Eligibility Hub API

For software that connects directly, Eligibility Hub offers a documented REST API with an OpenAPI specification and a developer guide. It covers eligibility checks, medical and dental claims, predeterminations, authorization and appeal records, an acknowledgment and remittance event feed, and onboarding status. Each practice gets its own keys, with separate test and live modes.

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At a glance

Availability: Launching after setupLaunches for a practice after its setup steps. Live mode starts only after agreements are signed and the practice approves production.
Part of the cycle: Connect: api for your own software
What it costs: Included in the full service at 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included.
Your practice: Build and test your software against test mode

Who does what

Eligibility Hub does

Provide the OpenAPI specification and developer guide
Issue each practice its own keys, with separate test and live modes
Keep test mode isolated: it never sends real patient data to the clearinghouse

Your practice does

Build and test your software against test mode
Approve production before live mode is switched on

What the API covers

Capabilities

Eligibility checks
Medical and dental claims
Predeterminations
Authorization and appeal records
Acknowledgment and remittance event feed
Onboarding status

Limits worth knowing

Only built capabilities are documented. Planned ones are not described as available.
Keys belong to one practice. No practice can read another practice's data.

Questions

Is there an API specification?

Yes. The API is documented with an OpenAPI specification and a developer guide.

Can we test without real patient data?

Yes. Each practice gets separate test and live modes, and test mode never sends real patient data to the clearinghouse.

When can we use live mode?

After the agreements are signed and your practice approves production. Live mode is switched on per practice.

Do we need the API to use Eligibility Hub?

No. Practices connect through the API or through the admin software we build for them.

Review the scope before you begin

The full service is 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included. See pricing for how the fee is calculated.