Mantys Eligibility API

Eight outcomes

Everything a finished check can say, in two groups: three answers about the patient and five reports about the run, each with the body it produces.

A check that finishes has eight things it can tell you, and they divide in two. Three of them are answers about the patient: the payer was asked, and it said something. Five are reports about the run: the payer was not asked, or was asked and never answered, for a reason that is about the clinic, the payer's site or the attempt itself.

The division is the whole page. Every field worth reading, every retry worth making and every sentence worth showing a person follows from which side of it an outcome sits on, and the eight statuses do not line up with the split in any way you could guess from their names.

A report about the run is not a negative answer

The four outcomes with no data block are the expensive ones. A client that polls until the task completes and then reads data_dump.data.is_eligible gets undefined on those, and in most languages undefined is falsy: a patient whose check hit a broken portal is rendered as a patient who is not covered. Read status first, every time.

The eight

Each card names the status the outcome reports, what its data block holds, whether a retry buys you anything, and what belongs in front of a person. The same eight are the buttons on the Try it simulator, so anything here can be built and stepped through in the browser.

The portal answered

A fact about the patient. Show it.

Eligiblefound

Member found and covered

data
Full: patient, policy, networks, copay, documents, warnings.
error_type
None. A determination carries no message and no error_type.
Retry
Nothing to retry.
Show
The cover, and the copay the desk has to collect.
Not eligiblemember_not_found

Member found, this visit not covered

data
Full, plus failure_reason carrying the refusal in the wording the payer used.
error_type
None, which is what separates it from a real miss.
Retry
No. The policy has to change first.
Show
failure_reason. It is the only field that says why.
Member not foundmember_not_found

No match at this payer

data
Five keys, none of them about a person. show_data is false.
error_type
MemberNotFoundError
Retry
Once, with a different identifier.
Show
Not found at this payer, and never the words not covered.

The check produced no answer

A fact about the run. Never render it as "not covered".

Invalid credentialsinvalid_credentials

The clinic portal login was rejected

data
Absent. There is no data key at all.
error_type
TPAInvalidCredentialsError
Retry
No. Retrying is what produces backoff.
Show
message, to whoever administers the payer logins the clinic holds.
Failedfailed

The check ran and did not complete

data
Absent.
error_type
KnownScrapingErrors, usually. Log it, do not branch on it.
Retry
Once.
Show
That the check did not complete, plus message.
Errorerror

Something unexpected broke mid-run

data
Absent.
error_type
The exception class: TimeoutError, KeyError, and others.
Retry
Once.
Show
Your own wording. message is sometimes empty of meaning.
Backoffbackoff

Recent credential failures, so nothing was attempted

data
null on a search-all row. The payer was never asked.
error_type
None on a fan-out row: a row carries status and message only.
Retry
No. Fix the credential or wait the window out.
Show
message. It carries the remaining time as prose.
Not configuredtpa_not_configured

Your clinic has no credentials for this payer

data
Present, and misleading: is_eligible reads false, not null.
error_type
None on a fan-out row.
Retry
No. Nothing about this check will change it.
Show
Nothing, usually. It is a fact about the setup at this clinic.

All eight report a completed task

The task lifecycle says whether the work finished, not whether it answered. Every capture on this page comes from a task reporting PROCESS_COMPLETE, or SEARCH_ALL_COMPLETE on a search-all. None of them reports FAILED. See polling.

The portal answered

Three outcomes, all of them facts about the patient, and only two distinct statuses between them.

Eligible

status: "found", data.is_eligible: true. The member was found and is covered for the visit_type you asked about.

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

Highlighted on eligibility_result.data_dump: status, data.is_eligible. The rest of the keys are documented on Results.

This is the only outcome whose data_dump is three keys: status, tpa and data. There is no message and no error_type on a determination, so code that reads message for a headline finds nothing on the happy path. The screenshot lives inside the body at data.screenshot_key, not beside it.

show_data is not here either. It appears only on responses that carry no determination, so treating a missing show_data as "do not show" hides every eligible result you have.

Where each field a front desk acts on sits in that body is laid out on eligible response structure.

