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The Eligibility API uses the standard X12 EDI 270 eligibility transaction, and formats it in JSON for an HTTP request. It makes this popular EDI transaction set more accessible to developers and to users’ applications. We manage the X12 standards behind the scenes and give you efficient access to medical subscriber or dependent plan membership, copays, coinsurances, deductibles, and more in an easy-to-use, human-readable format.

We also support a dedicated X12-formatted Eligibility API to send your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 270 transaction set.

Our Eligibility API solution provides complete patient profile and benefits information, to support health care delivery and more-efficient and accurate reimbursement. Providers get better front-end information to improve claiming processes and reimbursement rates. For payers, it means claims spend less time in pending status, and also means fewer rejected and reworked claims.

Release Notes


View our Change Log/Release Notes for information about the history of our programmatic updates for the Eligibility API.

Check out our FAQ for help with specific questions about this API!