stagfe2/sample.json

{
    "created_at": "2022-01-18T12:51:22Z",
    "eligible_id": "3GSG50JUTCF43",
    "known_issues": [],
    "date_of_death": null,
    "last_name": "SHAH",
    "first_name": "RASIKLAL",
    "middle_name": "R",
    "member_id": "3U26R07JQ63",
    "group_id": null,
    "group_name": null,
    "dob": "1931-10-14",
    "gender": "M",
    "address": {
        "street_line_1": "8572 263RD ST",
        "street_line_2": null,
        "city": "FLORAL PARK",
        "state": "NY",
        "zip": "110011138"
    },
    "payer_name": "CMS",
    "payer_id": "00431",
    "plan_number": "",
    "eligibilty_dates": {
        "start": "2022-01-18",
        "end": null
    },
    "eligibility_dates": {
        "start": "2022-01-18",
        "end": null
    },
    "inactivity_dates": {
        "start": null,
        "end": null
    },
    "plan_types": {
        "MA": "Medicare Part A (Hospital)",
        "MB": "Medicare Part B (Professional Services)",
        "MC": "Medicare Part C (Advantage)",
        "MD": "Medicare Part D (Prescription drugs)",
        "PR": "Primary insurance (Medicare Secondary, This Insurance is Primary)"
    },
    "plan_details": {
        "MA": {
            "active": true,
            "start_date": "2004-07-01",
            "end_date": null,
            "deductible": 0.0,
            "deductible_remaining": null,
            "insurance_type": "QM",
            "insurance_type_label": "Qualified Medicare Beneficiary",
            "coinsurance_percent": null,
            "copayment": null,
            "info_valid_until": "2022-12-31",
            "info_valid_till": "2022-12-31",
            "comments": [
                "0-Beneficiary insured due to age OASI"
            ]
        },
        "MB": {
            "active": true,
            "start_date": "1996-10-01",
            "end_date": null,
            "deductible": 0.0,
            "deductible_remaining": null,
            "insurance_type": "QM",
            "insurance_type_label": "Qualified Medicare Beneficiary",
            "coinsurance_percent": 0,
            "copayment": null,
            "info_valid_until": "2022-12-31",
            "info_valid_till": "2022-12-31",
            "comments": [
                "0-Beneficiary insured due to age OASI"
            ]
        },
        "MC": {
            "active": false,
            "payer_name": null,
            "insurance_type": null,
            "insurance_type_label": null,
            "mco_bill_option_code": null,
            "mco_bill_option_label": null,
            "locked": null,
            "policy_number": null,
            "effective_date": null,
            "termination_date": null,
            "contacts": null,
            "address": {
                "street_line_1": null,
                "street_line_2": null,
                "city": null,
                "state": null,
                "zip": null
            },
            "comments": []
        },
        "MD": {
            "active": true,
            "payer_name": "CIGNA HEALTH AND LIFE INSURANCE COMPANY",
            "policy_number": "S5617",
            "effective_date": "2016-01-01",
            "termination_date": null,
            "contacts": [
                {
                    "contact_type": "telephone",
                    "contact_value": "8002226700"
                },
                {
                    "contact_type": "url",
                    "contact_value": "www.cignamedicare.com"
                }
            ],
            "address": {
                "street_line_1": "900 Cottage Grove Rd",
                "street_line_2": "B4SRS",
                "city": "Hartford",
                "state": "CT",
                "zip": "06152"
            },
            "comments": []
        },
        "PR": []
    },
    "requested_service_types": [
        {
            "type": "30",
            "type_label": "Health Benefit Plan Coverage",
            "plan_type": "MA",
            "active": true,
            "start_date": "2004-07-01",
            "end_date": null,
            "deductible": 0.0,
            "deductible_remaining": null,
            "insurance_type": "QM",
            "insurance_type_label": "Qualified Medicare Beneficiary",
            "coinsurance_percent": null,
            "copayment": null,
            "info_valid_until": "2022-12-31",
            "info_valid_till": "2022-12-31"
        },
        {
            "type": "30",
            "type_label": "Health Benefit Plan Coverage",
            "plan_type": "MB",
            "active": true,
            "start_date": "1996-10-01",
            "end_date": null,
            "deductible": 0.0,
            "deductible_remaining": null,
            "insurance_type": "QM",
            "insurance_type_label": "Qualified Medicare Beneficiary",
            "coinsurance_percent": 0,
            "copayment": null,
            "info_valid_until": "2022-12-31",
            "info_valid_till": "2022-12-31"
        }
    ],
    "requested_procedure_codes": [],
    "history": {
        "plan_details": {
            "MA": [],
            "MB": [],
            "MC": [],
            "MD": [],
            "PR": []
        },
        "requested_service_types": []
    }
}