Mantys Eligibility APINetworks and plans
One policy, more than one network: which of the four network fields to key on, and why matched_plan_name is usually null.
A policy is not on one network. It is on one network per setting, sometimes per
emirate, and the payer prints all of them. policy_network.all_networks carries
one entry per applicable network, and each entry names that network four
different ways.
What the portal showed
Nextcare provider portal, member eligibility
Member eligibility
Eligible- Member
- Sample Patient
- Card number
- MBR-0000000
- Payer
- ORIENT INSURANCE PJSC
- Valid until
- 30 Sep 2026
Applicable networks
| Network | Plan | Setting |
|---|---|---|
| RN Enhanced (UAE)1 | Z0243 | OP (Out Patient) |
| GN (Non-UAE) (ENBD)2 | P025-13 | OP (Out Patient) |
- 1The portal's own wording for the first network. It reaches you unchanged as
network_name_as_in_text. - 2A second network on the same policy. Two rows on the page means two entries in
all_networks, not two policies. - 3Each network carries its own
plan_code. The plan is per network, so a client that stores one plan per policy loses one of them.
What came back
{"id": "00000000-0000-4000-a000-000000000001","tenant_id": "yourorg","clinic_id": "00000000-0000-4000-a000-000000000002","created_at": "2026-04-12T15:29:22.074000","updated_at": "2026-04-12T15:29:55.602000","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": 1776007762.0590498},"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": "2026-04-12T15:29:56.401000","updated_at": "2026-04-12T15:29:56.401000","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: 20% | \n\n ","visit_type": "Out-Patient","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Outpatient","copay_currency": "AED","copay_percentage": 20,"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": "20.0","coinsurance_percentage": null},{"remarks": "Citation: Co-Part: 20% Max(100 AED) | \n\n ","visit_type": "Pharmacy","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Outpatient","copay_currency": "AED","copay_percentage": 20,"copay_maximum_scope": null,"copay_maximum_amount": 100,"coinsurance_percentage": null},"visit_setting": "Outpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": 100,"copay_percentage": "20.0","coinsurance_percentage": null},{"remarks": "Citation: Co-Part: 20% | \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,"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": "20.0","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": 20,"copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": "Out-Patient","service_category_standardized": "Out-Patient"},{"limits": null,"remarks": null,"conditions": null,"cost_sharing": [{"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Outpatient","copay_currency": "AED","copay_percentage": 20,"copay_maximum_scope": null,"copay_maximum_amount": 100,"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": null,"visit_setting": "Outpatient","copay_currency": "AED","copay_percentage": 20,"copay_maximum_scope": null,"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": 11,"MM": 11,"YYYY": 2024},"air_arabia_referral_number": "REF-0000000"},"general_remarks": [],"abbreviations_defined": []}},"failure_reason": null,"policy_network": {"is_vip": "No","payer_name": "ORIENT INSURANCE PJSC - INS008","sponsor_id": "INS008","start_date": "2025-10-01","valid_upto": "2026-09-30","all_networks": [{"network": "RN Enhanced","plan_code": "Z024","visit_type": "OP (Out Patient)","network_code": null,"network_value": "RN Enhanced","raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ","matched_plan_name": "RN Enhanced","network_name_as_in_text": "RN Enhanced (UAE)"},{"network": "NEXTCARE GN-OP","plan_code": "P025-1","visit_type": "OP (Out Patient)","network_code": null,"network_value": "GN","raw_plan_string": "ORIENT INSURANCE CO (INS008)(NEXTCARE) - SHJ","matched_plan_name": "NEXTCARE GN-OP","network_name_as_in_text": "GN (Non-UAE) (ENBD)"}],"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": [],"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": "20.0","deductible": "0","_copayAmount": "0","_maxDeductible": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0"},"MEDICINES": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "100.0","should_set_copay": true,"_deductibleLegacy": "100.0"},"PROCEDURE": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0"},"RADIOLOGY": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0"},"DIAGNOSTICS": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0"},"CONSULTATION": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0"},"PHYSIOTHERAPY": {"copay": "20.0","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 Enhanced","network_status": null,"matched_plan_name": "RN Enhanced"},"available_networks": [{"network": "RN Enhanced","plan_code": "Z024","visit_type": "OP (Out Patient)","network_code": null,"network_value": "RN Enhanced","raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ","matched_plan_name": "RN Enhanced","network_name_as_in_text": "RN Enhanced (UAE)"},{"network": "NEXTCARE GN-OP","plan_code": "P025-1","visit_type": "OP (Out Patient)","network_code": null,"network_value": "GN","raw_plan_string": "ORIENT INSURANCE CO (INS008)(NEXTCARE) - SHJ","matched_plan_name": "NEXTCARE GN-OP","network_name_as_in_text": "GN (Non-UAE) (ENBD)"}],"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": "RN Enhanced","network_status": null,"matched_plan_name": "RN Enhanced"},"available_networks": [{"network": "RN Enhanced","plan_code": "Z024","visit_type": "OP (Out Patient)","network_code": null,"network_value": "RN Enhanced","raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ","matched_plan_name": "RN Enhanced","network_name_as_in_text": "RN Enhanced (UAE)"},{"network": "NEXTCARE GN-OP","plan_code": "P025-1","visit_type": "OP (Out Patient)","network_code": null,"network_value": "GN","raw_plan_string": "ORIENT INSURANCE CO (INS008)(NEXTCARE) - SHJ","matched_plan_name": "NEXTCARE GN-OP","network_name_as_in_text": "GN (Non-UAE) (ENBD)"}],"has_multiple_networks": true},{"name": "Specialization","values_to_fill": {"LAB": {"copay": "20.0","deductible": "0","_copayAmount": "0","_maxDeductible": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true},"MEDICINES": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "100.0","should_set_copay": true,"_deductibleLegacy": "100.0","_is_outpatient_fallback": true},"PROCEDURE": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true},"RADIOLOGY": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true},"DIAGNOSTICS": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true},"CONSULTATION": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true},"PHYSIOTHERAPY": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_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 Enhanced","network_status": null,"matched_plan_name": "RN Enhanced"},"available_networks": [{"network": "RN Enhanced","plan_code": "Z024","visit_type": "OP (Out Patient)","network_code": null,"network_value": "RN Enhanced","raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ","matched_plan_name": "RN Enhanced","network_name_as_in_text": "RN Enhanced (UAE)"},{"network": "NEXTCARE GN-OP","plan_code": "P025-1","visit_type": "OP (Out Patient)","network_code": null,"network_value": "GN","raw_plan_string": "ORIENT INSURANCE CO (INS008)(NEXTCARE) - SHJ","matched_plan_name": "NEXTCARE GN-OP","network_name_as_in_text": "GN (Non-UAE) (ENBD)"}],"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": "RN Enhanced","network_status": null,"matched_plan_name": "RN Enhanced"},"available_networks": [{"network": "RN Enhanced","plan_code": "Z024","visit_type": "OP (Out Patient)","network_code": null,"network_value": "RN Enhanced","raw_plan_string": "ORIENT INSURANCE CO (INS008) -RN - SHJ","matched_plan_name": "RN Enhanced","network_name_as_in_text": "RN Enhanced (UAE)"},{"network": "NEXTCARE GN-OP","plan_code": "P025-1","visit_type": "OP (Out Patient)","network_code": null,"network_value": "GN","raw_plan_string": "ORIENT INSURANCE CO (INS008)(NEXTCARE) - SHJ","matched_plan_name": "NEXTCARE GN-OP","network_name_as_in_text": "GN (Non-UAE) (ENBD)"}],"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.policy_network.all_networks. Every other key on the response is documented on Results.
