{ "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" }, "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": "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": "2026-04-06T11:50:31.391000", "message": "TPA `TPA032` is not configured for the practice.", "screenshot_url": null }, { "tpa_name": "TPA001", "status": "member_not_found", "data": { "payer_id": "TPA001", "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": "2026-04-06T11:51:17.110000", "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": "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": "2026-04-06T11:50:11.718000", "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": "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 provided page content shows a Member Eligibility portal header but contains no actual insurance details (no copay info, policy number, eligibility status, or active/valid indicators). Without explicit eligibility indicators, we cannot confirm coverage for the patient in Sample Facility (Sharjah, UAE). Therefore, not eligible based on missing 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": [], "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": "2026-04-06T11:51:18.417000", "message": null, "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": "2026-04-06T11:50:12.392000", "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": "2026-04-06T09:27:44.335000", "message": "Identification via DHPO / Riayati failed, triggering pool-based search_all.", "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": "2026-04-06T11:51:14.189000", "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": "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": "2026-04-06T11:50:29.375000", "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": "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": "2026-04-06T11:50:33.341000", "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": "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 Emirates ID, indicating the member 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": [ { "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": "2026-04-06T11:50:41.900000", "message": null, "screenshot_url": null }, { "tpa_name": "INS012", "status": "failed", "data": null, "created_at": "2026-04-06T11:58:32.434000", "message": "Oman portal has not responded with the eligibility status after 500 seconds", "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": "2026-04-06T11:50:34.665000", "message": "TPA `TPA037` is not configured for the practice.", "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": "2026-04-06T11:50:46.932000", "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": "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": "Explicitly mentioned as not covered in the input.", "visit_type": "Maternity", "copay_amount": null, "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 ", "visit_type": "Dental", "copay_amount": null, "cost_sharing": { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 30.0, "applicable_location": "UAE", "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": "30.0", "coinsurance_percentage": null }, { "remarks": "Explicitly mentioned as not covered in the input.", "visit_type": "Optical", "copay_amount": null, "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: Op - Ded : Pc: 20% Max. Aed 30 | \n\n General deductible applied to outpatient services.", "visit_type": "Consultation", "copay_amount": null, "cost_sharing": { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": "per visit", "copay_maximum_amount": 30.0, "coinsurance_percentage": null }, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_max_scope": "per visit", "copay_max_amount": 30.0, "copay_percentage": "20.0", "coinsurance_percentage": null }, { "remarks": "Citation: Op : 20% On All Services Including Medicine | \n\n ", "visit_type": "Pharmacy", "copay_amount": null, "cost_sharing": { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": null, "copay_maximum_amount": null, "coinsurance_percentage": null }, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_max_scope": null, "copay_max_amount": null, "copay_percentage": "20.0", "coinsurance_percentage": null }, { "remarks": "Citation: Op : 20% On All Services Including Medicine | \n\n ", "visit_type": "Outpatient Services", "copay_amount": null, "cost_sharing": { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": null, "copay_maximum_amount": null, "coinsurance_percentage": null }, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_max_scope": null, "copay_max_amount": null, "copay_percentage": "20.0", "coinsurance_percentage": null } ], "waiting_period": "Not Specified", "special_remarks": [], "new_version_of_copay_analysis": { "benefits": [ { "limits": null, "remarks": "Explicitly mentioned as not covered in the input.", "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": "Outpatient", "copay_currency": "AED", "copay_percentage": 30.0, "applicable_location": "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": "Explicitly mentioned as not covered in the input.", "conditions": null, "cost_sharing": [], "coverage_status": "Not Covered", "service_category_original": null, "service_category_standardized": "Optical" }, { "limits": null, "remarks": "General deductible applied to outpatient services.", "conditions": null, "cost_sharing": [ { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": "per visit", "copay_maximum_amount": 30.0, "coinsurance_percentage": null } ], "coverage_status": "Covered", "service_category_original": "Op - Ded : Pc: 20% Max. Aed 30", "service_category_standardized": "Consultation" }, { "limits": null, "remarks": null, "conditions": null, "cost_sharing": [ { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": null, "copay_maximum_amount": null, "coinsurance_percentage": null } ], "coverage_status": "Covered", "service_category_original": "Op : 20% On All Services Including Medicine", "service_category_standardized": "Pharmacy" }, { "limits": null, "remarks": null, "conditions": null, "cost_sharing": [ { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": null, "copay_maximum_amount": null, "coinsurance_percentage": null } ], "coverage_status": "Covered", "service_category_original": "Op : 20% On All Services Including Medicine", "service_category_standardized": "Outpatient Services" }, { "limits": null, "remarks": null, "conditions": null, "cost_sharing": [ { "visit_type": "Outpatient", "copay_amount": null, "visit_setting": "Outpatient", "copay_currency": "AED", "copay_percentage": 20.0, "applicable_location": "UAE", "copay_maximum_scope": null, "copay_maximum_amount": null, "coinsurance_percentage": null } ], "coverage_status": "Covered", "service_category_original": "Ip : 20% At Al Zahra Hosp.