name',
'66' => 'Invalid/Missing patient gender code',
'67' => 'Patient not found
not found',
'69' => 'Inconsistent with patient age.',
'70' => 'Inconsistent with patient gender.',
'71' => 'Patient birth date does not match that for the patient in the Invalid/Missing subscriber/insured ID
Invalid/Missing subscriber/insured name
Invalid/Missing subscriber/insured gender code
Subscriber/Insured not found
Duplicate Subscriber/Insured ID number
Subscriber found, patient not found
Subscriber/Insured not in Group/Plan identified
Invalid participant identification
invalid or missing provider address
Payer name or identifier missing
Certification Information Missing
No response received by clearinghouse
Expiremental service or procedure.
Authorization number not found.
Requires primary care physician authorization.
Invalid/Missing diagnosis codes.
Invalid/Missing procedure codes.
Additional patient condition information required.
Certification information does not match patient.
Requires medical review.
Invalid authorization number format.
Missing authorization number.

{
    "data": {
        "insurers": [
            {
                "id": "car7551",
                "name": "AETNA"
            },
            {
                "id": "car7414",
                "name": "AETNA BETTER HEALTH OF ILLINOIS"
            },
            {
                "id": "car11406",
                "name": "ANTHEM BLUE SHIELD"
            },
            {
                "id": "car7147",
                "name": "CIGNA HEALTH CARE"
            },
            {
                "id": "car7147car7580",
                "name": "CIGNA"MONTGOMERY HEALTH INSURANCE"
            },
            {
                "id": "car7551car7556",
                "name": "AETNA"HEALTH CHOICE ARIZONA"
            }
        ]
    }
}