Documents and warnings

The files a check produces and the notices it raises: two arrays whose shapes vary by payer, and one field pair that contradicts itself.

Two arrays carry things that are neither eligibility nor cost sharing: referral_documents, the files pulled off the portal, and warning_messages, the notices raised while the check ran. Both look simple and both vary by payer in a way that breaks a first implementation.

What the portal showed

Nextcare provider portal, member eligibility

Member eligibility

Eligible

Member: Sample Patient
Card number: MBR-0000000
Network: Sample Network A
Valid until: 30 Sep 2026

Downloads

Document	Kind
Claim Form1	The clinic submits this
Claim Form Image	The clinic submits this
Table of Benefits1	Reference
Member Eligibility Document2	Evidence of what the page said

This policy is a Referral Policy which requires a referral from the assigned Gatekeeper. Gatekeeper: Yes3

1Paperwork. These are the entries a front desk actually opens, and they sit in the same array as the evidence captures.
2A capture of this page, for the audit trail. Distinguishable only by its tag.
3A rule printed on the page. It becomes a warning_messages entry, and it contradicts one of the two gatekeeper fields on the same response.

Redrawn from a production Nextcare eligibility page carrying four documents and a gatekeeper notice.

referral_documents

Four documents from a Nextcare check

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:15:44.832000",
"updated_at": "2026-04-23T04:16:20.953000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"name": "Sample Patient",
"phone": "+971 50 000 0000",
"id_type": "CARDNUMBER",
"tpa_name": "TPA002",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"request_start_time": 1776917744.8226814
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA002",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA002",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:16:21.691000",
"updated_at": "2026-04-23T04:16:21.691000",
"data_dump": {
"tpa": "TPA002",
"data": {
"payer_id": "TPA002",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"patient_emirates_id": "784-0000-0000000-0",
"policy_primary_member_id": "MBR-0000000",
"policy_primary_dha_member_id": "0000000000"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Laboratory",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Radiology",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Pharmacy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Deductible Excess: 50 AED Per Claim | \n\n ",
"visit_type": "Consultation",
"copay_amount": 50,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": "Per Claim",
"copay_max_amount": null,
"copay_percentage": "None",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Laboratory",
"service_category_standardized": "Laboratory"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Radiology",
"service_category_standardized": "Radiology"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Pharmacy",
"service_category_standardized": "Pharmacy"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultation",
"service_category_standardized": "Consultation"
}
],
"policy_info": {
"waiting_period": "Not Specified",
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": {
"DD": 1,
"MM": 1,
"YYYY": 2025
}
},
"general_remarks": [
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "No",
"payer_name": "DUBAI INSURANCE COMPANY - INS005",
"sponsor_id": "INS005",
"start_date": "2026-01-01",
"valid_upto": "2027-06-30",
"all_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "MOH",
"policy_plan_name": null,
"work_site_covered": "Could not determine",
"policy_holder_name": "Sample Policy Holder",
"payer_name_as_in_text": "INS005 - Dubai Insurance",
"is_general_physician_referral_required_for_specialist_referral": true
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
{
"message": "WARNING: GP referral is required for specialist referral.\n\"Gatekeeper: Yes\"\n\"This Policy is a Referral Policy* which requires a Referral from the assigned Gatekeeper**.\"",
"warning": true,
"screenshot": null
}
],
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0"
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA002",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted: eligibility_result.data_dump.data.referral_documents. Every other key on the response is documented on Results.

Each entry is an object: tag is the label to show a person, s3_url is the link, and id is a slug for the same kind of document across checks.

id is not always there

The same array from a NAS check carries tag and s3_url and no id at all. Display tag, and group on tag if you need to group. Code that reads document.id throws on half the payers.

