---
title: "Request ClearCoverage Eligibility"
method: POST
path: "/ClearCoverage"
tags: ["clearCoverage"]
---

# Request ClearCoverage Eligibility

`POST /ClearCoverage`

Submit an enhanced eligibility and benefits verification request via Vyne ClearCoverage. Returns enriched, standardized, and normalized data relevant for dental use cases with deep benefit insights across supported payers.

## Request body

- ClearCoverageRequest
  - `payer` object, required
    - `id` string, required — ClearCoverage payer ID (see supported carriers list)
  - `provider` object, required
    - `npi` string, required — Provider's National Provider Identifier (10 digits)
    - `tax_id` string, required — Provider's Tax Identification Number (9 digits)
  - `subscriber` object, required
    - `first_name` string, required
    - `last_name` string, required
    - `member_id` string, required
    - `dob` string, required — MM/DD/YYYY format
    - `group_number` string, required
  - `dependent` object — Optional dependent information
    - `first_name` string
    - `last_name` string
    - `member_id` string
    - `dob` string
    - `group_number` string
  - `version` 'v1' | 'v2', required — API version. Use "v2" for the current version. Version "v1" is deprecated and returns a legacy response format.
  - `location_id` string — Optional location identifier

## Response `200`

Enhanced eligibility verification results with detailed benefit data

- ClearCoverageResponse — ClearCoverage response wrapped in a WunderGraph data envelope. The actual data is under data.clearcoverage_post_enhanced_eligibility.
  - `data` object
    - `clearcoverage_post_enhanced_eligibility` object — Enhanced eligibility data with standardized benefit breakdowns. Contains benefits (with network tiers), coverages (13 categories with subcategories), rules (policy flags), limitation, service_history, and fees sections. Response size varies significantly by payer (10KB-550KB).
      - `benefits` object[] — Benefit entries with 0-3 network tiers (IN_NETWORK, OUT_OF_NETWORK, plus PPO/PREMIER for Delta Dental).
      - `coverages` object — 13 fixed coverage categories (diagnostic, preventive, basic_restorative, major_restorative, endodontics, periodontics, oral_surgery, prosthodontics, orthodontics, implants, adjunctive, TMJ, misc), each containing variable subcategories with coinsurance and limitations.
      - `rules` object — Policy-level flags including missing_tooth clause, seat/prep date rules, waiting periods, and COB (coordination of benefits) information.
      - `deductible` object — Individual and family deductible amounts by network tier.
      - `maximums` object — Annual and lifetime maximum amounts by network tier.
      - `plan` object — Plan identification and effective dates.
      - `subscriber` object
      - `payer` object
      - `provider` object

## Other responses

- `400` — Bad request - invalid payer ID, missing required fields, or upstream payer error
- `401` — Authentication required - invalid or missing API key
- `402` — Payment required - no active subscription or payment method
- `403` — Forbidden - API key is disabled
- `429` — Rate limit exceeded

---

[API](https://skmtc.net/api-dental/apis/api-dental-sdk.md) · [All operations](https://skmtc.net/api-dental/apis/api-dental-sdk/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/api-dental/api-dental-sdk/versions/d7d63efc6c52/schema)