-Shj (Azhs) & Zulekha Hosps.", "service_category_standardized": "Inpatient" } ], "policy_info": { "waiting_period": "Not Specified", "policy_period_end": null, "policy_jurisdiction": "Not Specified", "policy_period_start": null, "beneficiary_start_date": null }, "general_remarks": null, "abbreviations_defined": null } }, "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": [ { "network": "LIMITED", "plan_code": "L003", "visit_type": "IP (In Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "OP (Out Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "Not Specified", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Covered Networks : 1.Limited Incl. NMC Royal Hosp.-Shj (ex.AZHS)" } ], "package_name": null, "is_gatekeeper": "Not Mentioned", "waiting_period": null, "policy_authority": "MOH", "policy_plan_name": "E", "work_site_covered": "Could not determine", "policy_holder_name": "Sample Policy Holder", "payer_name_as_in_text": null, "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": { "LAB": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_maxDeductible": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "MEDICINES": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "PROCEDURE": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "RADIOLOGY": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "DIAGNOSTICS": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "CONSULTATION": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "30.0", "should_set_copay": true, "_deductibleLegacy": "30.0" }, "PHYSIOTHERAPY": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "DENTAL CONSULTATION & PROCEDURE": { "copay": "30.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" } }, "primary_network": { "network": "LIMITED", "network_status": null, "matched_plan_name": null }, "available_networks": [ { "network": "LIMITED", "plan_code": "L003", "visit_type": "IP (In Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "OP (Out Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "Not Specified", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Covered Networks : 1.Limited Incl. NMC Royal Hosp.-Shj (ex.AZHS)" } ], "has_multiple_networks": true }, { "name": "Maternity", "values_to_fill": { "LAB": { "copay": "0", "deductible": "0", "_copayAmount": "0", "_maxDeductible": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "MEDICINES": { "copay": "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, "_deductibleLegacy": "0" }, "RADIOLOGY": { "copay": "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, "_deductibleLegacy": "0" }, "CONSULTATION": { "copay": "0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "PHYSIOTHERAPY": { "copay": "0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0" }, "DENTAL CONSULTATION & PROCEDURE": { "copay": "0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true } }, "primary_network": { "network": "LIMITED", "network_status": null, "matched_plan_name": null }, "available_networks": [ { "network": "LIMITED", "plan_code": "L003", "visit_type": "IP (In Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "OP (Out Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "Not Specified", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Covered Networks : 1.Limited Incl. NMC Royal Hosp.-Shj (ex.AZHS)" } ], "has_multiple_networks": true }, { "name": "Specialization", "values_to_fill": { "LAB": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_maxDeductible": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "MEDICINES": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "PROCEDURE": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "RADIOLOGY": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "DIAGNOSTICS": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "CONSULTATION": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "30.0", "should_set_copay": true, "_deductibleLegacy": "30.0", "_is_outpatient_fallback": true }, "PHYSIOTHERAPY": { "copay": "20.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true }, "DENTAL CONSULTATION & PROCEDURE": { "copay": "30.0", "deductible": "0", "_copayAmount": "0", "_copayMaxAmount": "0", "should_set_copay": true, "_deductibleLegacy": "0", "_is_outpatient_fallback": true } }, "primary_network": { "network": "LIMITED", "network_status": null, "matched_plan_name": null }, "available_networks": [ { "network": "LIMITED", "plan_code": "L003", "visit_type": "IP (In Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "OP (Out Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "Not Specified", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Covered Networks : 1.Limited Incl. NMC Royal Hosp.-Shj (ex.AZHS)" } ], "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": "LIMITED", "network_status": null, "matched_plan_name": null }, "available_networks": [ { "network": "LIMITED", "plan_code": "L003", "visit_type": "IP (In Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "OP (Out Patient)", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Network (NW): IP & OP : Limited Incl. NMC" }, { "network": "LIMITED", "plan_code": "L003", "visit_type": "Not Specified", "network_code": null, "network_value": "LIMITED", "raw_plan_string": "LIMITED NETWORK - SHJ", "matched_plan_name": null, "network_name_as_in_text": "Covered Networks : 1.Limited Incl. NMC Royal Hosp.-Shj (ex.AZHS)" } ], "has_multiple_networks": true } ], "policy_holder_emirates_id": "784-0000-0000000-0", "was_identified_by_aggregator": false }, "created_at": "2026-04-06T11:51:01.039000", "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": "2026-04-06T11:51:20.808000", "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": "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": "2026-04-06T11:51:29.852000", "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": "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": "No visible policy details or eligibility indicators are present. The document contains an explicit 'Given Member ID/Emirates ID is invalid' message and lacks any validation indicators (policy ID, network, eligibility status). Therefore, eligibility cannot be established and is treated as not eligible based on the invalid ID instruction.", "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": "2026-04-06T11:52:20.288000", "message": null, "screenshot_url": null }, { "tpa_name": "TPA008", "status": "invalid_credentials", "data": null, "created_at": "2026-04-06T11:52:24.118000", "message": "Invalid Credentials for TPA `Inayah`. Username used: `REDACTED`. Please ask your team admin to update the credentials.", "screenshot_url": "https://storage.example.com/eligibility/00000000-0000-4000-a000-000000000001/document.png?sig=PLACEHOLDER&se=2026-01-01T00%3A00%3A00Z" } ], "total_tpas_checked": 18, "found_results": 1, "created_at": "2026-04-06T09:22:16.177000", "updated_at": "2026-04-06T12:09:36.567000" }