Not eligible

data.is_eligible: false, with a member attached. The payer knows this person, holds a live policy for them, and will not cover this visit.

member_not_found, and the member was found
.json
{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-09-09T21:48:02.953000",
"updated_at": "2026-09-09T22:02:06.674000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"emirates_id": "MBR-0000000",
"phone": "+971 50 000 0000",
"practice_id": "00000000-0000-4000-a000-000000000002",
"tpa_name": "TPA003",
"id_type": "CARDNUMBER",
"visit_type": "MATERNITY",
"extra_args": {
"title": "LocationGroup",
"value": "MATERNITY",
"request_start_time": 1788990482.9462805
},
"doctorName": "Sample Clinician",
"payerName": "ALMADALLAH HEALTHCARE MANAGEMENT FZ-LLC",
"is_special_location": true,
"user_id": "00000000-0000-4000-a000-000000000003"
},
"interim_results": {
"referral_documents": [
{
"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 Document",
"id": "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",
"tag": "Member Claim Form",
"id": "claim_form_document"
},
{
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"tag": "Member Reimbursement Form",
"id": "reimbursement_form_document"
}
],
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"tpa_name": "TPA003"
},
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA003",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-09-09T22:02:06.666000",
"updated_at": "2026-09-09T22:02:06.666000",
"data_dump": {
"status": "member_not_found",
"tpa": "TPA003",
"data": {
"patient_info": {
"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": {
},
"policy_network": {
"policy_plan_name": null,
"payer_name_as_in_text": "Dubai Government",
"sponsor_id": null,
"payer_name": "Dubai Government - DHA - INS002",
"valid_upto": "2026-12-31",
"start_date": "2026-01-01",
"all_networks": [
{
"network_name_as_in_text": "Network: Enaya Platinum",
"network": "Enaya Platinum",
"visit_type": "Not Specified",
"network_value": "Enaya Platinum",
"matched_plan_name": null,
"network_code": null
},
{
"network_name_as_in_text": "Network: GN+",
"network": "GN+",
"visit_type": "Not Specified",
"network_value": "GN+",
"matched_plan_name": null,
"network_code": null
}
],
"policy_authority": "DHA",
"is_general_physician_referral_required_for_specialist_referral": false,
"is_gatekeeper": "Not Mentioned",
"is_vip": "Not Mentioned",
"waiting_period": null,
"policy_holder_name": null,
"work_site_covered": "Could not determine",
"package_name": null
},
"copay_details_to_fill": [
],
"policy_holder_name": "Sample Policy Holder",
"policy_holder_emirates_id": "784-0000-0000000-0",
"is_eligible": false,
"failure_reason": "Policy is active (01-Jan-2026 to 31-Dec-2026) but the document explicitly states '**NOT ELIGIBLE**' and notes maternity coverage applies only to married female members; therefore the patient is not eligible for the requested maternity service.",
"referral_documents": [
{
"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 Document",
"id": "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",
"tag": "Member Claim Form",
"id": "claim_form_document"
},
{
"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"tag": "Member Reimbursement Form",
"id": "reimbursement_form_document"
}
],
"payer_id": "TPA003",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
}
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA003",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "member_not_found"
}
}

Highlighted on eligibility_result.data_dump: status, data.is_eligible, data.failure_reason. The rest of the keys are documented on Results.

Its status is member_not_found. Not found, and not a status of its own. A member the payer has never heard of and a member it knows and refuses arrive under the same value, and there is no third one: status: "found" with is_eligible: false does not ship on this endpoint.

The capture above proves the member was found. It carries a name, an Emirates ID, a member id, a DHA member id, two networks, three documents and a policy running from January to December of the same year. Then it refuses, because maternity cover on that plan is limited to married female members. failure_reason is the only field that says so, and it is free text written by the payer: display it, do not parse it.

Do not retry this. The answer reflects the policy as the payer holds it, so an immediate re-check returns the same thing. Re-check after the policy is expected to have changed, once a renewal has been processed for instance.

Member not found

Same status, and a body a tenth the size.

member_not_found, and nobody was found
.json
{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-16T13:34:21.373000",
"updated_at": "2026-05-16T13:34:31.583000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"name": "Sample Patient",
"phone": "+971 50 000 0000",
"id_type": "EMIRATESID",
"tpa_name": "TPA002",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"request_start_time": 1778938461.363816
},
"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": null,
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:TPA002",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-16T13:34:31.647000",
"updated_at": "2026-05-16T13:34:31.647000",
"data_dump": {
"tpa": "TPA002",
"data": {
"payer_id": "TPA002",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"status": "member_not_found",
"message": "`This beneficiary is  Invalid ` was seen",
"error_type": "MemberNotFoundError",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA002",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "member_not_found"
}
}

Highlighted on eligibility_result.data_dump: status, message, error_type, data.show_data. The rest of the keys are documented on Results.