The same array at a payer that omits id

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-11T15:55:28.478000",
"updated_at": "2026-05-11T15:59:12.502000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "CARDNUMBER",
"tpa_name": "TPA004",
"payerName": "NAS ADMINISTRATION SERVICES",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "LocationGroup",
"value": "OUTPATIENT",
"request_start_time": 1778514928.3394394,
"is_member_present_at_the_facility": true
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"is_special_location": true,
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA004",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"tag": "Member Eligibility - Main Page",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Details Modal",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Alternative Screenshot",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Consultation / Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Prescription Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA004",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-11T15:59:24.120000",
"updated_at": "2026-05-11T15:59:24.120000",
"data_dump": {
"tpa": "TPA004",
"data": {
"payer_id": "TPA004",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "01-01-1990",
"policy_holder_name": "Sample Policy Holder",
"patient_emirates_id": "784-0000-0000000-0",
"policy_primary_member_id": "MBR-0000000",
"policy_primary_dha_member_id": "0000000000"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Citation: Copay 20% Max 50.00 AED applicable for \n                                                                    :\n\nConsultation / Evaluation and Management, Teleconsultations | \n\n ",
"visit_type": "Consultation",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": 50,
"copay_percentage": "20",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Citation: Copay 20% Max 50.00 AED applicable for \n                                                                    :\n\nConsultation / Evaluation and Management, Teleconsultations | \n\n ",
"visit_type": "Teleconsultations",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": 50,
"copay_percentage": "20",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Citation: Copay 20%  applicable for \n                                                                    :\n\nDialysis | \n\n ",
"visit_type": "Dialysis",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "20",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Citation: Copay 30%  applicable for \n                                                                    :\n\nAcute Drugs, Chronic Drugs | \n\n ",
"visit_type": "Pharmacy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 30,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "30",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
"Work Injury Covered",
"No referral required for specialist consultation"
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultation / Evaluation and Management",
"service_category_standardized": "Consultation"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": 50,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Teleconsultations",
"service_category_standardized": "Teleconsultations"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 20,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Dialysis",
"service_category_standardized": "Dialysis"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 30,
"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Acute Drugs, Chronic Drugs",
"service_category_standardized": "Pharmacy"
}
],
"policy_info": {
"waiting_period": "Not Specified",
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": null
},
"general_remarks": [
"No referral required for specialist consultation",
"Work Injury Covered"
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "Not Mentioned",
"payer_name": "QATAR INSURANCE COMPANY - INS019",
"sponsor_id": "INS019",
"start_date": "2025-09-01",
"valid_upto": "2026-08-31",
"all_networks": [
{
"network": "CN",
"plan_code": "NASCNP29-DXB",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "Comprehensive Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS -CN -DXB",
"matched_plan_name": null,
"network_name_as_in_text": "Comprehensive Network [Applicable Tariff: Comprehensive Network]"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "DHA",
"policy_plan_name": null,
"applicable_tariff": null,
"work_site_covered": "Could not determine",
"policy_holder_name": null,
"network_payment_limit": "Not Mentioned",
"payer_name_as_in_text": "at Qatar Insurance Company",
"is_consultation_excluded_from_payment_limit": false,
"is_general_physician_referral_required_for_specialist_referral": false
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
],
"policy_holder_dob": "01-01-1990",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"tag": "Member Eligibility - Main Page",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Details Modal",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Member Eligibility - Alternative Screenshot",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Consultation / Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tag": "Prescription Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "30.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "50.0",
"should_set_copay": true,
"_deductibleLegacy": "50.0"
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "CN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "CN",
"plan_code": "NASCNP29-DXB",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "Comprehensive Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS -CN -DXB",
"matched_plan_name": null,
"network_name_as_in_text": "Comprehensive Network [Applicable Tariff: Comprehensive Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "CN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "CN",
"plan_code": "NASCNP29-DXB",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "Comprehensive Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS -CN -DXB",
"matched_plan_name": null,
"network_name_as_in_text": "Comprehensive Network [Applicable Tariff: Comprehensive Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "30.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "20.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "50.0",
"should_set_copay": true,
"_deductibleLegacy": "50.0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "CN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "CN",
"plan_code": "NASCNP29-DXB",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "Comprehensive Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS -CN -DXB",
"matched_plan_name": null,
"network_name_as_in_text": "Comprehensive Network [Applicable Tariff: Comprehensive Network]"
}
],
"has_multiple_networks": false
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "CN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "CN",
"plan_code": "NASCNP29-DXB",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "Comprehensive Network",
"raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS -CN -DXB",
"matched_plan_name": null,
"network_name_as_in_text": "Comprehensive Network [Applicable Tariff: Comprehensive Network]"
}
],
"has_multiple_networks": false
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA004",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted on every entry of eligibility_result.data_dump.data.referral_documents: tag. The rest of the keys are documented on Results.

Two kinds of file in one array

The array mixes evidence with paperwork, and only the labels tell them apart.

`tag`	What it is
`Member Eligibility - Main Page`	A capture of the portal page, evidence that the check saw what it says it saw
`Member Eligibility - Details Modal`	The same, one level in
`Member Eligibility - Alternative Screenshot`	The same again, from a different view
`Consultation / Claim Form`	A form the clinic submits
`Prescription Form`	A form the clinic submits
`Table of Benefits`	The plan's benefit schedule

The first three are for an audit trail. The claim form and prescription form are documents the clinic actually uses, so a UI that renders all six as "attachments" buries the two that matter. Split them on tag.

