{ "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" ] } } ] }