Five keys, none of them about a person, and show_data: false. The data_dump around it carries message and error_type: "MemberNotFoundError", which the not-eligible response above carries neither of. That is the pair of tells: data.patient_info present means the payer answered about a member it knows, and data_dump.message present means it did not.

The common causes, in the order they actually occur: the patient is with a different payer, the Emirates ID is not yet linked at this payer, or the identifier has a typo in it. The middle one is the only one worth a second call, and the retry is with CARDNUMBER rather than the same Emirates ID again. Emirates ID not linked works through both sides of that with the two portal screens beside them.

The check produced no answer

Five outcomes, none of them about the patient. Four carry no data block at all and the fifth carries one that lies.

Invalid credentials

status: "invalid_credentials". The portal login your clinic has on file was rejected.

invalid_credentials
.json
{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-01-14T20:17:48.568000",
"updated_at": "2026-01-14T20:24:05.147000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "EMIRATESID",
"tpa_name": "TPA004",
"payerName": "NAS ADMINISTRATION SERVICES",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "LocationGroup",
"value": "OPTICAL",
"is_member_present_at_the_facility": false
},
"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": null,
"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": "2026-01-14T20:24:05.572000",
"updated_at": "2026-01-14T20:24:05.572000",
"data_dump": {
"tpa": "TPA004",
"status": "invalid_credentials",
"message": "Invalid Credentials for TPA `NAS/Neuron`. Username used: `REDACTED`. Please ask your team admin to update the credentials.",
"error_type": "TPAInvalidCredentialsError",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "TPA004",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "invalid_credentials"
}
}

Highlighted on eligibility_result.data_dump: status, message, error_type. The rest of the keys are documented on Results.

Nothing on this response is about the member, which is why there is no data key: not an empty object, not a null, absent. The message names the payer and the username that was refused, and it is written to be shown to whoever administers those logins.

Do not retry it. The account is not locked yet, and a loop is what locks it.

Failed

status: "failed". The check ran, got somewhere, and did not come back with a determination.

failed
.json
{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-13T10:31:54.583000",
"updated_at": "2026-05-13T10:32:40.293000",
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "PROCESS_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "EMIRATESID",
"tpa_name": "INS026",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"is_pod": false,
"is_maternity": false,
"request_start_time": 1778668314.568433,
"not_related_to_chief_complaint": false,
"free_followup_or_extended_followup": false
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"interim_results": null,
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:INS026",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-05-13T10:32:40.353000",
"updated_at": "2026-05-13T10:32:40.353000",
"data_dump": {
"tpa": "INS026",
"status": "failed",
"message": "Both credentials failed. Primary: 401 Client Error: Unauthorized for url: https://openjet.inhealth.ae/api/eligibilitycheck/geteligibilityrequestdetailsbyeligibilityId?eligibilityID=0000000000; Secondary: Error during API submission for secondary: Eligibility Request failed for secondary: Doctor with license 'Sample Clinician' not found in the system. Please verify the doctor license ID.",
"error_type": "KnownScrapingErrors",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "INS026",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "failed"
}
}

Highlighted on eligibility_result.data_dump: status, message, error_type. The rest of the keys are documented on Results.

error_type on this one reads KnownScrapingErrors, which tells you the failure was recognised rather than what it was. The useful half is message, and the capture above shows the shape it takes: a technical string, sometimes carrying an upstream status code, written for a log rather than for a person. Show your own wording and keep the message for support.

One failed is worth singling out because integrators hit it constantly, and it is not a payer problem at all: when doctorId holds a clinician's name rather than their licence ID, the payers that generate a claim form reject the whole check. Failures has the production example that quotes the rejected value back at you.

Retry once. If the second attempt fails the same way, the request is the problem.

