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POST
/
api
/
eligibility
/
v3
cURL
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
}
'
{
  "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"
    }
  ],
  "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

​
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

​
serviceTypeCodes
string[]

Service type codes to request coverage information for

​
procedureCodes
string[]

CPT or CDT codes to check coverage for

​
procedureCodesType
enum<string>

Type of procedure codes being provided. Must be either 'CPT' or 'CDT'

Available options:
CPT,
CDT
​
runCobCheck
boolean

Whether to run a coordination of benefits check

Response

Eligibility check successful

​
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

​
response
object

Map of service type codes to benefit information

​
message
string

Overall message about the eligibility check

​
cob
object

Coordination of benefits information, only present if runCobCheck was true