The four names for one network
Every entry carries all four, and they are not synonyms. Taking the second entry of the sample above:
| Field | What it is | Value |
|---|---|---|
network_name_as_in_text | The portal string, verbatim, punctuation and all | "GN (Non-UAE) (ENBD)" |
network_value | The cleaned name the portal meant | "GN" |
network | The network we normalised that to | "NEXTCARE GN-OP" |
matched_plan_name | The plan matched in our own plan catalogue | "NEXTCARE GN-OP" |
network is not always a short code. It is whichever normalised network the
portal's wording resolved to, which at one payer is "GN" and at another is
"NEXTCARE GN-OP". Compare it against values you have seen from that payer,
not against a global list of codes.
Alongside them, plan_code is the payer's code for the plan and
raw_plan_string is the untouched policy line the portal printed. visit_type
on the entry says which setting the network applies to, which is how a policy
can be on one network for outpatient and another for inpatient:
{"id": "00000000-0000-4000-a000-000000000001","tenant_id": "yourorg","clinic_id": "00000000-0000-4000-a000-000000000002","created_at": "2026-02-13T20:32:17.525000","updated_at": "2026-02-13T21:08:09.214000","task_id": "00000000-0000-4000-a000-000000000001","status": "PROCESS_COMPLETE","request_dump": {"phone": "+971 50 000 0000","id_type": "EMIRATESID","tpa_name": "INS010","payerName": "AXA INSURANCE - GULF","doctorName": "Sample Clinician","extra_args": {"title": "LocationGroup","value": "OPTICAL"},"visit_type": "OPTICAL","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": "INS010","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": "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:INS010","tenant_id": "yourorg","clinic_id": "00000000-0000-4000-a000-000000000002","created_at": "2026-02-13T21:08:09.754000","updated_at": "2026-02-13T21:08:09.754000","data_dump": {"tpa": "INS010","data": {"payer_id": "INS010","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: CONSULTATION:20% MAX AED 75 | \n\n ","visit_type": "Consultation - Northern Emirates (NE)","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 20,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": 75,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": 75,"copay_percentage": "20.0","coinsurance_percentage": null},{"remarks": "Citation: PH:20% | \n\n ","visit_type": "Pharmacy - Northern Emirates (NE)","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 20,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": null,"copay_percentage": "20.0","coinsurance_percentage": null},{"remarks": "Citation: MAT CONSULT:10% MAX AED 75 | \n\n ","visit_type": "Consultation (Maternity) - Northern Emirates (NE)","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 10,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": 75,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": 75,"copay_percentage": "10.0","coinsurance_percentage": null},{"remarks": "Citation: MAT PH:10% | \n\n ","visit_type": "Pharmacy (Maternity) - Northern Emirates (NE)","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 10,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": null,"copay_percentage": "10.0","coinsurance_percentage": null}],"waiting_period": "waiting_period_time=0 waiting_period_unit='Days' waiting_period_starting_from='policy_start_date'","special_remarks": [],"new_version_of_copay_analysis": {"benefits": [{"limits": null,"remarks": null,"conditions": null,"cost_sharing": [{"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 20,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": 75,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": null,"service_category_standardized": "Consultation"},{"limits": null,"remarks": null,"conditions": null,"cost_sharing": [{"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 20,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": null,"service_category_standardized": "Pharmacy"},{"limits": null,"remarks": null,"conditions": null,"cost_sharing": [{"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 10,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": 75,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": null,"service_category_standardized": "Consultation (Maternity)"},{"limits": null,"remarks": null,"conditions": null,"cost_sharing": [{"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 10,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": null,"service_category_standardized": "Pharmacy (Maternity)"}],"policy_info": {"waiting_period": {"waiting_period_time": 0,"waiting_period_unit": "Days","waiting_period_starting_from": "policy_start_date"},"policy_period_end": null,"policy_jurisdiction": "Not Specified","policy_period_start": null,"beneficiary_start_date": null},"general_remarks": [],"abbreviations_defined": [{"definition": "Maternity","abbreviation": "MAT"}]}},"failure_reason": null,"policy_network": {"is_vip": "No","payer_name": "Not Applicable","sponsor_id": null,"start_date": "2026-01-15","valid_upto": "2027-01-14","all_networks": [{"network": "A.1","plan_code": "P196-1-DXB","visit_type": "IP (In Patient)","network_code": null,"network_value": "A.1","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.1 