Error

status: "error". Something broke mid-run that nobody had a branch for.

error
.json
{
"id": "00000000-0000-4000-a000-000000000001",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-02-17T06:01:41.920000",
"updated_at": "2026-02-17T06:03:49.065000",
"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": "INS020",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": ""
},
"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": null,
"is_search_all": false,
"search_all_status": null,
"created_by_user_id": null,
"eligibility_result": {
"id": "00000000-0000-4000-a000-000000000001:INS020",
"tenant_id": "yourorg",
"clinic_id": "00000000-0000-4000-a000-000000000002",
"created_at": "2026-02-17T06:03:49.217000",
"updated_at": "2026-02-17T06:03:49.217000",
"data_dump": {
"tpa": "INS020",
"status": "error",
"message": "Unexpected error: Page.wait_for_selector: Timeout 30000ms exceeded.\nCall log:\n  - waiting for locator(\"div.x-window:has-text(\\\"Member Card\\\")\") to be visible\n",
"error_type": "TimeoutError",
"screenshot_key": null,
"was_identified_by_aggregator": false
},
"search_id": "0000-0000-0000-0000",
"tpa_name": "INS020",
"task_id": "00000000-0000-4000-a000-000000000001",
"user_id": null,
"status": "error"
}
}

Highlighted on eligibility_result.data_dump: status, message, error_type. The rest of the keys are documented on Results.

error_type here is the exception class, so it moves: TimeoutError, KeyError and others appear across the samples in these docs, and new ones arrive without notice. Branch on status, log error_type, quote it to support.

Design your copy for the worst version of this. A second production error in the same family reports "Unexpected error: None", which is the entire message the payer side produced. Your fallback sentence has to work when message says nothing.

Retry once.

Backoff

status: "backoff". The check was never attempted, because too many recent logins for this payer were refused.

backoff
.json
{
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "SEARCH_ALL_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "EMIRATESID",
"tpa_name": "BOTH",
"payerName": "",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "",
"value": "",
"is_member_present_at_the_facility": false
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"is_search_all": true,
"search_all_status": "SEARCH_ALL_COMPLETE",
"aggregated_results": [
{
"tpa_name": "TPA037",
"status": "failed",
"data": null,
"created_at": "2025-12-20T04:25:22.523000",
"message": "TPA `TPA037` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "INS015",
"status": "error",
"data": null,
"created_at": "2025-12-20T04:26:20.246000",
"message": "Unexpected error: Locator.click: Timeout 30000ms exceeded.\nCall log:\n  - waiting for get_by_role(\"button\", name=\"Login\")\n  -     - locator resolved to <button name=\"button\" value=\"login\" class=\"btn btn-primary\">Login</button>\n  -   - attempting click action\n  -     - waiting for element to be visible, enabled and stable\n  -     - element is visible, enabled and stable\n  -     - scrolling into view if needed\n  -     - done scrolling\n  -     - performing click action\n  -     - click action done\n  -     - waiting for scheduled navigations to finish\n",
"screenshot_url": null
},
{
"tpa_name": "INS012",
"status": "member_not_found",
"data": {
"payer_id": "INS012",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:38.857000",
"message": "Member Not Eligible for Insurance",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA026",
"status": "member_not_found",
"data": {
"payer_id": "TPA026",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:37.263000",
"message": "Member with ID 784-0000-0000000-0 not found or referral code was incorrect.",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA004",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "TPA004",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "Explicit negative eligibility indicators are present ('Not Eligible' and 'Invalid Member Identifier'), overriding anyDates or treatment type information.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"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"
}
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:26:20.926000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "INS017",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "INS017",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "Explicit message: 'Given Member ID/Emirates ID is invalid' indicates the member cannot be identified in the system; no other eligibility indicators are present to confirm eligibility.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"referral_documents": [
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:26:32.120000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "TPA010",
"status": "failed",
"data": null,
"created_at": "2025-12-20T04:25:22.400000",
"message": "TPA `TPA010` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "INS020",
"status": "member_not_found",
"data": {
"payer_id": "INS020",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:31.468000",
"message": "Member not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA003",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "TPA003",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "Document shows NOT ELIGIBLE with an invalid Emirates ID, indicating no active/valid eligibility.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"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"
}
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:39.192000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "INS010",
"status": "member_not_found",
"data": {
"payer_id": "INS010",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:27:44.518000",
"message": "Member not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA036",
"status": "member_not_found",
"data": {
"payer_id": "TPA036",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:35.791000",
"message": "Member with ID 784-0000-0000000-0 not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA032",
"status": "failed",
"data": null,
"created_at": "2025-12-20T04:25:22.571000",
"message": "TPA `TPA032` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "TPA002",
"status": "member_not_found",
"data": {
"payer_id": "TPA002",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:36.147000",
"message": "`This beneficiary is  Invalid ` was seen",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "DHPO / Riayati",
"status": "delegated_to_search_all_pool",
"data": null,
"created_at": "2025-12-20T04:25:19.448000",
"message": "Identification via DHPO / Riayati failed, triggering pool-based search_all.",
"screenshot_url": null
},
{
"tpa_name": "TPA008",
"status": "backoff",
"data": null,
"created_at": "2025-12-20T04:25:22.713000",
"message": "Access to username `REDACTED` on TPA008 has been limited due to repeated incorrect password attempts. Please try again after 22 hours 59 minutes.",
"screenshot_url": null
},
{
"tpa_name": "TPA001",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "TPA001",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "Explicit negative indicators found: 'Invalid Member Identifier' and 'Not Eligible' in the eligibility details, which means the member is not eligible for coverage for the visit.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"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"
}
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:26:17.142000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "TPA029",
"status": "failed",
"data": null,
"created_at": "2025-12-20T04:25:23.128000",
"message": "TPA `TPA029` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "INS038",
"status": "member_not_found",
"data": {
"payer_id": "INS038",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2025-12-20T04:25:52.444000",
"message": "Member with ID 784-0000-0000000-0 not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "search_all_pool",
"status": "member_not_found",
"data": null,
"created_at": "2025-12-20T04:27:45.649000",
"message": "Eligibility checks completed for all prioritized TPAs, no active policy found.",
"screenshot_url": null
}
],
"total_tpas_checked": 19,
"found_results": 0,
"created_at": "2025-12-20T04:25:15.670000",
"updated_at": "2025-12-20T04:27:45.760000"
}

