Mantys Eligibility APIResults
GET /eligibility-result/{task_id}: the envelope, and one section per outcome with a sample response.
GET /eligibility-result/{task_id}The same request you have been polling. Once its status is
PROCESS_COMPLETE, the body you are already holding is the answer: there is no
further call to make.
The envelope
Prop
Type
status is the specific lifecycle state
EXTRACTING_DATA and the other in-flight states appear here verbatim. Treat anything other than
PROCESS_COMPLETE, CANCELLED and FAILED as still running; see when to
stop.
eligibility_result
Prop
Type
data_dump
Prop
Type
So the two fields you branch on are nested like this:
eligibility_result.status ← what happened
eligibility_result.data_dump.data.is_eligible ← the answerOutcomes
eligibility_result.status is the discriminator. Each section below is one
value it can take.
Eligible
status: "found", is_eligible: true. The member was found and is covered for
the visit_type you asked about.
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[{"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"},{"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"}]},"is_search_all": false,"search_all_status": null,"created_by_user_id": null,"eligibility_result": {"id": "00000000-0000-4000-a000-000000000001:TPA036","tenant_id": "yourorg","clinic_id": "00000000-0000-4000-a000-000000000002","created_at": "2026-03-18T20:26:05.904000","updated_at": "2026-03-18T20:26:05.904000","data_dump": {"tpa": "TPA036","data": {"payer_id": "TPA036","is_eligible": true,"patient_info": {"policy_holder_dob": "1990-01-01","policy_holder_name": "Sample Policy Holder","patient_emirates_id": null,"policy_holder_phone": "+971 50 000 0000","policy_holder_last_name": 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"Outpatient Services - Northern Emirates (NE)","copay_amount": 0,"cost_sharing": {"visit_type": "Outpatient","copay_amount": 0,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 0,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": null,"copay_percentage": "0.0","coinsurance_percentage": null},{"remarks": "Citation: pharmaceutical copayment 0% | \n\n ","visit_type": "Pharmacy - Northern Emirates (NE)","copay_amount": 0,"cost_sharing": {"visit_type": "Outpatient","copay_amount": 0,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 0,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": null,"copay_percentage": "0.0","coinsurance_percentage": null},{"remarks": "Citation: dental copayment 20% | \n\n Dental access covered on direct billing","visit_type": "Dental - Northern Emirates (NE)","copay_amount": null,"cost_sharing": {"visit_type": "Outpatient","copay_amount": null,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 20,"applicable_location": "Northern Emirates (NE)","copay_maximum_scope": null,"copay_maximum_amount": null,"coinsurance_percentage": null},"visit_setting": "Inpatient","copay_currency": "AED","copay_max_scope": null,"copay_max_amount": null,"copay_percentage": "20.0","coinsurance_percentage": null},{"remarks": "Citation: alternative medicine copayment 0% | \n\n Alternative medicine access reimbursment only","visit_type": "Alternative Medicine - Northern Emirates (NE)","copay_amount": 0,"cost_sharing": {"visit_type": "Outpatient","copay_amount": 0,"visit_setting": "Inpatient","copay_currency": "AED","copay_percentage": 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null,"cost_sharing": [],"coverage_status": "Not Covered","service_category_original": null,"service_category_standardized": "Check-up"}],"policy_info": {"waiting_period": {"waiting_period_time": 0,"waiting_period_unit": "Months","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": ["pre-existing conditions waiting period (months) 0 month(s)","chronic condition waiting period (months) 0 month(s)","outpatient plan covered"],"abbreviations_defined": []}},"failure_reason": null,"policy_network": {"is_vip": "Not Mentioned","payer_name": "ORIENT INSURANCE PJSC - INS008","sponsor_id": null,"start_date": "2025-06-02","valid_upto": "2026-06-01","all_networks": [{"network": "Silver Premium","plan_code": "P025-2-DXB","visit_type": "OP (Out Patient)","network_code": null,"network_value": "Silver Premium","raw_plan_string": "INS008 - ORIENT INSURANCE 