POST
/
api
/
eligibility
/
v3
curl --request POST \
  --url https://forecaster.cairhealth.com/api/eligibility/v3 \
  --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",
  "serviceTypeCodes": [
    "30"
  ],
  "procedureCodes": [
    "99213",
    "85025"
  ],
  "procedureCodesType": "CPT",
  "runCobCheck": true
}'
{
  "response": {
    "30": {
      "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": "Benefits information retrieved successfully"
    }
  },
  "message": "Eligibility check successful",
  "cob": {
    "cobCode": "CobInstanceExistsPrimacyDetermined",
    "requestedPlanBenefits": [
      {
        "payerName": "Blue Cross",
        "serviceTypeCodes": [
          {
            "code": "30",
            "name": "Health Benefit Plan Coverage"
          }
        ],
        "benefitDate": {
          "planStartDate": "2024-01-01"
        }
      }
    ],
    "additionalPlanBenefitInfo": [
      {
        "payerName": "Aetna",
        "payerPrimacy": "SecondaryPayer",
        "serviceTypeCodes": [
          {
            "code": "30",
            "name": "Health Benefit Plan Coverage"
          }
        ],
        "benefitDate": {
          "overlapBeginDate": "2024-01-01",
          "overlapEndDate": "2024-12-31",
          "planStartDate": "2024-01-01",
          "planEndDate": "2024-12-31",
          "coordinationOfBenefits": "2024-01-01"
        },
        "subscriber": {
          "firstName": "John",
          "lastName": "Doe",
          "dateOfBirth": "1990-01-01",
          "memberId": "W9876543"
        }
      }
    ]
  }
}

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.

​
Coordination of Benefits

This route allows an optional runCobCheck flag to automatically call the Coordination of Benefits using the information in the eligibility check request. Using this flag may incur additional costs. Reach out to Cair for pricing.

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

The body is of type object.

Response

200
application/json

Eligibility check successful

The response is of type object.