Get an eligibility check

curl "https://sandbox.myclaimhouse.com/api/v1/eligibility/elg_01JM000000E00800000000000G" \
  -H "Authorization: Bearer $CLAIMHOUSE_KEY"

{
  "id": "elg_01JM000000E00800000000000G",
  "object": "eligibility_check",
  "office_id": "off_01JM000000E008000000000003",
  "patient_id": "pat_01JM000000E00800000000004K",
  "payer": {
    "id": "pyr_01JM000000E008000000000004",
    "payer_id": "00000",
    "name": "Example Dental Plan"
  },
  "state": "completed",
  "outcome": "answered",
  "status": "active",
  "billing": {
    "charged": false,
    "state": "not_billable",
    "reason": "test_mode",
    "label": "Not billed: test mode"
  },
  "cache": {
    "state": "fresh",
    "source_id": null
  },
  "parent_id": null,
  "request_id": "req_01JM000000E008000000000010",
  "idempotency_key": "visit-1042-attempt-1",
  "source": {
    "network": "sandbox",
    "latency_ms": 180,
    "completed_at": "2026-03-10T15:30:00.430000+00:00"
  },
  "tenant_reference": "visit-1042",
  "created_at": "2026-03-10T15:30:00.250000+00:00",
  "request": {
    "subscriber": {
      "first_name": "Alex",
      "last_name": "Example",
      "date_of_birth": "1985-04-12",
      "member_id": "CH-ACTIVE-FULL",
      "group_number": "GRP-100"
    },
    "patient": null,
    "service_date": "2026-03-10",
    "procedure_codes": [
      "D0120",
      "D1110"
    ],
    "detail_level": "standard",
    "office_npi": "1900000000"
  },
  "coverage_effective_date": "2024-01-01",
  "coverage_termination_date": null,
  "plan": {
    "name": "Example Dental Plan PPO",
    "type": "PPO",
    "group_number": "GRP-100",
    "benefit_period": "Calendar year"
  },
  "network_status": "in_network",
  "maximums": [
    {
      "level": "individual",
      "period": "calendar_year",
      "amount": "2000.00",
      "used": "0.00",
      "remaining": "2000.00",
      "applies_to": null
    },
    {
      "level": "individual",
      "period": "lifetime",
      "amount": "3000.00",
      "used": "0.00",
      "remaining": "3000.00",
      "applies_to": "orthodontics"
    }
  ],
  "deductibles": [
    {
      "level": "individual",
      "period": "calendar_year",
      "amount": "50.00",
      "used": "0.00",
      "remaining": "50.00",
      "applies_to": "basic and major services"
    },
    {
      "level": "family",
      "period": "calendar_year",
      "amount": "150.00",
      "used": "0.00",
      "remaining": "150.00",
      "applies_to": "basic and major services"
    }
  ],
  "coverage": [
    {
      "category": "preventive",
      "percent_paid": 100,
      "covered": true,
      "frequency": null,
      "notes": "Exams and cleanings 2 per calendar year; bitewings 1 per year"
    },
    {
      "category": "diagnostic",
      "percent_paid": 100,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "basic",
      "percent_paid": 80,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "endodontics",
      "percent_paid": 80,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "periodontics",
      "percent_paid": 80,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "oral_surgery",
      "percent_paid": 80,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "major",
      "percent_paid": 50,
      "covered": true,
      "frequency": null,
      "notes": "Every 5 years; paid on seat date"
    },
    {
      "category": "prosthodontics",
      "percent_paid": 50,
      "covered": true,
      "frequency": null,
      "notes": null
    },
    {
      "category": "implants",
      "percent_paid": 0,
      "covered": false,
      "frequency": null,
      "notes": null
    },
    {
      "category": "orthodontics",
      "percent_paid": 50,
      "covered": true,
      "frequency": null,
      "notes": "To age 26; $3,000 lifetime maximum"
    }
  ],
  "procedures": [
    {
      "code": "D0120",
      "description": "Periodic oral exam",
      "percent_paid": 100,
      "covered": true,
      "frequency": {
        "count": 2,
        "period": "calendar_year",
        "scope": null
      },
      "max_age": null,
      "last_service_date": "2025-09-10",
      "next_eligible_date": null,
      "status": "covered_now",
      "note": null
    },
    {
      "code": "D1110",
      "description": "Adult cleaning",
      "percent_paid": 100,
      "covered": true,
      "frequency": {
        "count": 2,
        "period": "calendar_year",
        "scope": null
      },
      "max_age": null,
      "last_service_date": "2025-09-10",
      "next_eligible_date": null,
      "status": "covered_now",
      "note": "Shares 4 visits a year with D4910"
    }
  ],
  "plan_rules": {
    "missing_tooth_clause": "No",
    "waiting_period": "None",
    "pre_authorization": "Suggested over $300",
    "coordination_of_benefits": "Standard, birthday rule",
    "major_services_paid_on": "seat_date"
  },
  "payer_notes": [
    "Posterior composites are paid as amalgam on molars.",
    "Porcelain is downgraded on molars, not on bicuspids.",
    "Multi-visit procedures are paid on the seat date.",
    "D1110 and D4910 share 4 visits per calendar year.",
    "D0210 and D0330 share one limit every 60 months."
  ],
  "not_returned": [],
  "rejection": null
}