Eligibility API Implementation
.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 |