> ## Documentation Index > Fetch the complete documentation index at: https://docs.shasta.health/llms.txt > Use this file to discover all available pages before exploring further. # Get eligibility check status > Returns the current processing status of an eligibility check. Poll this endpoint after submitting a check via `POST /api/eligibility` until the status is no longer `open`. ## OpenAPI ````yaml /openapi/eligibility.json get /api/eligibility/{id}/status openapi: 3.1.0 info: title: Shasta Health Eligibility API description: >- API for submitting insurance eligibility check requests and polling their status. Requests are authenticated using an API key issued from the Shasta provider portal. version: 1.0.0 servers: - url: https://app.shasta.health description: Production security: [] tags: - name: Eligibility description: Submit insurance eligibility check requests and retrieve their status. - name: Webhooks description: Webhook events fired by Shasta when async operations complete. paths: /api/eligibility/{id}/status: get: tags: - Eligibility summary: Get eligibility check status description: >- Returns the current processing status of an eligibility check. Poll this endpoint after submitting a check via `POST /api/eligibility` until the status is no longer `open`. parameters: - schema: type: string example: a1b2c3d4-e5f6-7890-abcd-ef1234567890 required: true name: id in: path responses: '200': description: Current status of the eligibility check. content: application/json: schema: $ref: '#/components/schemas/EligibilityCheckResponse' examples: Completed: summary: COMPLETED – full eligibility result value: id: a1b2c3d4-e5f6-7890-abcd-ef1234567890 status: COMPLETED payer: payerName: Aetna payerId: '60054' entityIdentifier: Payer entityType: Non-Person Entity subscriber: memberId: XYZ123456 firstName: Jane lastName: Doe dateOfBirth: '19800101' groupNumber: GRP001 gender: F address: address1: 123 Main St city: Springfield state: IL postalCode: '62701' tradingPartnerServiceId: '60054' planInformation: planName: PPO Gold Plan insuranceType: Preferred Provider Organization insuranceTypeCode: PR planDateInformation: eligibility: '20240101' plan: 20240101-20241231 planActive: true providerNetwork: status: In Network tier: Tier 1 specialty: General Practice benefits: - serviceType: Medical Nutrition inNetwork: true copay: 30 deductible: 500 deductibleRemaining: 200 deductibleApplies: true outOfPocketMax: 5000 outOfPocketRemaining: 3000 visitLimit: 20 visitsUsed: 5 authorizationRequired: false confidence: score: 0.9 criteria: - Copay confirmed on payer portal benefits page - Visit limit matched across two portal sections In Progress: summary: IN_PROGRESS – check still processing value: id: a1b2c3d4-e5f6-7890-abcd-ef1234567890 status: IN_PROGRESS Failed: summary: >- FAILED – error codes and follow-up action (see EligibilityCheckError for code mapping) value: id: a1b2c3d4-e5f6-7890-abcd-ef1234567890 status: FAILED payer: payerName: Aetna payerId: '60054' subscriber: memberId: XYZ123456 firstName: Jane lastName: Doe dateOfBirth: '19800101' tradingPartnerServiceId: '60054' errors: - code: '67' description: Patient not found field: AAA followupAction: Please Correct and Resubmit Failed (DOB mismatch, code 71): summary: FAILED – code 71 with location and possibleResolutions value: id: a1b2c3d4-e5f6-7890-abcd-ef1234567890 status: FAILED payer: payerName: Aetna payerId: '60054' subscriber: memberId: XYZ123456 firstName: Jane lastName: Doe dateOfBirth: '19800101' tradingPartnerServiceId: '60054' errors: - code: '71' description: >- Patient Birth Date Does Not Match That for the Patient on the Database field: AAA followupAction: Please Correct and Resubmit location: Loop 2100C possibleResolutions: >- The subscriber's birth date doesn't match what's in the payer's database. • Check that the `subscriber.dateOfBirth` is correct. • If so, contact the payer to resolve this issue. '401': description: Missing or invalid API key. content: application/json: schema: $ref: '#/components/schemas/ErrorResponse' example: code: UnauthorizedException message: Unauthorized '403': description: The API key does not have permission to perform this action. content: application/json: schema: $ref: '#/components/schemas/ErrorResponse' example: code: AccessDeniedException message: API key lacks access '404': description: The requested resource was not found. content: application/json: schema: $ref: '#/components/schemas/ErrorResponse' example: code: ResourceNotFoundException message: Eligibility check not found '500': description: Unexpected server error. content: application/json: schema: $ref: '#/components/schemas/ErrorResponse' example: code: InternalFailureException message: Internal server error security: - ApiKeyAuth: [] components: schemas: EligibilityCheckResponse: type: object properties: id: type: string description: >- Unique identifier for the eligibility check. Use this to poll status. example: a1b2c3d4-e5f6-7890-abcd-ef1234567890 status: type: string enum: - IN_PROGRESS - COMPLETED - FAILED description: Processing status, e.g. `IN_PROGRESS`, `COMPLETED`, `FAILED`. example: IN_PROGRESS provider: allOf: - $ref: '#/components/schemas/Provider' - description: The rendering or billing provider on the eligibility check. payer: $ref: '#/components/schemas/Payer' subscriber: $ref: '#/components/schemas/ResponseSubscriber' dependents: type: array items: $ref: '#/components/schemas/ResponseDependent' tradingPartnerServiceId: type: string planInformation: $ref: '#/components/schemas/PlanInformation' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planActive: type: boolean planCoverage: type: string providerNetwork: $ref: '#/components/schemas/ProviderNetwork' benefits: type: array items: $ref: '#/components/schemas/BenefitEntry' additionalNotes: type: - string - 'null' errors: type: array items: $ref: '#/components/schemas/EligibilityCheckError' warnings: type: array items: $ref: '#/components/schemas/Warning' benefitsInformation: type: array items: $ref: '#/components/schemas/BenefitsInformation' confidence: type: object properties: score: type: - number - 'null' criteria: type: object additionalProperties: type: boolean meta: $ref: '#/components/schemas/EligibilityMeta' subscriberTraceNumbers: type: array items: $ref: '#/components/schemas/SubscriberTraceNumber' x12: type: string description: Raw X12 EDI transaction string. required: - id - status description: >- Response returned immediately after submitting an eligibility check. The check is processed asynchronously — poll `/api/eligibility/{id}/status` to track completion. ErrorResponse: type: object properties: code: type: string description: Machine-readable error classification. enum: - ValidationException - UnauthorizedException - AccessDeniedException - ResourceNotFoundException - ThrottlingException - InternalFailureException message: type: string required: - message Provider: type: object properties: organizationName: type: string example: Shasta Medical Group firstName: type: string lastName: type: string npi: type: string description: 10-digit National Provider Identifier. example: '1234567890' address: $ref: '#/components/schemas/RequestAddress' providerType: type: string enum: - provider - facility description: >- Type of provider. `provider` for individual provider, `facility` for organization or facility. example: provider description: The rendering or billing provider. Payer: type: object properties: payerName: type: string payerId: type: string entityIdentifier: type: string entityType: type: string ResponseSubscriber: type: object properties: memberId: type: string firstName: type: string lastName: type: string middleName: type: string dateOfBirth: type: string groupNumber: type: string gender: type: string enum: - M - F - U entityIdentifier: type: string entityType: type: string address: $ref: '#/components/schemas/RequestAddress' ResponseDependent: type: object properties: firstName: type: string lastName: type: string middleName: type: string dateOfBirth: type: string gender: type: string entityIdentifier: type: string entityType: type: string address: $ref: '#/components/schemas/RequestAddress' aaaErrors: type: array items: $ref: '#/components/schemas/EligibilityCheckError' PlanInformation: type: object properties: planName: type: string insuranceType: type: string insuranceTypeCode: type: string PlanDateInformation: type: object properties: eligibility: type: string plan: type: string service: type: string status: type: string ProviderNetwork: type: object properties: status: type: string enum: - In Network - Out of Network description: The status of the provider network. tier: type: string description: The tier of the provider network. specialty: type: string description: The specialty of the provider network. BenefitEntry: type: object properties: coverageStatus: type: string enum: - Active Coverage - Not Covered - Not Found description: 'Coverage status: Active Coverage, Not Covered, or Not Found.' serviceType: type: string enum: - Preventive Nutrition - Medical Nutrition - Outpatient Physical Therapy - Mental Health - Occupational Therapy - Speech Therapy - Chiropractic description: The service type this benefit applies to. example: Preventive Nutrition inNetwork: type: - boolean - 'null' description: Whether this benefit applies to in-network services. copay: type: - number - 'null' description: Copay amount in dollars. example: 30 coinsurance: type: - number - 'null' description: Coinsurance percentage (0-1). example: 0.2 deductible: type: - number - 'null' description: Individual deductible amount. deductibleRemaining: type: - number - 'null' description: Individual deductible remaining. familyDeductible: type: - number - 'null' description: Family deductible amount. familyDeductibleRemaining: type: - number - 'null' description: Family deductible remaining. deductibleApplies: type: - boolean - 'null' description: Whether the deductible applies to this service type. outOfPocketMax: type: - number - 'null' description: Individual out-of-pocket maximum. outOfPocketRemaining: type: - number - 'null' description: Individual out-of-pocket remaining. familyOutOfPocketMax: type: - number - 'null' description: Family out-of-pocket maximum. familyOutOfPocketRemaining: type: - number - 'null' description: Family out-of-pocket remaining. visitLimit: type: - number - 