POST
/
coordination-of-benefits
cURL
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/coordination-of-benefits \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "tradingPartnerServiceId": "SOMEID",
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "firstName": "John",
    "lastName": "Doe",
    "dateOfBirth": "1985-05-27",
    "memberId": "W000000000"
  },
  "dependent": {
    "firstName": "Jordan",
    "lastName": "Doe",
    "dateOfBirth": "2002-12-31"
  },
  "encounter": {
    "dateOfService": "2024-08-02",
    "serviceTypeCode": "30"
  }
}'
{
  "benefitsInformation": [
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "1"
      ],
      "serviceTypes": [
        "Medical Care"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "88"
      ],
      "serviceTypes": [
        "Pharmacy"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "1",
      "name": "Active Coverage",
      "serviceTypeCodes": [
        "AL"
      ],
      "serviceTypes": [
        "Vision (Optometry)"
      ],
      "benefitsDateInformation": {
        "benefitBegin": "2023-03-01"
      },
      "subscriber": {
        "dateOfBirth": "2002-02-27"
      }
    },
    {
      "code": "R",
      "name": "Other or Additional Payor",
      "serviceTypeCodes": [
        "1"
      ],
      "serviceTypes": [
        "Medical Care"
      ],
      "benefitsDateInformation": {
        "coordinationOfBenefits": "2024-07-01"
      },
      "benefitsRelatedEntities": [
        {
          "entityIdentifier": "Primary Payer",
          "entityName": "CIGNA",
          "entityIdentification": "PI",
          "entityIdentificationValue": "1006"
        },
        {
          "entityIdentifier": "Insured or Subscriber",
          "entityFirstname": "JOHN",
          "entityMiddlename": "X",
          "entityIdentification": "MI",
          "entityIdentificationValue": "00000000000",
          "entityLastname": "DOE"
        }
      ],
      "subscriber": {
        "dateOfBirth": "2002-12-31"
      }
    }
  ],
  "coordinationOfBenefits": {
    "classification": "CobInstanceExistsPrimacyDetermined",
    "instanceExists": true,
    "primacyDetermined": true,
    "coverageOverlap": true,
    "benefitOverlap": true
  },
  "dependent": {
    "firstName": "JORDAN",
    "lastName": "DOE",
    "gender": "M",
    "dateOfBirth": "2002-12-31",
    "relationToSubscriber": "Child",
    "relationToSubscriberCode": "19",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  },
  "errors": [],
  "meta": {
    "applicationMode": "production",
    "traceId": "01JDQFT4W3KTWZNTADEZ55BFFX",
    "outboundTraceId": "01JDQFT4W3KTWZNTADEZ55BFFX"
  },
  "payer": {
    "name": "Aetna",
    "payerIdentification": "AETNA-USH"
  },
  "provider": {
    "providerName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "memberId": "W000000000",
    "firstName": "JOHN",
    "lastName": "DOE",
    "address": {
      "address1": "1 MAIN ST.",
      "city": "NEW YORK",
      "state": "NY",
      "postalCode": "10000"
    }
  }
}
Coordination of benefits (COB) checks help you determine whether patients are covered by multiple health plans, whether coverage overlap requires coordination of benefits, and each payer’s responsibility for payment (primacy).
  1. Call this endpoint with a JSON payload. Each check must be for a Stedi-supported payer with which the patient has coverage. Visit the Payer Network for a complete list of supported payers.
  2. Stedi searches a national database containing 245+ million patient coverage records from 45+ health plans, ASOs, TPAs, and others, including participation from the vast majority of national commercial health plans. Data is updated weekly to ensure accuracy.
  3. The endpoint returns information about the patient’s active health plans, the responsibility sequence number for each payer if available (such as primary or secondary), and whether coordination of benefits is required.
Visit Coordination of benefits checks for a full how-to guide.

Authorizations

​
Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json

Response

200
application/json

CoordinationOfBenefits 200 response

The response is of type object.