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
The portal gives you all of them in a single field, joined with a plus sign:
12- 1One field on the page. Each side of it reaches you as its own
all_networksentry, and the string here is whatnetwork_name_as_in_textholds, verbatim. - 2The join. Two networks on one policy means two entries, not two policies, and the plus sign is the only thing separating them.
The plan codes are not on this screen. plan_code comes out of the plan string
behind the network, so a page that shows you two network names is already
hiding the thing that distinguishes 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": "MBR-0000000","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 - 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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.
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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%.
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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
Search-all response structure
The flat list a search-all returns, the four kinds of entry in it, and the two status fields that disagree about whether the sweep is finished.
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.