Highlighted on aggregated_results.14: tpa_name, status, message, data. The rest of the keys are documented on Results.

data is null here rather than thin: no browser was ever opened, so there is nothing to report and no screenshot either. The message carries the remaining time as prose, 22 hours 59 minutes in this production example, so display it rather than parsing a duration out of it.

What the window costs escalates with the number of refused logins. The first two cost nothing and can be retried straight away. The third holds the payer for five minutes, the fourth for six hours, and the fifth and every one after it for a day. This is why the advice on invalid_credentials is to stop rather than retry: three impatient retries turn a wrong password into a locked payer for the whole clinic.

Waiting is not the only way out. Updating the stored credential clears the window immediately, so the fix and the recovery are the same action.

Not configured

status: "tpa_not_configured". Your clinic holds no credentials for this payer, so it was never asked.

tpa_not_configured
.json
{
"task_id": "00000000-0000-4000-a000-000000000001",
"status": "SEARCH_ALL_COMPLETE",
"request_dump": {
"phone": "+971 50 000 0000",
"id_type": "EMIRATESID",
"tpa_name": "BOTH",
"payerName": "AL-BUHAIRA NATIONAL INSURANCE COMPANY",
"doctorName": "Sample Clinician",
"extra_args": {
"title": "LocationGroup",
"value": "OUTPATIENT",
"request_start_time": 1776449698.1679382
},
"visit_type": "OUTPATIENT",
"emirates_id": "784-0000-0000000-0",
"practice_id": "00000000-0000-4000-a000-000000000002",
"user_id": "00000000-0000-4000-a000-000000000003",
"name": null,
"dob": null,
"mode": "prod",
"test_mode": false
},
"is_search_all": true,
"search_all_status": "SEARCH_ALL_COMPLETE",
"aggregated_results": [
{
"tpa_name": "TPA036",
"status": "member_not_found",
"data": {
"payer_id": "TPA036",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:15:53.176000",
"message": "Member with ID 784-0000-0000000-0 not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA026",
"status": "member_not_found",
"data": {
"payer_id": "TPA026",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:24.618000",
"message": "Member with ID 784-0000-0000000-0 not found or member is inactive. Notification:  member not found !!",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA032",
"status": "tpa_not_configured",
"data": {
"payer_id": "TPA032",
"show_data": false,
"is_eligible": false,
"screenshot_key": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:15:55.878000",
"message": "TPA `TPA032` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "TPA010",
"status": "member_not_found",
"data": {
"payer_id": "TPA010",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:00.374000",
"message": "Saw `No data found` for the given ID: 784-0000-0000000-0",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA003",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "TPA003",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "The document shows a negative eligibility result with an explicit message 'NOT ELIGIBLE' due to an invalid Emirates ID, and no valid insurance information is provided.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"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"
}
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:11.400000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "TPA029",
"status": "member_not_found",
"data": {
"payer_id": "TPA029",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:29.797000",
"message": "Member with ID 784-0000-0000000-0 not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "INS010",
"status": "member_not_found",
"data": {
"payer_id": "INS010",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:38.085000",
"message": "Member not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA002",
"status": "member_not_found",
"data": {
"payer_id": "TPA002",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:15:58.885000",
"message": "`This beneficiary is  Invalid ` was seen",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA004",
"status": "member_not_found",
"data": {
"payer_id": "TPA004",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:19.740000",
"message": "Member not found, Final page was not member not found page.",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "INS038",
"status": "member_not_found",
"data": {
"payer_id": "INS038",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:25.876000",
"message": "Member with ID 784-0000-0000000-0 not found",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA008",
"status": "tpa_not_configured",
"data": {
"payer_id": "TPA008",
"show_data": false,
"is_eligible": false,
"screenshot_key": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:15:54.414000",
"message": "TPA `TPA008` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "INS017",
"status": "member_not_found",
"data": {
"payer_id": "INS017",
"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:23.049000",
"message": "Member not eligible: Given Member ID/Emirates ID is invalid",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "TPA001",
"status": "member_not_found",
"data": {
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"show_data": false,
"is_eligible": false,
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:29.802000",
"message": "Member not found, Final page was not member not found page.",
"screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z"
},
{
"tpa_name": "DHPO / Riayati",
"status": "delegated_to_search_all_pool",
"data": null,
"created_at": "2026-04-17T18:15:00.244000",
