API Integration Guide for Eligibility Services Specification

Our JSON Eligibility API processes requests in JSON format, simplifying access to EDI transaction sets for developers and user applications. We handle X12 standards in the background, providing efficient access to medical subscriber or dependent plan details, including copays, coinsurances, deductibles, and more, in a clear, human-readable format.

Our Eligibility API offers comprehensive patient profiles and benefits information to enhance healthcare delivery and streamline reimbursements. For providers, it improves front-end data, supporting smoother claims processes and higher reimbursement rates.

Available Endpoints

Service	Endpoint	HTTP Method	Description
JSON Response	https://api.eligifai.com/VerifyEligbility	POST	Generates a detailed, parsed EDI 271 JSON response for eligibility, making it easy for developers to understand and embed. All loops and segments are fully parsed.
Iframe Embedded Response	https://api.eligifai.com/html	POST	Generates iFrame embedded response allowing developers to embed iframe in their code and get started quickly with White-labeling.

AUTHENTICATION

Our eligibility API is fully secure and compliant with HIPAA (Health Insurance Portability and Accountability Act) standards. Before making a request to the eligibility API, each client application must obtain a client ID and client secret. These credentials will be provided by our team.

JSON Response

This POST call will return the Eligibility Status & response id for a requested provider. The Eligibility endpoint is designed to facilitate easy access to Eligibility Information in just one step with easy Json file format.

Client posts the request to eligibility services at the Provided URL.

REQUEST

Key	Value
URL	https://api.eligifai.com/VerifyEligbility
Method	Post
Client-API-Id	Client-API-Id
Client-Secret	Client-secret (encrypted private key)
Content-Type	Application/JSON

REQUEST BODY

Property Name	Data Type	Usage	Description
payerCode	String	Required	Eligifai Provider Payer ID
npi	String	Required	10-digit provider/organization valid NPI
providerLastname	String	Required	Provider Last Name
providerFirstname	String	Optional	Provider First Name (Not required if reference Lab Or Organization NPI)
memberID	String	Required	Patient payer member id
patientFirstName	String	Required	Patient Last Name
patientLastName	String	Required	Patient First Name
patientdateofbirth	Date	Required	Patient Date of Birth with format (mm/dd/yyyy)
dos	Date	Required	Patient Date of Birth with format (mm/dd/yyyy)
servicecode	String	Optional	Service type code

EXAMPLE REQUEST

Sample JSON

--request POST https://eligibilityapiv2.eligifai.com/api/External/CheckEligibility

--header 'Client-API-Id: {{client-api-id}}' \

--header 'Client-Secret: {{client-secret}}' \

--header 'Content-Type: application/json' \

--data-raw ' {

" patientFirstName": "dave",

" patientLastName": "Elfard",

" patientdateofbirth": "01/01/1980",

"dos": "11/12/2021",

"memberID": "PolicyNumber",

"payerCode": "87726",

"providerLastname": "Wyoming care",

"providerFirstname": null,

"npi": "1234567890",

" servicecode":"30"

Iframe Embedded Response

This POST call will return the detailed and wrapped Iframe embedded response which can be incorporated to any webpage. By embedding the iFrame directly into an application, developers can present eligibility details in a formatted, user-friendly interface. This feature reduces development time and ensures a consistent look and feel across different platforms.