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.1"},{"network": "A.3","plan_code": "NPDXB-158","visit_type": "OP (Out Patient)","network_code": null,"network_value": "A.3","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.3 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.3"}],"package_name": null,"is_gatekeeper": "Not Mentioned","waiting_period": null,"policy_authority": "DHA","policy_plan_name": "Group Plan","work_site_covered": "Could not determine","policy_holder_name": "Sample Policy Holder","network_payment_limit": "Not Mentioned","payer_name_as_in_text": "Sample Policy Holder","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": "1990-01-01","policy_holder_name": "Sample Policy Holder","referral_documents": [{"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": "20.0","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},"CONSULTATION": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "75.0","should_set_copay": true,"_deductibleLegacy": "75.0"},"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": "A.1","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "A.1","plan_code": "P196-1-DXB","visit_type": "IP (In Patient)","network_code": null,"network_value": "A.1","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.1 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.1"},{"network": "A.3","plan_code": "NPDXB-158","visit_type": "OP (Out Patient)","network_code": null,"network_value": "A.3","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.3 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.3"}],"has_multiple_networks": true},{"name": "Maternity","values_to_fill": {"LAB": {"copay": "0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true},"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": "0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true},"CONSULTATION": {"copay": "10.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "75.0","should_set_copay": true,"_deductibleLegacy": "75.0"},"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": "A.1","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "A.1","plan_code": "P196-1-DXB","visit_type": "IP (In Patient)","network_code": null,"network_value": "A.1","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.1 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.1"},{"network": "A.3","plan_code": "NPDXB-158","visit_type": "OP (Out Patient)","network_code": null,"network_value": "A.3","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.3 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.3"}],"has_multiple_networks": true},{"name": "Specialization","values_to_fill": {"LAB": {"copay": "0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true},"MEDICINES": {"copay": "20.0","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},"CONSULTATION": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "75.0","should_set_copay": true,"_deductibleLegacy": "75.0"},"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": "A.1","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "A.1","plan_code": "P196-1-DXB","visit_type": "IP (In Patient)","network_code": null,"network_value": "A.1","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.1 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.1"},{"network": "A.3","plan_code": "NPDXB-158","visit_type": "OP (Out Patient)","network_code": null,"network_value": "A.3","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.3 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.3"}],"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},"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": "A.1","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "A.1","plan_code": "P196-1-DXB","visit_type": "IP (In Patient)","network_code": null,"network_value": "A.1","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.1 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.1"},{"network": "A.3","plan_code": "NPDXB-158","visit_type": "OP (Out Patient)","network_code": null,"network_value": "A.3","raw_plan_string": "INS010 - (AXA) GULF INSURANCE GROUP (GULF) B S C - STAR, STAR PLUS NETWORK - A.3 - DXB","matched_plan_name": null,"network_name_as_in_text": "A.3"}],"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": "INS010","task_id": "00000000-0000-4000-a000-000000000001","user_id": null,"status": "found"}}
Highlighted: eligibility_result.data_dump.data.policy_network.all_networks. Every other key on the response is documented on Results.
A.1 applies to IP (In Patient) and A.3 to OP (Out Patient). Pick the
entry whose visit_type matches the encounter, not the first one in the array.
Which field to key on
Key your mapping on network, and fall back to network_value.
Do not map on network_name_as_in_text
The raw portal string can name two different things at once. In the sample below it reads
"Restricted Network [Applicable Tariff: General Network]": the member's network is Restricted,
the tariff being applied is General, and it is the tariff that decides what you charge. A client
that string-matches the raw text lands on "Restricted"; network_value and network both say
General, which is the answer.