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"0","should_set_copay": true,"_deductibleLegacy": "0.0","_is_outpatient_fallback": true},"RADIOLOGY": {"copay": "0.0","deductible": "0.0","_copayAmount": "0.0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0.0","_is_outpatient_fallback": true},"CONSULTATION": {"copay": "0.0","deductible": "0.0","_copayAmount": "0.0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0.0","_is_outpatient_fallback": true},"PHYSIOTHERAPY": {"copay": "0.0","deductible": "0.0","_copayAmount": "0.0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0.0","_is_outpatient_fallback": true},"DENTAL CONSULTATION & PROCEDURE": {"copay": "20.0","deductible": "0","_copayAmount": "0","_copayMaxAmount": "0","should_set_copay": true,"_deductibleLegacy": "0","_is_outpatient_fallback": true}},"primary_network": {"network": "Silver Premium","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "Silver Premium","plan_code": "P025-2-DXB","visit_type": "OP (Out Patient)","network_code": null,"network_value": "Silver Premium","raw_plan_string": "INS008 - ORIENT INSURANCE COMPANY - MEDNET - SILVER PREMIUM - DXB","matched_plan_name": null,"network_name_as_in_text": "Silver Premium"}],"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},"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": "Silver Premium","network_status": null,"matched_plan_name": null},"available_networks": [{"network": "Silver Premium","plan_code": "P025-2-DXB","visit_type": "OP (Out Patient)","network_code": null,"network_value": "Silver Premium","raw_plan_string": "INS008 - ORIENT INSURANCE COMPANY - MEDNET - SILVER PREMIUM - DXB","matched_plan_name": null,"network_name_as_in_text": "Silver Premium"}],"has_multiple_networks": false}],"policy_holder_emirates_id": null,"was_identified_by_aggregator": false},"status": "found"},"search_id": "0000-0000-0000-0000","tpa_name": "TPA036","task_id": "00000000-0000-4000-a000-000000000001","user_id": null,"status": "found"}}
For where each field a front desk acts on lives in that body, see eligible response structure.
Not eligible
status: "member_not_found", is_eligible: false. The member exists, but is
not covered: lapsed policy, benefit excluded, or the visit type not on the plan.
The reason is in failure_reason.
{"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: eligibility_result.data_dump.data.failure_reason. Every other key on the response is documented on Results.
The status says member_not_found, and the member was found. Read that again
before you write the branch, because it is the single most expensive thing to
get wrong on this API. In the response above the payer returned a name, a member
id, a DHA member id, two networks, three documents and a policy period running
to the end of the year, and then refused the visit, because maternity cover on
that plan is limited to married female members. None of that reaches you as a
distinct status.
Branch on data.patient_info, not on the status. If it is present, the
payer answered about a member it knows. If it is absent, the payer has nobody
matching that identifier. data_dump differs too: a true miss carries message
and error_type, and this response carries neither.
This is a determination, not an error. Do not retry automatically: the answer reflects the policy as the payer holds it, so an immediate re-check returns the same outcome. Re-check only after the underlying policy is expected to have changed, for example once a renewal has been processed.
Member not found
status: "member_not_found", is_eligible: false, show_data: false, and no
data.patient_info. The portal has no member matching that identifier.
{"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"}}
Same status as the outcome above, and a far thinner body: five keys, none of
them about a person. data_dump here carries message and
error_type: "MemberNotFoundError", which the not-eligible response does not.
The most common causes, in order: the patient is with a different payer; the
Emirates ID is not yet linked at this payer, in which case retry with
CARDNUMBER; the identifier contains a typo.
was_identified_by_aggregator indicates whether an aggregator directed the
check to this payer.
Invalid credentials
status: "invalid_credentials". Your clinic's payer credentials were rejected.
This is a configuration problem, not a determination about the patient.
{"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"}}
Display the credential error to the user and contact Mantys support at kriti@mantys.io or sudhanshu@mantys.io. Do not retry in a loop: repeated failures cause the payer to lock the account, and unlocking it requires manual intervention.