"message": "Identification via DHPO / Riayati failed, triggering pool-based search_all.",
"screenshot_url": null
},
{
"tpa_name": "TPA037",
"status": "tpa_not_configured",
"data": {
"payer_id": "TPA037",
"show_data": false,
"is_eligible": false,
"screenshot_key": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:15:58.349000",
"message": "TPA `TPA037` is not configured for the practice.",
"screenshot_url": null
},
{
"tpa_name": "INS020",
"status": "found",
"data": {
"payer_id": "INS020",
"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": "Maternity : No",
"visit_type": "Maternity",
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"visit_setting": "Outpatient",
"copay_currency": null,
"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "Not Covered",
"deductible_scope": null,
"deductible_amount": null,
"deductible_currency": null,
"coinsurance_percentage": null
},
{
"remarks": "Citation: Dental : Yes 30% Copay | \n\n ",
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"cost_sharing": {
"visit_type": "Outpatient",
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"visit_setting": "Inpatient",
"copay_currency": "AED",
"copay_percentage": 30,
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"coinsurance_percentage": null
},
"visit_setting": "Inpatient",
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},
{
"remarks": "Optical : No",
"visit_type": "Optical",
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"visit_setting": "Outpatient",
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"copay_max_scope": null,
"copay_max_amount": null,
"copay_percentage": "Not Covered",
"deductible_scope": null,
"deductible_amount": null,
"deductible_currency": null,
"coinsurance_percentage": null
},
{
"remarks": "Citation: OP - Ded : PC: 10% max. AED 30 | \n\n ",
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"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Inpatient",
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},
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"copay_max_amount": 30,
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"coinsurance_percentage": null
},
{
"remarks": "Citation: OP : 10% on all services including medicine | \n\n Citation: OP - Ded : PC: 10% max. AED 30 | \n\n ",
"visit_type": "Outpatient",
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"cost_sharing": {
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Inpatient",
"copay_currency": "AED",
"copay_percentage": 10,
"applicable_location": "Outside UAE",
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"coinsurance_percentage": null
},
"visit_setting": "Inpatient",
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"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": "Maternity : No",
"conditions": null,
"cost_sharing": [
],
"coverage_status": "Not Covered",
"service_category_original": null,
"service_category_standardized": "Maternity"
},
{
"limits": null,
"remarks": null,
"conditions": null,
"cost_sharing": [
{
"visit_type": "Outpatient",
"copay_amount": null,
"visit_setting": "Inpatient",
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"applicable_location": "Outside UAE",
"copay_maximum_scope": null,
"copay_maximum_amount": null,
"coinsurance_percentage": null
}
],
"coverage_status": "Covered",
"service_category_original": null,
"service_category_standardized": "Dental"
},
{
"limits": null,
"remarks": "Optical : No",
"conditions": null,
"cost_sharing": [
],
"coverage_status": "Not Covered",
"service_category_original": null,
"service_category_standardized": "Optical"
},
{
"limits": null,
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"conditions": null,
"cost_sharing": [
{
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},
{
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},
{
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}
],
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"service_category_standardized": "Outpatient"
},
{
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{
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},
{
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}
],
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"service_category_standardized": "Inpatient"
}
],
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"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": [
]
}
},
"failure_reason": null,
"policy_network": {
"is_vip": "Not Mentioned",
"payer_name": "Not Applicable",
"sponsor_id": null,
"start_date": "2026-01-01",
"valid_upto": "2026-12-31",
"all_networks": [
{
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"plan_code": "P167-2",
"visit_type": "OP (Out Patient)",
"network_code": null,
"network_value": "COMPREHENSIVE",
"raw_plan_string": "AL-BUHAIRA NATIONAL INSURANCE COMPANY - COMPREHENSIVE AND COMPREHENSIVE PLUS - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
},
{
"network": "COMPREHENSIVE",
"plan_code": "P167-2",
"visit_type": "IP (In Patient)",
"network_code": null,
"network_value": "COMPREHENSIVE",
"raw_plan_string": "AL-BUHAIRA NATIONAL INSURANCE COMPANY - COMPREHENSIVE AND COMPREHENSIVE PLUS - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
}
],
"package_name": null,
"is_gatekeeper": "Not Mentioned",
"waiting_period": null,
"policy_authority": "MOH",
"policy_plan_name": "Unified",
"work_site_covered": "Could not determine",
"policy_holder_name": "Sample Policy Holder",
"payer_name_as_in_text": "Sample Policy Holder",
"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",
"policy_holder_dob": "1990-01-01",
"policy_holder_name": "Sample Policy Holder",
"referral_documents": [
{
"id": "member_eligibility_document_main_page",
