...
| Code Block |
|---|
{
"id": "5c34979c-30dc-496c-8cd3-6eb9925862c1",
"type": "eligibility.checked",
"created": 1546950556,
"account_code": "vclinic",
"data": {
"eligibility_id": "28540",
"member_id": "60610",
"eligibility_response": "Invalid/Missing subscriber/insured ID",
"external_member_id": 1111
}
} |
Rejection reason and codes
...
Eligibility Responses List
eligibility_response may be one of the following:
| Code Block |
|---|
Success / Reject reason not found 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' => ' current time. 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', '56' => ' provider type 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', '69' => ' not found Inconsistent with patient age.', '70' => 'Inconsistent with patient gender.', '71' => 'Patient birth date does not match that for the patient in the database', '72' => 'Invalid/Missing subscriber/insured ID', '73' => 'Invalid/Missing subscriber/insured name', '74' => 'Invalid/Missing subscriber/insured gender code', '75' => 'Subscriber/Insured not found', '76' => 'Duplicate Subscriber/Insured ID number', '77' => 'Subscriber found, patient not found', '78' => 'Subscriber/Insured not in Group/Plan identified', '79' => 'Invalid participant identification', '97' => ' participant identification invalid or missing provider address', 'T4' => 'Payer name or identifier missing', 'T5' => 'Certification Information Missing', '80' => 'No response received by clearinghouse', '98' => 'Expiremental service or procedure.', 'AA' => ' or procedure. Authorization number not found.', 'AE' => 'Requires primary care physician authorization.', 'AF' => 'Invalid/Missing diagnosis codes.', 'AG' => 'Invalid/Missing procedure codes.', 'AO' => 'Additional patient condition information required.', 'CI' => 'Certification information does not match patient.', 'E8' => 'Requires medical review.', 'IA' => 'Invalid authorization number format.', 'MA' => 'Missing authorization number.' |
Eligibility Responses List
eligibility_response may be one of the following:
| Code Block |
|---|
Success / Reject reason not found
|
Rejection reason and codes
| Code Block |
|---|
'04' => 'Authorized quantity exceeded', '15' => 'Required application data missing', '33' => 'Input Errors', '35' => 'Out of Network', '41' Authorization/Access restrictions => '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 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', '56' => 'Inappropriate date', '57' => 'Invalid/Missing dates of service', '58' => 'Invalid/Missing date of birth', '60' => 'Date of birth follows date of service 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 patient name', '66' => 'Invalid/Missing patient gender code', '67' => 'Patient 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 database', '72' => 'Invalid/Missing subscriber/insured ID', '73' => 'Invalid/Missing subscriber/insured name', '74' => 'Invalid/Missing subscriber/insured gender code', '75' => 'Subscriber/Insured not found', '76' => 'Duplicate Subscriber/Insured ID number', '77' => 'Subscriber found, patient not found not found', '78' => 'Subscriber/Insured not in Group/Plan identified', '79' => 'Invalid participant identification', '97' => 'invalid or missing provider address', 'T4' => 'Payer name or identifier missing', 'T5' => 'Certification Information Missing Information Missing', '80' => 'No response received by clearinghouse', '98' => 'Expiremental service or procedure.', 'AA' => 'Authorization number not found.', 'AE' => 'Requires primary care physician authorization.', 'AF' => 'Invalid/Missing diagnosis codes. diagnosis codes.', 'AG' => 'Invalid/Missing procedure codes.', 'AO' => 'Additional patient condition information required.', 'CI' => 'Certification information does not match patient.', 'E8' => 'Requires medical review.', 'IA' => 'Invalid authorization number format.', 'MA' => 'Missing authorization number.' |
GET /insurances/
https://api-vclinic.vseepreview.com/vc/next/api_v3/insurance/
...