Failed, error, backoff, tpa_not_configured
The remaining values eligibility_result.status can take.
status | Meaning | Retry? |
|---|---|---|
failed | The check ran and did not complete. | Yes, once. |
error | An unexpected error occurred while running the check. | Yes, once. |
backoff | Too many recent credential failures for this payer; the check was not attempted. | No, wait. |
tpa_not_configured | Your clinic has no credentials for this payer. | No. |
{"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"}}
failed, error, backoff and invalid_credentials carry no data block at
all. Read error_type for the class of failure and message for the text to
put in front of a human. Code that reaches straight for
data_dump.data.is_eligible finds nothing on these four, and in most languages
that reads as false: a check that broke then renders as a patient who is not
covered.
is_eligible reads false on a config error, not null
tpa_not_configured never reached the portal, so no determination was made, and the field does
not say so: inside aggregated_results these entries carry data.is_eligible: false, which is
indistinguishable from a real negative. status is the only thing that separates "we never asked"
from "we asked and the answer was no". See eight outcomes.
Cancelled
status on the task is CANCELLED. Someone stopped the check before it
finished. There is no result to read.
Search all
A search-all result has a completely different envelope: no
eligibility_result key anywhere in it, and an aggregated_results array
instead. Everything on this page above this line is about the single-payer
shape and does not apply.
{"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": "MEDNET GLOBAL HEALTHCARE SOLUTIONS L.L.C.","doctorName": "Sample Clinician","extra_args": {"title": "LocationGroup","value": "OUTPATIENT"},"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": "DHPO / Riayati","status": "delegated_to_search_all_pool","data": null,"created_at": "2026-02-24T10:34:21.285000","message": "Identification via DHPO / Riayati failed, triggering pool-based search_all.","screenshot_url": null},{"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 explicitly states NOT ELIGIBLE and Invalid member, overriding any policy start/end dates; therefore the member is not eligible for the claimed benefits.","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": "2026-02-24T10:47:07.951000","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": "Document does not contain any insurance eligibility indicators (no policy number, copays, eligibility status, or transaction/date). Therefore cannot determine eligibility from provided content.","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": "2026-02-24T10:47:34.382000","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": "2026-02-24T10:47:28.393000","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": "member_not_found","data": {"network": null,"payer_id": "TPA008","show_data": false,"payer_name": null,"valid_upto": null,"is_eligible": false,"copay_details": null,"other_details": null,"failure_reason": "Insufficient visible information to confirm eligibility. The page shows a mismatch message and lacks policy details or explicit status indicating Active/Eligible. Therefore, cannot determine eligibility and defaults to not eligible based on absence of valid indicators.","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": "2026-02-24T10:48:31.485000","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": "The document explicitly states that the Member ID/Emirates ID is invalid. No explicit eligibility indicators (active policy, coverage, network, or policy numbers) are present. Therefore, 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": "2026-02-24T10:51:07.037000","message": null,"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": "2026-02-24T10:46:48.746000","message": "TPA 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The placeholder content and invalid credentials suggest this is not a valid eligibility record.","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": "2026-02-24T10:47:23.730000","message": null,"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": "Policy status indicates expiration before the check date and explicitly states 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": [{"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": "2026-02-24T10:47:55.207000","message": null,"screenshot_url": null},{"tpa_name": "INS012","status": "member_not_found","data": {"network": null,"payer_id": "INS012","show_data": false,"payer_name": null,"valid_upto": null,"is_eligible": false,"copay_details": null,"other_details": null,"failure_reason": "The message indicates an invalid health card number and states the patient is ineligible, with no information suggesting active or valid coverage for the current service.","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": "2026-02-24T10:49:22.788000","message": null,"screenshot_url": null}],"total_tpas_checked": 18,"found_results": 2,"created_at": "2026-02-24T10:33:49.196000","updated_at": "2026-02-24T10:47:36.229000"}
Highlighted on every entry of aggregated_results: tpa_name, status, data.is_eligible. The rest of the keys are documented on Results.
Each entry is the same six keys: tpa_name, status, data, created_at,
message and screenshot_url. data is null on every entry that is not a
determination, so partition the list on status before you read anything else.
Search-all response structure is the page for this envelope: the field-by-field card, the two status fields that disagree about whether the sweep is finished, and the partitioning code. The situations it produces in production are on search-all.
