# Check Eligibility (270/271)

> Perform Check Eligibility (270/271) through ClaimMD.

Source: [https://genhealth.ai/docs/workflows/integrations/claim-md/claimmd_check_eligibility](https://genhealth.ai/docs/workflows/integrations/claim-md/claimmd_check_eligibility)

Integration: [ClaimMD](https://genhealth.ai/docs/workflows/integrations/claim-md.md)

- Handler: `claimmd_check_eligibility`

- Connection type: `claimmd`

## Inputs

- `enabled` — Enabled (boolean)
  Optional true-or-false value.
  Default: `true`
- `payer_id` — Payer Id (expression, required)
  Required literal value or workflow expression.
- `insured_last_name` — Insured Last Name (expression, required)
  Required literal value or workflow expression.
- `insured_first_name` — Insured First Name (expression, required)
  Required literal value or workflow expression.
- `insured_middle_name` — Insured Middle Name (expression)
  Optional literal value or workflow expression.
- `member_id` — Member Id (expression)
  Optional literal value or workflow expression.
- `insured_date_of_birth` — Insured Date Of Birth (expression)
  Optional literal value or workflow expression.
- `insured_sex` — Insured Sex (expression)
  Optional literal value or workflow expression.
- `patient_relationship` — Patient Relationship (expression, required)
  Required literal value or workflow expression.
- `patient_last_name` — Patient Last Name (expression)
  Optional literal value or workflow expression.
- `patient_first_name` — Patient First Name (expression)
  Optional literal value or workflow expression.
- `patient_middle_name` — Patient Middle Name (expression)
  Optional literal value or workflow expression.
- `patient_date_of_birth` — Patient Date Of Birth (expression)
  Optional literal value or workflow expression.
- `patient_sex` — Patient Sex (expression)
  Optional literal value or workflow expression.
- `provider_npi` — Provider Npi (expression)
  Optional literal value or workflow expression.
- `provider_tax_id` — Provider Tax Id (expression)
  Optional literal value or workflow expression.
- `provider_tax_id_type` — Provider Tax Id Type (expression)
  Optional literal value or workflow expression.
- `provider_name` — Provider Name (expression)
  Optional literal value or workflow expression.
- `provider_first_name` — Provider First Name (expression)
  Optional literal value or workflow expression.
- `provider_taxonomy` — Provider Taxonomy (expression)
  Optional literal value or workflow expression.
- `service_date` — Service Date (expression, required)
  Required literal value or workflow expression.
- `service_type_codes` — Service Type Codes (expression)
  Optional literal value or workflow expression.
- `procedure_code` — Procedure Code (expression)
  Optional literal value or workflow expression.
- `use_raw_x12` — Use Raw X12 (boolean)
  Optional true-or-false value.
  Default: `false`
- `service_date_lookback_days` — Service Date Lookback Days (number)
  Optional numeric value.
- `payer_name` — Payer Name (expression)
  Optional literal value or workflow expression.
- `generate_pdf` — Generate Pdf (boolean)
  Optional true-or-false value.
  Default: `false`
- `pdf_document_title` — Pdf Document Title (expression)
  Optional literal value or workflow expression.
- `pdf_patient_id` — Pdf Patient Id (expression)
  Optional literal value or workflow expression.
- `pdf_source_document_id` — Pdf Source Document Id (expression)
  Optional literal value or workflow expression.
- `other_insurance_history` — Other Insurance History (expression)
  Optional literal value or workflow expression.
- `skip_reason` — Skip Reason (expression)
  Optional literal value or workflow expression.

