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Eligibility API Implementation

September 23, 2016Support Documentation

.Net client library is available upon request.

Authentication

ReveMed services use a single-sign on service to authenticate users and grant them access to agreed upon features.  The first eligibility request can be submitted using a username/password. The response includes a session token which can be used for future requests.  Tokens are valid for up to eight hours or when the account logs off, whichever comes first.

Service Address

The current testing URI is: https://dev.revemed.com:8001/ReveMedEligibilityService/service

Eligibility request batch format

Below are the parameters to be submitted with an eligibility request batch.

Parameter Description DataType
userName Can be null if token is supplied string
password Can be null if token is supplied string
token Can be null if username and password are supplied string
searchType 0 is Standard Search and 1 is Insurance Discovery enum
discoverySearchType only relevant when search type is insurance discovery, 0 is First Result, 1 is all results enum
searchListName For insurance discovery, this is the name of the list of payers to be searched. string
searchExclusions For insurance discovery, this is comma separated payer ids to be excluded from the list specified in search list name string
requests the collection of eligibility requests for this batch List

Eligibility request format

Below are the parameters to be submitted with each eligibility request within the batch’s Requests parameter.

Parameter Description DataType
facility List the name of your company for personalized service string
serviceTypeCode This field is part of planned future development and can be left blank at this time string
dateOfService Date of service to check for eligibility in YYYYMMDD format string
trackingID Place your unique id for this transaction here string
payerID The payer Id for the payer to check eligibility on. Can be left blank for Insurance Discovery string
providerID The NPI number of the individual or organization responsible for this eligibility search string
subscriberID If known, the member’s subscriber id with the specified payer string
subscriberSSN If known, the subscriber’s social security number string
subscriberGroupNumber This field is part of planned future development and can be left blank at this time string
subscriberFirstName First name of the subscriber or patient if subscriber is not known string
subscriberLastName Last name of the subscriber or patient if subscriber is not known string
subscriberDOB Date of birth of the subscriber or patient if subscriber is not known string
subscriberGender M or F if known, can be blank if gender is not known string
subscriberMiddleInitial Middle initial of the subscriber or patient, can be left blank string
dependentFirstName This field is part of planned future development and can be left blank at this time string
dependentLastName This field is part of planned future development and can be left blank at this time string
dependentMiddleInitial This field is part of planned future development and can be left blank at this time string
dependentDOB This field is part of planned future development and can be left blank at this time string
dependentGender This field is part of planned future development and can be left blank at this time string
dependentGroupNumber This field is part of planned future development and can be left blank at this time string
dependentSSN This field is part of planned future development and can be left blank at this time string

Eligibility Response Batch

Below are values returned by an eligibility request batch.

Parameter Description DataType
token The token either submitted with the batch or returned as the result of a username/password request string
originalPayerResponse ReveMed cleans up and organizes data received from the payer. This is the original XML response for auditing the cleanup process. string
payerInfos A list of payers and payerid associated with the insurance discovery request Dictionary<string,string>
eligibilityResponses A list of Eligibility Responses corresponding to the Eligibility Requests List

Eligibility Response

Below are values returned for each eligibility request. Please note, values returned may match what the payer has on record. I.e. if you submit under one subscriber id but the patient is found under a different id. The payer will return the correct id. Benefits are still being mapped. This will change.

Parameter Description DataType
payerID The id of the payer making the response string
RMCSID The ReveMed Id for the claim string
payerName The name of the payer associated with the payer Id string
transactionID The payer’s Id for the transaction string
street The patient’s street address string
city The patient’s City string
state The patient’s state string
zip The Patient’s zip string
phoneNumber  The Patient’s phone number string
subscriberDOB The subscriber’s date of birth string
subscriberID The subscriber’s id with the payer string
subscriberFirstName The subscriber’s first name string
subscriberLastName The subscriber’s last name string
subscriberGender The subscriber’s gender string
subscriberAddressStreet The subscriber’s street address string
subscriberAddressCity The subscriber’s city string
subscriberAddressState The subscriber’s state string
subscriberAddressZip The subscriber’s zip code string
subscriberPrimaryPhoneNumber The subscriber’s phone number string
insuranceType The type of plan I.e. hmo, ppo, medicare supplemental, etc… string
payerContactEntityName The name of the entity to call for more information on this member (IPA, TPA, MCO, etc…) string
payerContactEntityAddressStreet The street address of the payer contact entity string
payerContactEntityAddressCity The city address of the payer contact entity string
payerContactEntityAddressState The state address of the payer contact entity string
payerContactEntityAddressZip The zip code of the payer contact entity string
payerContactEntityPrimaryPhoneNumber The primary phone number of the payer contact entity string
payerContactEntityPrimaryFaxNumber The primary fax number of the payer contact entity string
PCPName Primary Care Physician’s name string
PCPPhoneNumber The Primary Care Physician’s Phone Number string
eligibilityStatus1 Eligibility status is broken up into two parts, this is the first string
eligibilityStatus2 second part of the eligibility status providing more detail string
coverageStartDate This is a new feature and not fully mapped for all payers. It represents the earliest plan begin date for the member. DateTime
coverageEndDate This is a new feature and not fully mapped for all payers. It represents the known plan end date or empty if no date is set. DateTime
inNetworkOutOfPocketRemaining This is the out-of-pocket amount remaining of the payer contact entity  string
inNetworkOutOfPocketMaximum This is the out-of-pocket maximum amount of the payer contact entity string
lifeTimeMaximum This is the life time maximum amount of the payer contact entity string
errorCode This is the error code if the request has any invalid information (i.e. missing Date Of Service, Payer Id, etc…) string
errorMessage A description for the error code string

 

 Benefits

 

Parameter  Description DataType
type  Type of Benefit (i.e. Deductible, Out of Pocket,  CoInsurance etc.) string
network  In-Network or Out-Of-Network string
message  Special note from the payer for this benefit string
period  Optional field, typical values include Calendar Year,  Remaining and Lifetime string
percent  Optional field, The percentage amount of the benefit  (common or coinsurance) coinsurance string
amount  Fixed amount of the benefit string
indOrFam  Individual or Family benefit, occasional other values  include employee and spouse string
effectiveDate  When the benefit started string

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