Poll status, not search_all_status
The body carries both. search_all_status is recomputed on every read from a rule that needs
seventeen entries to call a sweep complete, so a smaller sweep reports SEARCH_ALL_PROCESSING on
a task that has already finished. See the two
statuses.
Daman multi-card
A Daman member can hold several packages, each on its own network. The check
runs once per card and the result carries card_index and multi_card_total.
The same fields arrive from Nextcare (TPA002), so do not gate on the payer.
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"0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"RADIOLOGY": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"PROCEDURE": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"DIAGNOSTICS": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"DENTAL CONSULTATION & PROCEDURE": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"MEDICINES": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"PHYSIOTHERAPY": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false},"OPTICAL": {"deductible": "0","copay": "0","should_set_copay": true,"_copayAmount": "0","_copayMaxAmount": "0","_is_outpatient_fallback": false}},"available_networks": [{"network_name_as_in_text": "Network Billing Reference: NW2","network": "NW2","network_value": "NW2","visit_type": "Not Specified","matched_plan_name": null,"network_code": null,"raw_plan_string": "DAMAN NETWORK-2-DXB","plan_code": "D003-DXB"}],"has_multiple_networks": false,"primary_network": {"network": "NW2","network_status": null,"matched_plan_name": null}}],"policy_holder_name": "Sample Policy Holder","policy_holder_emirates_id": "784-0000-0000000-0","eligibility_id": "REF-0000000","policy_holder_dob": "1990-01-01","is_eligible": true,"failure_reason": null,"adjusted_tpa_name": "INS026","screenshot_key": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z","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 Card Pdf","id": "member_eligibility_card_pdf","original_filename": "member-eligibility.png"},{"s3_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z","tag": "Schedule of Benefits Pdf","id": "schedule_of_benefits_pdf","original_filename": "member-eligibility.png"},{"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","original_filename": "member-eligibility.png"}],"payer_id": "INS026","warning_messages": [],"was_identified_by_aggregator": false,"card_index": 2,"card_number": "MBR-0000000","package_name": "Gold","card_network": "NW UAE: Royal","multi_card_total": 2}},"search_id": "0000-0000-0000-0000","tpa_name": "INS026","task_id": "00000000-0000-4000-a000-000000000001","user_id": null,"status": "found"}}
Highlighted on eligibility_result.data_dump.data: card_index, multi_card_total, card_number, package_name, card_network, is_eligible. The rest of the keys are documented on Results.
This endpoint returns one card, and which one is not a stable choice: it is
whichever result row came back first, so card_index varies between otherwise
identical checks. There is no array of cards and no way to ask for the others
through this endpoint, so multi_card_total is how you know you are looking at
part of the picture. Show the user how many packages the member holds and which
one is displayed. See Daman multi-card for the whole
case.
all_cards is not on this endpoint
An internal response shape for the same situation carries is_multi_card: true and an all_cards
array. GET /eligibility-result emits neither key. Do not write code that waits for them.
Warnings
data.warning_messages is an array of objects, one per notice raised while
the check ran. Each entry carries message, the text to put in front of a
person, screenshot, a signed link to the portal at that moment which is
usually null, and warning, a boolean that is true on every entry and so
carries no information. Severity is message_type, "warning" or
"information", and it is present on some entries and absent on others in the
same response: when it is missing, treat the entry as a warning.
What lands here is portal-derived and unstructured: claim-form outcomes, a prior
approval request and its id, a doctor or service the portal did not list, and
rules configured for your clinic. Display message as it stands; the wording
changes with the portal, so do not parse it or match on it.
{"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: eligibility_result.data_dump.data.warning_messages. Every other key on the response is documented on Results.
For the shapes that vary and the gatekeeper contradiction, see documents and warnings.
The gatekeeper rule is not in here
policy_network.is_gatekeeper is the only place the response reports whether a GP referral gates
specialist visits, so a client that renders warning_messages and nothing else drops it entirely.
See gatekeeper.
Documents and screenshots
screenshot_key, and the s3_url on every entry in referral_documents, are
signed links with a limited lifetime. This endpoint re-signs them on every read, so a stale
link is always fixable by asking again.
Do not cache the URLs. Cache the result and re-request the links when you need them.