Every link expires, and this endpoint re-signs them

s3_url and screenshot_key are presigned links with a limited lifetime. GET /eligibility-result mints fresh ones on every read, so cache the result and re-request it when you need a file. Do not cache the URL, put it in an email, or hand it to a client that will open it hours later. See link expiry.

warning_messages

Notices raised while the check ran: a rule on the policy, something the portal would not let us do, a form that did not generate.

A gatekeeper warning

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:15:44.832000",
"updated_at": "2026-04-23T04:16:20.953000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"name": "Sample Patient",
"phone": "+971 50 000 0000",
"id_type": "CARDNUMBER",
"tpa_name": "TPA002",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"request_start_time": 1776917744.8226814
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA002",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA002",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:16:21.691000",
"updated_at": "2026-04-23T04:16:21.691000",
"data_dump": {
"tpa": "TPA002",
"data": {
"payer_id": "TPA002",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"patient_emirates_id": "784-0000-0000000-0",
"policy_primary_member_id": "MBR-0000000",
"policy_primary_dha_member_id": "0000000000"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Laboratory",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Radiology",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Pharmacy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Deductible Excess: 50 AED Per Claim | \n\n ",
"visit_type": "Consultation",
"copay_amount": 50,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": "Per Claim",
"copay_max_amount": null,
"copay_percentage": "None",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Laboratory",
"service_category_standardized": "Laboratory"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Radiology",
"service_category_standardized": "Radiology"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Pharmacy",
"service_category_standardized": "Pharmacy"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultation",
"service_category_standardized": "Consultation"
}
],
"policy_info": {
"waiting_period": "Not Specified",
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": {
"DD": 1,
"MM": 1,
"YYYY": 2025
}
},
"general_remarks": [
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "No",
"payer_name": "DUBAI INSURANCE COMPANY - INS005",
"sponsor_id": "INS005",
"start_date": "2026-01-01",
"valid_upto": "2027-06-30",
"all_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "MOH",
"policy_plan_name": null,
"work_site_covered": "Could not determine",
"policy_holder_name": "Sample Policy Holder",
"payer_name_as_in_text": "INS005 - Dubai Insurance",
"is_general_physician_referral_required_for_specialist_referral": true
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
{
"message": "WARNING: GP referral is required for specialist referral.\n\"Gatekeeper: Yes\"\n\"This Policy is a Referral Policy* which requires a Referral from the assigned Gatekeeper**.\"",
"warning": true,
"screenshot": null
}
],
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0"
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA002",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted: eligibility_result.data_dump.data.warning_messages. Every other key on the response is documented on Results.

Entries are objects, not strings. Every entry carries:

Key	Type	Notes
`message`	string	The text to display. Portal-derived, multi-line, and it changes with the portal.
`warning`	boolean	`true` on all fifteen entries across every sample in this section, including the ones marked informational. It is a constant, not a severity.
`screenshot`	string or null	A signed link to the portal at that moment. `null` on all fifteen.
`message_type`	string	`"warning"` or `"information"`. Present on some entries and absent on others in the same response.

message_type is the severity, and it is optional

warning looks like the severity flag and is not: an entry reading "Medical check-up / wellness is covered under this policy" carries message_type: "information" and warning: true, exactly like a real warning does. Read message_type, and when it is absent treat the entry as a warning. Do not branch on warning at all.

message is unstructured and multi-line. Render it as text. Do not match on it, because the wording comes from the portal:

WARNING: GP referral is required for specialist referral.
"Gatekeeper: Yes"
"This Policy is a Referral Policy* which requires a Referral from the assigned Gatekeeper**."

The gatekeeper contradiction

That warning is from a check whose policy_network says this:

