Common search scenarios

Every other payer takes some variation of OUTPATIENT and INPATIENT. Daman takes a service taxonomy instead: consultation reasons, ultrasound trimesters, dental fee models, and two flows that are not visits at all (VALIDITY_CHECK and BABY_FLOW). Nothing is validated at create time, so OUTPATIENT is accepted here and then fails at the portal. Pick the value from the Daman row of the TPA matrix.

{
  "tpa_name": "TPA023",
  "id_type": "EMIRATESID",
  "id_value": "784-0000-0000000-0",
  "visit_type": "CONSULTATION_ELECTIVE"
}

Daman calls it DENTAL_SERVICES, and Daman Thiqa splits that again into a capitation programme and two fee-for-service tiers, so the value decides which dental scheme the portal is asked about. MedNet is the other payer that splits it, there by setting: DENTAL is the outpatient one and INPATIENT_DENTAL the inpatient. Read the value off the payer matrix rather than mapping your own "dental" to one value everywhere.

{
  "tpa_name": "TPA023",
  "id_type": "EMIRATESID",
  "id_value": "784-0000-0000000-0",
  "visit_type": "DENTAL_SERVICES_ROUTINE_FFS"
}

Both payers ask whether the maternity treatment is inpatient, and nothing makes you answer. Omitting maternity_treatment is not an error: the portal answers as though you had said no, and you get outpatient maternity cover back without being told.

{
  "tpa_name": "TPA004",
  "id_type": "EMIRATESID",
  "id_value": "784-0000-0000000-0",
  "visit_type": "MATERNITY",
  "extra_args": {
    "maternity_treatment": true,
    "is_member_present_at_the_facility": true
  }
}

AXA is the payer that makes the general rule about visit_type false. Its scraper never reads the field: the dental flow is switched on by extra_args.use_dental, compared against the literal string "YES", and it needs a card or DHA member ID because the dental search is not on the Emirates ID form. visit_type is left as DENTAL here because it costs nothing and keeps your own records honest.

{
  "tpa_name": "INS010",
  "id_type": "CARDNUMBER",
  "id_value": "MBR-0000000",
  "visit_type": "DENTAL",
  "extra_args": {
    "use_dental": "YES"
  }
}

CONSULTATION_REFERRAL is the one Daman visit type that carries a referring clinician, and referring_physician is where the licence goes: it becomes referralClinicianLicense on the eligibility payload. On any other Daman visit type the key is read and dropped, so pairing the two is the whole rule.

{
  "tpa_name": "INS026",
  "id_type": "EMIRATESID",
  "id_value": "784-0000-0000000-0",
  "visit_type": "CONSULTATION_REFERRAL",
  "extra_args": {
    "referring_physician": "DHA-P-0000000"
  }
}

Daman has no MATERNITY value. An antenatal scan goes in as the trimester it falls in, which your system knows from the gestational age and the appointment type does not; a delivery goes in as INPATIENT; a newborn not yet on the policy goes through BABY_FLOW. MATERNITY here is accepted at create time and fails at the portal, and maternity_treatment is a NAS and Neuron question that Daman never reads.

{
  "tpa_name": "INS026",
  "id_type": "EMIRATESID",
  "id_value": "784-0000-0000000-0",
  "visit_type": "ULTRASOUND_SECOND_TRIMESTER"
}