## Outputs

- `success` — Success
- `status` — Status
- `is_eligible` — Is Eligible
- `is_capitated` — Is Capitated
- `has_non_covered_benefit` — Has Non Covered Benefit
- `payer_cannot_process` — Payer Cannot Process
- `managed_care_organizations` — Managed Care Organizations
- `plan_assignments` — Plan Assignments
- `contracted_service_providers` — Contracted Service Providers
- `plan_name` — Plan Name
- `plan_number` — Plan Number
- `group_name` — Group Name
- `group_number` — Group Number
- `coverage_start` — Coverage Start
- `coverage_end` — Coverage End
- `payer_names` — Payer Names
- `payer_program_identifier` — Payer Program Identifier
- `related_entities` — Related Entities
- `other_insurance` — Other Insurance
- `has_other_insurance` — Has Other Insurance
- `coverage_codes` — Coverage Codes
- `coverage_descriptions` — Coverage Descriptions
- `service_type_codes` — Service Type Codes
- `service_type_descriptions` — Service Type Descriptions
- `insurance_plans` — Insurance Plans
- `insurance_type_codes` — Insurance Type Codes
- `insurance_type_descriptions` — Insurance Type Descriptions
- `network_statuses` — Network Statuses
- `network_status_descriptions` — Network Status Descriptions
- `benefit_coverage_windows` — Benefit Coverage Windows
- `plan_begin_date` — Plan Begin Date
- `plan_end_date` — Plan End Date
- `eligibility_begin_date` — Eligibility Begin Date
- `eligibility_end_date` — Eligibility End Date
- `benefit_count` — Benefit Count
- `relevant_benefit_count` — Relevant Benefit Count
- `eligibility_id` — Eligibility Id
- `result_date` — Result Date
- `document_id` — Document Id
- `pdf_path` — Pdf Path
- `pdf_error` — Pdf Error
- `payer_errors` — Payer Errors
- `retryable` — Retryable
- `error` — Error
- `skipped` — Skipped
- `skip_reason` — Skip Reason

Output schema completeness: `best_effort_declared`

## Safety

- External effect: `write`
- Confirmation recommended: no
- Retry safe: no
- Dry run supported: no

## Schemas

These schemas are first-pass authoring guidance. Runtime validation remains authoritative.

### Input schema

```json
{
  "type": "object",
  "required": [
    "payer_id",
    "insured_last_name",
    "insured_first_name",
    "patient_relationship",
    "service_date"
  ],
  "properties": {
    "enabled": {
      "type": "boolean",
      "default": true,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "payer_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "member_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "payer_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_sex": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_sex": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "skip_reason": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "use_raw_x12": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "generate_pdf": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "provider_npi": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "service_date": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "pdf_patient_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "procedure_code": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_tax_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_last_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_last_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_taxonomy": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_first_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_first_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "pdf_document_title": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "service_type_codes": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_middle_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_middle_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_first_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_relationship": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_tax_id_type": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_date_of_birth": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_date_of_birth": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "pdf_source_document_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "other_insurance_history": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "service_date_lookback_days": {
      "type": "number",
      "description": "Optional numeric value.",
      "x-workflow-field-type": "number"
    }
  },
  "additionalProperties": false
}
```

### Output schema

```json
{
  "type": "object",
  "properties": {
    "error": {},
    "status": {},
    "skipped": {},
    "success": {},
    "pdf_path": {},
    "pdf_error": {},
    "plan_name": {},
    "retryable": {},
    "group_name": {},
    "document_id": {},
    "is_eligible": {},
    "payer_names": {},
    "plan_number": {},
    "result_date": {},
    "skip_reason": {},
    "coverage_end": {},
    "group_number": {},
    "is_capitated": {},
    "payer_errors": {},
    "benefit_count": {},
    "plan_end_date": {},
    "coverage_codes": {},
    "coverage_start": {},
    "eligibility_id": {},
    "insurance_plans": {},
    "other_insurance": {},
    "plan_begin_date": {},
    "network_statuses": {},
    "plan_assignments": {},
    "related_entities": {},
    "service_type_codes": {},
    "has_other_insurance": {},
    "eligibility_end_date": {},
    "insurance_type_codes": {},
    "payer_cannot_process": {},
    "coverage_descriptions": {},
    "eligibility_begin_date": {},
    "relevant_benefit_count": {},
    "has_non_covered_benefit": {},
    "benefit_coverage_windows": {},
    "payer_program_identifier": {},
    "service_type_descriptions": {},
    "managed_care_organizations": {},
    "insurance_type_descriptions": {},
    "network_status_descriptions": {},
    "contracted_service_providers": {}
  },
  "additionalProperties": true
}
```