"tag": "Member Eligibility Document - Main Page",
"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": {
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"_copayAmount": "0",
"_maxDeductible": "0",
"_copayMaxAmount": "0",
"should_set_copay": true,
"_deductibleLegacy": "0"
},
"MEDICINES": {
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"deductible": "0",
"_copayAmount": "0",
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"should_set_copay": true,
"_deductibleLegacy": "0"
},
"PROCEDURE": {
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},
"RADIOLOGY": {
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"should_set_copay": true,
"_deductibleLegacy": "0"
},
"DIAGNOSTICS": {
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"should_set_copay": true,
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},
"CONSULTATION": {
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},
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"should_set_copay": true,
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},
"DENTAL CONSULTATION & PROCEDURE": {
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"_copayAmount": "0",
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"should_set_copay": true,
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}
},
"primary_network": {
"network": "COMPREHENSIVE",
"network_status": null,
"matched_plan_name": null
},
"available_networks": [
{
"network": "COMPREHENSIVE",
"plan_code": "P167-2",
"visit_type": "OP (Out Patient)",
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"network_value": "COMPREHENSIVE",
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"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
},
{
"network": "COMPREHENSIVE",
"plan_code": "P167-2",
"visit_type": "IP (In Patient)",
"network_code": null,
"network_value": "COMPREHENSIVE",
"raw_plan_string": "AL-BUHAIRA NATIONAL INSURANCE COMPANY - COMPREHENSIVE AND COMPREHENSIVE PLUS - SHJ",
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"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
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],
"has_multiple_networks": true
},
{
"name": "Maternity",
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"deductible": "0",
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"CONSULTATION": {
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"DENTAL CONSULTATION & PROCEDURE": {
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}
},
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"network": "COMPREHENSIVE",
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"matched_plan_name": null
},
"available_networks": [
{
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"visit_type": "OP (Out Patient)",
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}
},
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"matched_plan_name": null
},
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"network_value": "COMPREHENSIVE",
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"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
},
{
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],
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},
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},
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"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
},
{
"network": "COMPREHENSIVE",
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"visit_type": "IP (In Patient)",
"network_code": null,
"network_value": "COMPREHENSIVE",
"raw_plan_string": "AL-BUHAIRA NATIONAL INSURANCE COMPANY - COMPREHENSIVE AND COMPREHENSIVE PLUS - SHJ",
"matched_plan_name": null,
"network_name_as_in_text": "Network (NW): IP & OP : Comprehensive Incl."
}
],
"has_multiple_networks": true
}
],
"policy_holder_emirates_id": "784-0000-0000000-0",
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:16:39.315000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "INS012",
"status": "member_not_found",
"data": {
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"payer_id": "INS012",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "Ineligible - as indicated by the portal's transaction actions field",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"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"
}
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:17:08.326000",
"message": null,
"screenshot_url": null
},
{
"tpa_name": "INS015",
"status": "member_not_found",
"data": {
"network": null,
"payer_id": "INS015",
"show_data": false,
"payer_name": null,
"valid_upto": null,
"is_eligible": false,
"copay_details": null,
"other_details": null,
"failure_reason": "The document is a generic provider portal screen without any specific details about the patient's insurance eligibility or policy validity, so the patient is not eligible.",
"screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z",
"coverage_details": null,
"is_policy_active": false,
"policy_holder_dob": null,
"policy_holder_name": null,
"referral_documents": [
],
"policy_holder_phone": null,
"policy_holder_gender": null,
"policy_holder_last_name": null,
"policy_holder_member_id": null,
"payer_eligibility_status": null,
"policy_holder_first_name": null,
"policy_holder_card_number": null,
"policy_holder_emirates_id": null,
"policy_holder_middle_name": null,
"policy_holder_relationship": null,
"was_identified_by_aggregator": false
},
"created_at": "2026-04-17T18:17:00.815000",
"message": null,
"screenshot_url": null
}
],
"total_tpas_checked": 18,
"found_results": 1,
"created_at": "2026-04-17T18:14:58.179000",
"updated_at": "2026-04-17T18:16:41.403000"
}

