Skip to main content
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
}'
{
  "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

Body

application/json
​
patientFirstName
string
required
​
patientLastName
string
required
​
patientDOB
string
required
​
patientMemberId
string
required
​
dateOfCoverage
string
required
​
payerId
string
required
​
providerId
string
required
​
mockRequest
boolean
​
serviceTypeCodes
string[]
​
procedureCodes
string[]
​
procedureCodesType
enum<string>
Available options:
CPT,
CDT
​
runCobCheck
boolean

Response

​
response
object
​
message
string
​
cob
object