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POST
/
api
/
eligibility
/
v1
cURL
curl --request POST \
  --url https://forecaster.cairhealth.com/api/eligibility/v1 \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "patientFirstName": "John",
  "patientLastName": "Doe",
  "patientDOB": "01-01-1991",
  "patientMemberId": "U1234567",
  "dateOfCoverage": "03-24-2025",
  "payerId": "HGJLR",
  "providerId": "0195b964-5b2c-7bb3-875a-276ad770dc66"
}
'
{
  "inNetwork": {
    "individual": {
      "copay": "N/A",
      "deductible": {
        "total": "$2,000.00",
        "remaining": "$2,000.00"
      },
      "coinsurance": "N/A",
      "stopLoss": "$6,850.00"
    },
    "family": {
      "copay": "N/A",
      "deductible": {
        "total": "N/A",
        "remaining": "N/A"
      },
      "coinsurance": "N/A",
      "stopLoss": "N/A"
    }
  },
  "outNetwork": {
    "individual": {
      "copay": "N/A",
      "deductible": {
        "total": "$6,000.00",
        "remaining": "$6,000.00"
      },
      "coinsurance": "N/A",
      "stopLoss": "$14,000.00"
    },
    "family": {
      "copay": "N/A",
      "deductible": {
        "total": "N/A",
        "remaining": "N/A"
      },
      "coinsurance": "N/A",
      "stopLoss": "N/A"
    }
  },
  "message": "Eligibility check successful",
  "payerName": "AETNA INC",
  "status": "Active Coverage",
  "memberId": "1234567",
  "groupName": "N/A",
  "groupNumber": "7654321",
  "insuranceType": "PPO",
  "planName": "Open Access Plus",
  "effectiveDateRange": null,
  "eligibilityBeginDate": "2009-01-01",
  "dependents": [
    {
      "firstName": "John",
      "lastName": "Doe",
      "middleName": "M",
      "dateOfBirth": "01-01-2000",
      "relationToSubscriber": "Child",
      "address": {
        "city": "PALO ALTO",
        "state": "CA",
        "address1": "3533 LA MATA WAY",
        "postalCode": "94306"
      },
      "gender": "M",
      "insuredIndicator": "N"
    }
  ]
}
The following endpoint requires provider enrollment through our platform. Refer to the platform help guides or contact Cair Support with any questions.

​
Mock Requests

To send a mock request without incurring charges, set the mockRequest parameter in the body to true. There are 4 scenarios you may test with. Refer to Mock Eligibility for the scenarios.

​
Data Richness

The response you receive will vary by payer. We parse the EDI response to the best of our ability, and the presence of an N/A in any field does not necessarily mean that the benefit is not present in the subscriber’s insurance plan.

Authorizations

​
Authorization
string
header
required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Body

application/json

Patient and coverage information

​
patientFirstName
string
required

Patient first name

​
patientLastName
string
required

Patient last name

​
patientDOB
string
required

Patient Date of Birth, formatted as MM-DD-YYYY

​
patientMemberId
string
required

Member ID of patient's insurance policy

​
dateOfCoverage
string
required

Date to request coverage information. Formatted as MM-DD-YYYY

​
payerId
string
required

Payer ID. Can be found under the enrollments page in the platform, or the Fetch Enrollments API

​
providerId
string
required

Provider ID. Can be found by copying the enrollment ID in the enrollments page in the platform, or the Fetch Enrollments API

​
mockRequest
boolean

Optional flag to only return mock data

Response

Eligibility check successful

​
inNetwork
object

Object containing in-network benefit information

​
outNetwork
object

Object containing out-of-network benefit information

​
message
string

Message of response. Any errors will be displayed here.

​
payerName
string

Name of the insurance payer

​
status
enum<string>

Coverage status

Available options:
Active Coverage,
Inactive
​
memberId
string

Member ID of the subscriber

​
groupName
string

Group name from the plan

​
groupNumber
string

Group number from the plan

​
insuranceType
string

Type of insurance (e.g. PPO, HMO)

​
planName
string

Name of the plan

​
effectiveDateRange
object

Effective date range of the plan

​
eligibilityBeginDate
string

Eligibility begin date (YYYY-MM-DD)

​
dependents
object[]

Dependent details when the policy is mapped from a family member