Highlighted on aggregated_results.2: tpa_name, status, message, data.is_eligible. The rest of the keys are documented on Results.

This is the one no-answer outcome that carries a data block, and it is the most dangerous body on the page:

"data": {
  "payer_id": "TPA032",
  "show_data": false,
  "is_eligible": false,
  "screenshot_key": null,
  "was_identified_by_aggregator": false
}

is_eligible reads false. Not null, not absent. A payer that was never contacted is indistinguishable, on that field alone, from a payer that was asked and said no. show_data: false is the hint, and status is the answer.

On a search-all this is routine bookkeeping rather than an incident: a sweep of eighteen payers typically includes several the clinic has no login for. It is not something to put in front of a person per check.

Telling the look-alikes apart

Three pairs account for most of the misreadings, and none of them is separated by the field you would reach for first.

These two look the sameBecauseSeparate them on
Not eligible and member not foundThey report the same statusdata.patient_info, present only on the first; data_dump.message, present only on the second
Not covered and never askedBoth report data.is_eligible: falsestatus. tpa_not_configured never reached the portal
Not covered and the check brokedata.is_eligible is falsy either wayThe data key itself. On a failure it does not exist, so the read is undefined, not false

What your code has to do

Switch on status before you read anything under data_dump.data. On a search-all, do it once per entry in aggregated_results. Every branch below hangs off this one being first.

Treat the two groups as different kinds of event. An answer updates the patient's record. A non-answer is an operational message about the check, and belongs in a different place in your UI.

Split member_not_found on data.patient_info. One status, two outcomes, and the wrong one shown to a front desk either denies care to a covered patient or promises cover that does not exist.

Retry failed and error once, and nothing else. Retrying invalid_credentials produces backoff, and the second and third retry make the window longer for every check the clinic runs at that payer.

Ignore statuses you do not recognise. delegated_to_search_all_pool is routing bookkeeping and appears on essentially every search-all; a client that switches exhaustively and throws on the default will hit it constantly.

Log error_type and task_id on everything in the second group. Those two are what support needs to find the check.

Where to go next

Try it

Build a request and step through all eight of these outcomes in the browser.

Failures

The five no-answer outcomes in depth, including three of them in one search-all response.

Emirates ID not linked

The one member_not_found worth retrying, and how to tell it from the one that is not.

Result status

Every value the field can take, including the two this page does not cover.

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.

Eligible response structure

The ten fields a front desk acts on when a check comes back eligible, and where each one lives in the response.

On this page

The eightThe portal answeredEligibleNot eligibleMember not foundThe check produced no answerInvalid credentialsFailedErrorBackoffNot configuredTelling the look-alikes apartWhat your code has to doWhere to go next