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Overview

Eligibility.dev is a real-time insurance eligibility API for healthcare software builders. Send a patient and payer, get back coverage status, deductible, copay, and more in a single HTTP call.

How it works

Your backend calls POST /api/eligibility/check with an insurance member ID, payer name, and patient demographics. Eligibility.dev routes the request to the appropriate clearinghouse, normalizes the response, and returns a structured benefitSummary in under a second.

Every call is logged to your workspace so you can review outcomes, debug failures, and track usage — all from the console.

Key concepts

Workspace
Your account container. API keys, clinics, logs, and billing all live inside a workspace. One workspace typically maps to one business or integration.
Clinic (client)
Each clinic or facility you serve is a client record in your workspace. Every eligibility check is scoped to a clinic via the X-Client-Id header — this lets you track usage per facility and configure provider NPI per clinic.
Payer
An insurance company in our catalog (e.g. "Aetna", "Cigna", "UnitedHealthcare"). You pass the payer name as a string — we fuzzy-match it against the catalog and route to the correct clearinghouse trading partner.
API key
A workspace-scoped secret passed in the Authorization: Bearer header. One key authenticates all clinics in your workspace.

Next steps

  1. 1Create your workspace and claim your $25 in free trial credits.
  2. 2Add a clinic and note its Client ID UUID.
  3. 3Get your API key from the Account page.
  4. 4Make your first check using the mock endpoint (no credits consumed).