Sign in

v1

latestOpenAPI 3.1.0MIT2026-07-22172693.3 KB

Provides real-time access to patient eligibility benefits information, including procedure-specific benefits and optional coordination of benefits (COB) check.

post/api/eligibility/v3

Request body

patientFirstNamestring required

Patient first name

patientLastNamestring required

Patient last name

patientDOBstring required

Patient Date of Birth, formatted as MM-DD-YYYY

patientMemberIdstring required

Member ID of patient's insurance policy

dateOfCoveragestring required

Date to request coverage information. Formatted as MM-DD-YYYY

payerIdstring required

Payer ID. Can be found under the enrollments page in the platform, or the Fetch Enrollments API

providerIdstring required

Provider ID. Can be found by copying the enrollment ID in the enrollments page in the platform, or the Fetch Enrollments API

mockRequestboolean

Optional flag to only return mock data

serviceTypeCodesstring[]

Service type codes to request coverage information for

procedureCodesstring[]

CPT or CDT codes to check coverage for

procedureCodesType'CPT' | 'CDT'

Type of procedure codes being provided. Must be either 'CPT' or 'CDT'

runCobCheckboolean

Whether to run a coordination of benefits check

Response

Eligibility check successful

payerNamestring

Name of the insurance payer

status'Active Coverage' | 'Inactive'

Coverage status

memberIdstring

Member ID of the subscriber

groupNamestring

Group name from the plan

groupNumberstring

Group number from the plan

insuranceTypestring

Type of insurance (e.g. PPO, HMO)

planNamestring

Name of the plan

eligibilityBeginDatestring

Eligibility begin date (YYYY-MM-DD)

responseobject

Map of service type codes to benefit information

messagestring

Overall message about the eligibility check