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