The same check's gatekeeper fields

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:15:44.832000",
"updated_at": "2026-04-23T04:16:20.953000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"name": "Sample Patient",
"phone": "+971 50 000 0000",
"id_type": "CARDNUMBER",
"tpa_name": "TPA002",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"request_start_time": 1776917744.8226814
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA002",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA002",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-04-23T04:16:21.691000",
"updated_at": "2026-04-23T04:16:21.691000",
"data_dump": {
"tpa": "TPA002",
"data": {
"payer_id": "TPA002",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"patient_emirates_id": "784-0000-0000000-0",
"policy_primary_member_id": "MBR-0000000",
"policy_primary_dha_member_id": "0000000000"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Laboratory",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Radiology",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Pharmacy",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Deductible Excess: 50 AED Per Claim | \n\n ",
"visit_type": "Consultation",
"copay_amount": 50,
"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": "Per Claim",
"copay_max_amount": null,
"copay_percentage": "None",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Laboratory",
"service_category_standardized": "Laboratory"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Radiology",
"service_category_standardized": "Radiology"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Pharmacy",
"service_category_standardized": "Pharmacy"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": 50,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": null,
"copay_maximum_scope": "Per Claim",
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultation",
"service_category_standardized": "Consultation"
}
],
"policy_info": {
"waiting_period": "Not Specified",
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": {
"DD": 1,
"MM": 1,
"YYYY": 2025
}
},
"general_remarks": [
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "No",
"payer_name": "DUBAI INSURANCE COMPANY - INS005",
"sponsor_id": "INS005",
"start_date": "2026-01-01",
"valid_upto": "2027-06-30",
"all_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "MOH",
"policy_plan_name": null,
"work_site_covered": "Could not determine",
"policy_holder_name": "Sample Policy Holder",
"payer_name_as_in_text": "INS005 - Dubai Insurance",
"is_general_physician_referral_required_for_specialist_referral": true
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
{
"message": "WARNING: GP referral is required for specialist referral.\n\"Gatekeeper: Yes\"\n\"This Policy is a Referral Policy* which requires a Referral from the assigned Gatekeeper**.\"",
"warning": true,
"screenshot": null
}
],
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0"
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0",
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "50.0",
"_copayAmount": "50.0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "50.0",
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "PCP",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "PCP",
"plan_code": "P267",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "PCP",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OP@PCP"
},
{
"network": "RN3",
"plan_code": "P267",
"visit_type": "SP (Specialist Physician) Referral",
"network_code": null,
"network_value": "RN3",
"raw_plan_string": "DUBAI INSURANCE COMPANY(NEXTCARE) - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "SpRef@RN3"
}
],
"has_multiple_networks": true
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA002",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted on eligibility_result.data_dump.data.policy_network: is_gatekeeper, is_general_physician_referral_required_for_specialist_referral. The rest of the keys are documented on Results.

Three statements about one rule, in one response:

is_gatekeeper: "Not Mentioned"
is_general_physician_referral_required_for_specialist_referral: true
a warning_messages entry quoting the portal saying "Gatekeeper: Yes"

The tri-state is the one that is wrong here. A client that branches on is_gatekeeper alone sends the patient to a specialist without the referral the policy requires, and the visit is rejected later.

Treat any of the three saying yes as yes

Result objects recommends preferring the tri-state, on the grounds that "Not Mentioned" is meaningfully different from "No". That holds when the two fields agree. When they disagree, as they do here, the boolean and the warning are the ones carrying the portal's own words. Take the union: if the boolean is true, or the tri-state is "Yes", or a warning names a gatekeeper, tell the user a referral is required.

special_remarks is a different array

copay_analysis.special_remarks is an array of strings, and it carries policy facts rather than warnings.