{"id": "00000000-0000-4000-a000-000000000001","tenant_id": "yourorg","clinic_id": "00000000-0000-4000-a000-000000000002","created_at": "2026-05-08T06:28:46.230000","updated_at": "2026-05-08T06:30:52.245000","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": "TPA004","payerName": "","doctorName": "Sample Clinician","extra_args": {"title": "","value": "","request_start_time": 1778221726.2185426,"is_member_present_at_the_facility": true},"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": "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": "2026-05-08T06:30:55.631000","updated_at": "2026-05-08T06:30:55.631000","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: Copay 20% Max 50.00 AED applicable for \n :\n\nConsultation / Evaluation and Management, Teleconsultations","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: Copay 20% applicable for \n :\n\nDialysis","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}],"waiting_period": "Not Specified","special_remarks": ["No referral required for specialist consultation","Work Injury Covered"],"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, Teleconsultations","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": null,"coinsurance_percentage": null}],"coverage_status": "Covered","service_category_original": "Dialysis","service_category_standardized": "Dialysis"}],"policy_info": {"waiting_period": {"waiting_period_time": 0,"waiting_period_unit": "Days","waiting_period_starting_from": "policy_start_date"},"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": "2026-03-10","valid_upto": "2027-03-09","all_networks": [{"network": "GN","plan_code": "DXSHJ-P154","visit_type": "Out Mat","network_code": null,"network_value": "General Network","raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ","matched_plan_name": null,"network_name_as_in_text": "Restricted Network [Applicable Tariff: General 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": "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": "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": "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": "GN","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "GN","plan_code": "DXSHJ-P154","visit_type": "Out Mat","network_code": null,"network_value": "General Network","raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ","matched_plan_name": null,"network_name_as_in_text": "Restricted Network [Applicable Tariff: General 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": "GN","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "GN","plan_code": "DXSHJ-P154","visit_type": "Out Mat","network_code": null,"network_value": "General Network","raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ","matched_plan_name": null,"network_name_as_in_text": "Restricted Network [Applicable Tariff: General 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": "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": "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": "GN","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "GN","plan_code": "DXSHJ-P154","visit_type": "Out Mat","network_code": null,"network_value": "General Network","raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ","matched_plan_name": null,"network_name_as_in_text": "Restricted Network [Applicable Tariff: General 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": "GN","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "GN","plan_code": "DXSHJ-P154","visit_type": "Out Mat","network_code": null,"network_value": "General Network","raw_plan_string": "INS019 - QATAR INSURANCE COMPANY - NAS - GN -DXB-SHJ","matched_plan_name": null,"network_name_as_in_text": "Restricted Network [Applicable Tariff: General 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: eligibility_result.data_dump.data.policy_network.all_networks.0. Every other key on the response is documented on Results.
matched_plan_name is null more often than not
Across a 4,000-response sample of eligible results, network was null on none
of them and matched_plan_name was null on 75%.
{"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: eligibility_result.data_dump.data.policy_network.all_networks.0. Every other key on the response is documented on Results.
matched_plan_name: null is not an error and not a degraded result. It means
the plan is not one we hold a catalogue entry for; every other field on the
entry is populated as usual. Display network_value and plan_code and carry
on.
This matters for where you put your defensive code. An integration written to handle "unmapped network" is guarding a case that effectively does not occur, while the case that occurs on three requests in four goes unguarded.
What your code has to do
Treat all_networks as a list, always. A single-network policy is a list of
one. Reading all_networks[0] on a two-network policy is a coin flip between
two different plans.
Select by visit_type on the entry, matching the encounter you asked about,
before you read anything else off it.
Map on network, display network_value, never parse
network_name_as_in_text. Keep the raw string for support tickets.
Expect matched_plan_name to be null and fall back to plan_code.
Where to go next
Production cases
Nine situations that break a first integration, each with what the portal showed, the response it produced, and the branch your code needs.
Copay
copay_details_to_fill is cost sharing already resolved into numbers to bill against: how to read it, and how to tell when a number is standing in for one the payer never published.