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Healthcare

  • Eligibility
    • XML Request
    • XML Response
    • XML Benefit Info
    • IDF Request
    • IDF Responses
    • Eligibility Codes
    • Test Cases
  • Claims & Remittance
    • Claim Submission
      • Claim Required Data Elements
    • Remittance
  • Patient Import
    • HL7 Import
    • IDF Import
    • IDF Acknowledgement
  • Daily Healthcare Activity File
  • Request Sandbox API Key
  • Contact
  • Terms of Use
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InstaMed Developer Portal
  • Integration Overview
  • Consumer Payments
  • Consumer Billing
  • Healthcare
  • Disbursement Hub
  • Eligibility
    • XML Request
    • XML Response
    • XML Benefit Info
    • IDF Request
    • IDF Responses
    • Eligibility Codes
    • Test Cases
  • Claims & Remittance
    • Claim Submission
      • Claim Required Data Elements
    • Remittance
  • Patient Import
    • HL7 Import
    • IDF Import
    • IDF Acknowledgement
  • Daily Healthcare Activity File
  • Request Sandbox API Key
  • Contact
  • Terms of Use

XML Request

InstaMed Connect supports two methods to process XML real-time Eligibility transactions:

  • DoEligibilityInquiry: Returns the eligibility response supplied by the payer
  • DoEligibilityInquiryEnhanced: Returns the payer’s eligibility response with the Effective Benefit information determined by InstaMed

The request format is identical for both the DoEligibilityInquiry and DoEligibilityInquiryEnhanced methods.

FieldFormatRequired?MinMaxComments
PayerIDQualifierANN12NOT USED
RecipientID

 
ANY17Note: InstaMed Payer IDs are available in InstaMed Online in the Configure > EDI Enrollment > Payer List Search screen.
RecipientIDQualifierANY12
RecipientNameANY135
SubscriberIDANN130
SubscriberIDQualifierANN23
SubscriberID2ANN130
SubscriberIDQualifier2ANN23
SubscriberID3ANN130
SubscriberIDQualifier3ANN23
SubscriberLastNameANN135
SubscriberFirstNameANN125
SubscriberMiddleNameANN125
SubscriberDateOfBirthDTN135(MM/DD/YYYY)
AsOfDateDTNDefault value is Current Date. (MM/DD/YYYY)
PatientLastNameANN135
PatientFirstNameANN125
PatientMiddleNameANN125
PatientDateOfBirthDTN110(MM/DD/YYYY)
PatientRelationshipANY22
PatientGenderANN11
TraceNumberANN130
ServiceTypeCodeANN12
ProviderLastNameANN135
ProviderFirstNameANN125
ProviderMiddleNameANN125
ProviderID2ANN280
ProviderID1ANY280
ProviderIDQualifier2ANN23
ProviderIDQualifier1ANY23
PatientID2ANN23
PatientIDQualifier2ANN12
PatientID1ANN130
PatientIDQualifier1ANN23
CoverageLevelANN33
InNetworkBooleanN15
PatientSSNNUMN19
PatientAccountNumberANN180
FromDateDTN1010
ToDateDTN1010
SubscriberGroupNumberANN180
GroupIDANN130
SubscriberPrefixANN110
SubscriberSuffixANN110
PatientPrefixANN110
PatientSuffixANN110
ProviderPrefixANN110
ProviderSuffixANN110

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InstaMed is a wholly owned subsidiary and is a registered MSP/ISO of JPMorgan Chase Bank, N.A. Additionally, InstaMed is a registered ISO of U.S. Bank, N.A. and a registered MSP/ISO of Elavon, Inc., Georgia.

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