Mantys Eligibility APIVisit types by payer
The visit_type values v4 accepts for each payer code.
v4 checks visit_type against this table before it starts a check. A value not in the row for
your tpa_name is 400 UNSUPPORTED_VISIT_TYPE.
tpa_name | Accepted visit_type |
|---|---|
TPA026, TPA037, INS010, INS015, INS017 | Only the empty string "" |
TPA001, TPA004 | OUTPATIENT, INPATIENT, DENTAL, OPTICAL, MATERNITY, PSYCHIATRY, WELLNESS. DAYCASE is not accepted. |
TPA002 | INPATIENT, OUTPATIENT, DENTAL, LIFE, OPTICAL, TRAVEL_INSURANCE, CHRONIC_OUT, EMERGENCY, MATERNITY |
TPA003 | OUTPATIENT, INPATIENT, MATERNITY, DENTAL, OPTICAL, PSYCHIATRY |
TPA008, TPA010 | OUTPATIENT, INPATIENT |
TPA036 | OUTPATIENT, INPATIENT, and each of these after OUTPATIENT_ or INPATIENT_: ALTERNATIVE_TREATMENT, DENTAL, MATERNITY, OPTICAL, PREVENTATIVE_WELLNESS, PSYCHIATRY, STANDARD (for example OUTPATIENT_DENTAL) |
INS012 | OUTPATIENT, EMERGENCY, INPATIENT, INPATIENT_EMERGENCY, DAYCASE, DAYCASE_EMERGENCY |
INS038 | OUTPATIENT, INPATIENT, DAYCASE |
INS026, D004, INS078 | OUTPATIENT, INPATIENT, CONSULTATION, FREE_FOLLOWUP, DIAGNOSTIC, PHYSIOTHERAPY, DENTAL_SERVICES, PHARMACY, HOMECARE, REHABILITATION, DAYCARE, ULTRASOUND, TELEHEALTH, PCSP, OTHER_OP, CONSULTATION_ELECTIVE, CONSULTATION_EMERGENCY, CONSULTATION_ONCOLOGY, CONSULTATION_REFERRAL, CONSULTATION_SCREENING, CONSULTATION_VACCINATION, ULTRASOUND_FIRST_TRIMESTER, ULTRASOUND_SECOND_TRIMESTER, ULTRASOUND_THIRD_TRIMESTER |
TPA023 | Everything in the INS026 row, plus DENTAL_SERVICES_CAPITATION_PROGRAM, DENTAL_SERVICES_ROUTINE_FFS, DENTAL_SERVICES_ADVANCED_FFS, PCSP_COMPREHENSIVE_MAJOR_18_39, PCSP_COMPREHENSIVE_MAJOR_40_64, PCSP_COMPREHENSIVE_MAJOR_65_75, PCSP_COMPREHENSIVE_MINOR_VISION_40_75, PCSP_ORAL_HEALTH_18_75, PCSP_COLON_CANCER_40_75, PCSP_CERVICAL_CANCER_25_29, PCSP_CERVICAL_CANCER_30_65, PCSP_LUNG_CANCER_55_75, PCSP_MAMMOGRAPHY, PCSP_FIT, PCSP_AAA, PCSP_DEXA, PCSP_HEARING_DEMENTIA_50_64, PCSP_HEARING_DEMENTIA_65_75, PCSP_BREAST_CANCER_20_34, PCSP_BREAST_CANCER_GAIL_35_39, PCSP_REPRODUCTIVE_FEMALE_20_35, PCSP_REPRODUCTIVE_MALE_20_35 |
BOTH, DHPO, RIYATI | OUTPATIENT, INPATIENT, DAYCASE, MATERNITY, DENTAL, OPTICAL, PSYCHIATRY, WELLNESS, LIFE, TRAVEL_INSURANCE, CHRONIC_OUT, EMERGENCY |
| Any other code | Not checked by v4. Send the value the payer expects; see Visit types. |
An empty visit_type sent to a payer that needs a value is UNSUPPORTED_VISIT_TYPE ("an empty
visit_type is not accepted"), not MISSING_REQUIRED_FIELD.
Some accounts send encounter details instead of a visit type, and Mantys works the visit type out
from extra_args.admit_type, medical_service and encounter_type. Mantys tells you if your
account is one of them. On those accounts only, visit_type may be left out on
POST /v4/eligibility-checks, the table above does not apply to it, and encounter fields that name
no known value are 400 VISIT_TYPE_UNDERIVABLE, with one details[] entry per field
(field: extra_args.admit_type, ...). Every other account must send visit_type.