API

Soft Eligibility

The soft eligibility check is done by creating a Provider Eligibility resource.

1

Payer List

The patient must be able to select their insurance provider. Use the Payer Search API for the Patient’s discovery of Payers.

2

Patient Input

Using the list of States, have the Patient input the location they’ll be in for the visit and their payer. Only the state is required, not a full address.

3

Provider Eligibility

Use the Create Provider Eligibility API to resolve policy and Provider eligibility.

  • Only the state is required within the location.
  • If the date of service is unknown, use today’s date.
4

Evaluation

Inspect the status field of the Provider Eligibility. If INELIGIBLE, the state/payer combination is not available.

If ELIGIBLE, inspect the providers array. If this is empty, the payer is contracted in that state but there are no Providers available.

Allow the patient to move through, only if there are available Providers.