We’ve encountered an issue where a patient is returned as Eligible via the API, but when checking the same patient in the CHG portal, he is marked as Not Eligible. This discrepancy is causing confusion and impacting our workflow.
To assist with your investigation, we’ve attached the API response.
Could you please help us understand:
- Why there is a mismatch between the API and the portal?
- How did this behavior occur?
- What steps can we take to avoid this in the future?
Thanks
{
"links": {
"self": {
"href": https://api.availity.com/v1/coverages/-196431546163067490
}
},
"id": "-196431546163067490",
"customerId": "2272729",
"controlNumber": "75675051833",
"status": "Complete",
"statusCode": "4",
"createdDate": "2025-04-22T01:26:00.000+0000",
"updatedDate": "2025-04-22T01:26:00.000+0000",
"expirationDate": "2025-04-23T01:26:00.000+0000",
"asOfDate": "2025-04-21T04:00:00.000+0000",
"requestedServiceType": [
{
"code": "30",
"value": "Health Benefit Plan Coverage"
}
],
"subscriber": {
"firstName": "xxxxx",
"lastName": "xxxxx",
"memberId": "xxxx",
"birthDate": "xxx"
},
"patient": {
"firstName": "xxxx",
"lastName": "xxxx",
"subscriberRelationship": "Self",
"subscriberRelationshipCode": "18",
"birthDate": "xxxx"
},
"payer": {
"name": "COMMUNITY HEALTH GROUP",
"payerId": "95376",
"responseName": "COMMUNITY HEALTH GROUP",
"responsePayerId": "101299",
"thirdPartyAdministrator": false
},
"requestingProvider": {
"lastName": "AVAILITY",
"npi": "xxxx"
},
"plans": [
{
"status": "Active Coverage",
"statusCode": "1",
"eligibilityStartDate": "2016-08-01T04:00:00.000+0000",
"eligibilityEndDate": "2078-12-31T05:00:00.000+0000"
}
],
"hasHRAInformation": false
}