Create / Update Member Eligibility

This endpoint creates an eligible member record under a plan. If a match is found (via External Id) the record attributes are upserted, otherwise a new eligible patient record is created.

NOTE

Replace <base_url> from the examples below with one of the following:

Environment	Base URL
Production	https://api.cirrusmd.com
Sandbox	https://api-sandbox.cirrusmd.com

---

Request URL

POST <base_url>/v2/plans/:plan_id/eligibility

Request Body

Parameter	Type	Description	Notes
dob	ISO8601	Patient Date of Birth
effective_date	ISO8601	Access Active Since
email	String	Patient Email Address	MUST BE UNIQUE IF PROVIDED (optional) 1
expiry_date	ISO8601	Access Expires On
external_id	String	Global Identifier	MUST BE UNIQUE
first_name	String	Patient First Name
gender	String	Patient Sex (Biological)	Must be one of: (male female other unknown)
invite_immediately	boolean	Invite Member Immediately	(optional) See details 2
last_name	String	Patient Last Name
member_id	String	Patient Member/Program Id	MUST BE UNIQUE
middle_name	String	Patient Middle Name	(optional)
phone	String	Patient Phone (10 digits)	(optional)
zipcode	String	Patient Zipcode
city	String	Patient City	(optional)
county	String	Patient County	(optional)
medical_eligibility	String	TRUE or FALSE	(optional)
medical_enrollment	String	TRUE or FALSE	(optional)
medical_plan_description	String	Patient medical plan description	(optional)
payor_name	String	Patient Payor Name	(optional) e.g. BCBS
payor_plan_name	String	Patient Payor Plan Name	(optional) e.g. BCBS PPO Gold
relationship_code	String	Relationship code with respect to subscriber	(optional) e.g. Spouse
relationship_code_hipaa	String	HIPAA Relationship code with respect to subscriber	(optional) e.g. 01
state	String	Patient State	(optional)
subscriber_relationship	String	Primary or Dependent relationship to subscriber	(optional) e.g. Primary or Dependent

Example Request

curl -X POST "<base_url>/v2/plans/7/eligibility"
  -H "Authorization: Bearer <token>" \
  -H "Content-Type: application/json" \
  -H "Accept: application/json" \
  -d '{"external_id": "AB 123356", "first_name": "James", "last_name": "Jones", "email": "james@jones.com",
  "gender": "male", "dob": "1977-01-11T00:00:00Z", "member_id": "ABC1234", "zipcode": "80205", "effective_date": "2012-12-12",
  "expiry_date": "2030-12-12", "metadata": { "preferred_hospital": "St Almonds"} }'

Example Response

{
  "id": 2,
  "external_id": "AB 123356",
  "dob": "1977-01-11",
  "first_name": "James",
  "gender": "male",
  "last_name": "Jones",
  "member_id": "fdsa",
  "zipcode": "80205",
  "metadata": {
    "preferred_hospital": "St Almonds"
  }
}

Notes

1 Email Deliverability

Including patient emails is optional, however if a valid email address is included for a new patient, invitation deliverability rules should be configured via your Account Manager. When enabled, email invitations are delivered in batch, and rate limited on an hourly basis.

2 Invite Immediately

invite_immediately is an optional data element that indicates if an invitation email should be sent to the new member immediately after their record is added via the API. If the parameter is not provided, an invitation is not sent immediately.

Invitations are ONLY sent if:

• inviteimmediately is explicitly set to **_true**
• a valid email is provided
• the eligibility request is for a new patient

Please note When using invite_immediately, Email Deliverability configurations are IGNORED