'null' description: Maximum visits allowed per benefit period. visitsUsed: type: - number - 'null' description: Visits already used in the current period. authorizationRequired: type: - boolean - 'null' description: Whether prior authorization is required. confidence: $ref: '#/components/schemas/BenefitConfidence' required: - serviceType EligibilityCheckError: type: object properties: code: anyOf: - type: string enum: - '67' - '71' - '72' - '73' - '75' - '77' - SH01 - SH02 description: >- AAA error code. See EligibilityCheckError schema for code → description and follow-up action table. example: '67' - type: string description: >- AAA error code. See schema description for code → description and follow-up action mapping. example: '67' description: anyOf: - type: string enum: - Patient not found - >- Patient Birth Date Does Not Match That for the Patient on the Database - Invalid/Missing subscriber/insured ID - Invalid/Missing subscriber/insured name - Subscriber/Insured not found - Subscriber found, patient not found - Payer not supported - Payer portal check did not complete description: >- Human-readable error description; should match the code (see schema table). example: Patient not found - type: string description: Human-readable error description; should match the code. example: Patient not found enum: - Patient not found - >- Patient Birth Date Does Not Match That for the Patient on the Database - Invalid/Missing subscriber/insured ID - Invalid/Missing subscriber/insured name - Subscriber/Insured not found - Subscriber found, patient not found - Payer not supported - Payer portal check did not complete field: type: string example: AAA followupAction: type: string description: Recommended follow-up; set by the API from the error code. example: Please Correct and Resubmit location: type: string possibleResolutions: type: string description: >- A single error returned when an eligibility check fails (`status` is `FAILED`). Present in `GET /api/eligibility/{id}/status` responses and in the eligibility-check-completed webhook payload. **Error code → description and follow-up action:** | Code | Description | Follow-up action | |------|-------------|------------------| | `67` | Patient not found | Please Correct and Resubmit | | `71` | Patient Birth Date Does Not Match That for the Patient on the Database | Please Correct and Resubmit | | `72` | Invalid/Missing subscriber/insured ID | Please Correct and Resubmit | | `73` | Invalid/Missing subscriber/insured name | Please Correct and Resubmit | | `75` | Subscriber/Insured not found | Please Correct and Resubmit | | `77` | Subscriber found, patient not found | Please Correct and Resubmit | | `SH01` | Payer not supported | Resubmission Not Allowed | | `SH02` | Payer portal check did not complete | Resubmission Allowed | example: field: AAA code: '71' description: Patient Birth Date Does Not Match That for the Patient on the Database followupAction: Please Correct and Resubmit location: Loop 2100C possibleResolutions: >- The subscriber's birth date doesn't match what's in the payer's database. • Check that the `subscriber.dateOfBirth` is correct. • If so, contact the payer to resolve this issue. Warning: type: object properties: code: type: string description: type: string BenefitsInformation: type: object properties: code: type: string name: type: string coverageLevel: type: string coverageLevelCode: type: string inPlanNetworkIndicator: type: string inPlanNetworkIndicatorCode: type: string insuranceType: type: string insuranceTypeCode: type: string serviceTypeCodes: type: array items: type: string serviceTypes: type: array items: type: string timeQualifier: type: string timeQualifierCode: type: string quantityQualifier: type: string quantityQualifierCode: type: string benefitAmount: type: string benefitPercent: type: string benefitQuantity: type: string planCoverage: type: string additionalInformation: type: array items: type: object properties: code: type: string description: type: string EligibilityMeta: type: object properties: applicationMode: type: string billerId: type: string outboundTraceId: type: string senderId: type: string submitterId: type: string traceId: type: string SubscriberTraceNumber: type: object properties: originatingTransactionTraceNumber: type: string payerTraceNumber: type: string RequestAddress: type: object properties: address1: type: string address2: type: string city: type: string state: type: string description: Two-letter state code, e.g. `CA`. postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string description: Mailing or service address. example: address1: 123 Main St city: San Francisco state: CA postalCode: '94110' countryCode: US countrySubDivisionCode: CA BenefitConfidence: type: object properties: score: type: - number - 'null' description: Confidence score (0-1) for this benefit entry. example: 0.9 criteria: type: array items: type: string description: Human-readable reasons justifying the confidence score. description: Confidence assessment for this benefit entry. securitySchemes: ApiKeyAuth: type: apiKey in: header name: Authorization description: >- Pass your API key as `Key `. Example: `Authorization: Key sk_abc123` ````