special_remarks

.json

{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-16T05:12:06.877000",
"updated_at": "2026-05-16T05:17:28.942000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "CARDNUMBER",
"tpa_name": "TPA002",
"payerName": "ARAB GULF HEALTH SERVICES (NEXTCARE)",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "LocationGroup",
"value": "MATERNITY",
"request_start_time": 1778908326.8694143
},
"visit_type": "MATERNITY",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"is_special_location": true,
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": {
"tpa_name": "TPA002",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
]
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA002",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-16T05:17:30.501000",
"updated_at": "2026-05-16T05:17:30.501000",
"data_dump": {
"tpa": "TPA002",
"data": {
"payer_id": "TPA002",
"is_eligible": true,
"patient_info": {
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"patient_emirates_id": "784-0000-0000000-0",
"policy_primary_member_id": "MBR-0000000",
"policy_primary_dha_member_id": "0000000000"
},
"copay_analysis": {
"copay_details": [
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Maternity - Outpatient",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Maternity - Consultation",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
},
{
"remarks": "Citation: Co-Part: 10% | \n\n ",
"visit_type": "Maternity - Ultrasound",
"copay_amount": null,
"cost_sharing": {
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
},
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "10.0",
"coinsurance_percentage": null
}
],
"waiting_period": "Not Specified",
"special_remarks": [
"Pre Certification CAP: 3 Quantity Per Member Per Master Contract",
"Pre Certification CAP: 7 Quantity Per Member Per Master Contract"
],
"new_version_of_copay_analysis": {
"benefits": [
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Maternity",
"service_category_standardized": "Maternity - Outpatient"
},
{
"limits": null,
"remarks": [
"Pre Certification CAP: 7 Quantity Per Member Per Master Contract"
],
"conditions": null,
"cost_sharing": [
{
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Consultations",
"service_category_standardized": "Maternity - Consultation"
},
{
"limits": null,
"remarks": [
"Pre Certification CAP: 3 Quantity Per Member Per Master Contract"
],
"conditions": null,
"cost_sharing": [
{
"visit_type": "Maternity",
"copay_amount": null,
"visit_setting": "Outpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": "Pregnancy Ultrasound / Obstetrical Ultrasound",
"service_category_standardized": "Maternity - Ultrasound"
}
],
"policy_info": {
"waiting_period": "Not Specified",
"policy_period_end": null,
"policy_jurisdiction": "Not Specified",
"policy_period_start": null,
"beneficiary_start_date": {
"DD": 1,
"MM": 11,
"YYYY": 2025
},
"air_arabia_referral_number": "REF-0000000"
},
"general_remarks": [
"Pre Certification CAP: 7 Quantity Per Member Per Master Contract",
"Pre Certification CAP: 3 Quantity Per Member Per Master Contract"
],
"abbreviations_defined": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "No",
"payer_name": "ORIENT INSURANCE PJSC - INS008",
"sponsor_id": "INS008",
"start_date": "2025-11-01",
"valid_upto": "2026-10-31",
"all_networks": [
{
"network": "RN",
"plan_code": "Z024",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "RN",
"raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OIC-RN UAE Only"
}
],
"package_name": null,
"is_gatekeeper": "No",
"waiting_period": null,
"policy_authority": "MOH",
"policy_plan_name": null,
"work_site_covered": "Could not determine",
"policy_holder_name": "Sample Policy Holder",
"payer_name_as_in_text": "INS008 - Orient Insurance PJSC",
"is_general_physician_referral_required_for_specialist_referral": false
},
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"warning_messages": [
{
"message": "Referral Details Dropdown does not have any options to select",
"warning": true,
"screenshot": null
}
],
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"id": "claim_form",
"tag": "Claim Form",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "claim_form_image",
"tag": "Claim Form Image",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "table_of_benefits",
"tag": "Table of Benefits",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"id": "member_eligibility_document",
"tag": "Member Eligibility Document",
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
}
],
"copay_details_to_fill": [
{
"name": "Outpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "RN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "RN",
"plan_code": "Z024",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "RN",
"raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OIC-RN UAE Only"
}
],
"has_multiple_networks": false
},
{
"name": "Maternity",
"values_to_fill": {
"LAB": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"RADIOLOGY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"CONSULTATION": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PHYSIOTHERAPY": {
"copay": "10.0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "RN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "RN",
"plan_code": "Z024",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "RN",
"raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OIC-RN UAE Only"
}
],
"has_multiple_networks": false
},
{
"name": "Specialization",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_is_outpatient_fallback": true
}
},
"primary_network": {
"network": "RN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "RN",
"plan_code": "Z024",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "RN",
"raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OIC-RN UAE Only"
}
],
"has_multiple_networks": false
},
{
"name": "Inpatient",
"values_to_fill": {
"LAB": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"MEDICINES": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"RADIOLOGY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DIAGNOSTICS": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"CONSULTATION": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"PHYSIOTHERAPY": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
},
"DENTAL CONSULTATION & PROCEDURE": {
"copay": "0",
"deductible": "0",
"_copayAmount": "0",
"_copayMaxAmount": "0",
"should_set_copay": true
}
},
"primary_network": {
"network": "RN",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "RN",
"plan_code": "Z024",
"visit_type": "Not Specified",
"network_code": null,
"network_value": "RN",
"raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "OIC-RN UAE Only"
}
],
"has_multiple_networks": false
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"status": "found"
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA002",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "found"
}
}

Highlighted: eligibility_result.data_dump.data.copay_analysis.special_remarks. Every other key on the response is documented on Results.

"Pre Certification CAP: 3 Quantity Per Member Per Master Contract" is a limit on the policy, not a problem with the check. Others in this section include provider terms such as "NIL All OP/Maternity Copay for In house clinics", which is the reason a benefit has two different rates.

Show special_remarks beside the cost sharing it qualifies, and warning_messages beside the eligibility verdict. They are different information for different people.

What your code has to do

Read referral_documents entries as objects and guard id. Display tag, and separate the portal captures from the forms the clinic submits.

Never cache a signed URL. Cache the result and re-read it for a fresh link.

Render warning_messages[].message, not the entry. An array of objects rendered as strings prints [object Object], which is the most common bug on this field.

Take the union of the three gatekeeper signals, and show special_remarks next to the copay numbers rather than in the warnings list.

What the portal showed

Member eligibility

referral_documents

Two kinds of file in one array

warning_messages

The gatekeeper contradiction

special_remarks is a different array

What your code has to do

Where to go next

referral_documents

Copay

interim_results

On this page