cURL

curl --request POST \
  --url https://api.clarionhealth.com/v1/eligibility \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "patient": {
    "first_name": "John",
    "last_name": "Doe",
    "date_of_birth": "1990-01-01",
    "member_id": "X12345678",
    "customer_patient_id": "1234567890"
  },
  "insurance": {
    "payer_id": "87726"
  },
  "provider": {
    "organization_name": "Acme Medical Center",
    "npi": "1234567890"
  },
  "webhook_url": "https://your-domain.com/webhooks-url",
  "webhook_secret": "your_webhook_secret_here"
}
'

import requests

url = "https://api.clarionhealth.com/v1/eligibility"

payload = {
    "patient": {
        "first_name": "John",
        "last_name": "Doe",
        "date_of_birth": "1990-01-01",
        "member_id": "X12345678",
        "customer_patient_id": "1234567890"
    },
    "insurance": { "payer_id": "87726" },
    "provider": {
        "organization_name": "Acme Medical Center",
        "npi": "1234567890"
    },
    "webhook_url": "https://your-domain.com/webhooks-url",
    "webhook_secret": "your_webhook_secret_here"
}
headers = {
    "Authorization": "Bearer <token>",
    "Content-Type": "application/json"
}

response = requests.post(url, json=payload, headers=headers)

print(response.text)

const options = {
  method: 'POST',
  headers: {Authorization: 'Bearer <token>', 'Content-Type': 'application/json'},
  body: JSON.stringify({
    patient: {
      first_name: 'John',
      last_name: 'Doe',
      date_of_birth: '1990-01-01',
      member_id: 'X12345678',
      customer_patient_id: '1234567890'
    },
    insurance: {payer_id: '87726'},
    provider: {organization_name: 'Acme Medical Center', npi: '1234567890'},
    webhook_url: 'https://your-domain.com/webhooks-url',
    webhook_secret: 'your_webhook_secret_here'
  })
};

fetch('https://api.clarionhealth.com/v1/eligibility', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://api.clarionhealth.com/v1/eligibility",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "POST",
  CURLOPT_POSTFIELDS => json_encode([
    'patient' => [
        'first_name' => 'John',
        'last_name' => 'Doe',
        'date_of_birth' => '1990-01-01',
        'member_id' => 'X12345678',
        'customer_patient_id' => '1234567890'
    ],
    'insurance' => [
        'payer_id' => '87726'
    ],
    'provider' => [
        'organization_name' => 'Acme Medical Center',
        'npi' => '1234567890'
    ],
    'webhook_url' => 'https://your-domain.com/webhooks-url',
    'webhook_secret' => 'your_webhook_secret_here'
  ]),
  CURLOPT_HTTPHEADER => [
    "Authorization: Bearer <token>",
    "Content-Type: application/json"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"strings"
	"net/http"
	"io"
)

func main() {

	url := "https://api.clarionhealth.com/v1/eligibility"

	payload := strings.NewReader("{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}")

	req, _ := http.NewRequest("POST", url, payload)

	req.Header.Add("Authorization", "Bearer <token>")
	req.Header.Add("Content-Type", "application/json")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

HttpResponse<String> response = Unirest.post("https://api.clarionhealth.com/v1/eligibility")
  .header("Authorization", "Bearer <token>")
  .header("Content-Type", "application/json")
  .body("{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}")
  .asString();

require 'uri'
require 'net/http'

url = URI("https://api.clarionhealth.com/v1/eligibility")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Post.new(url)
request["Authorization"] = 'Bearer <token>'
request["Content-Type"] = 'application/json'
request.body = "{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}"

response = http.request(request)
puts response.read_body

{
  "id": 123,
  "status": "in-progress",
  "created_at": "2023-11-07T05:31:56Z",
  "customer_patient_id": "1234567890"
}

{
  "error": "Bad Request",
  "message": "Bad Request",
  "statusCode": 400
}

Verification of Benefits

Submit Eligibility Check

Submit a new eligibility check. This endpoint processes requests asynchronously.

How it works:

Submit your request with patient, insurance, and provider information
You’ll receive a numeric ID and “in-progress” status immediately
We’ll process the check asynchronously

Accepted Payers: We currently support eligibility checks for the following major payers and their subsidiaries:

United Healthcare Group
Aetna
Cigna
Oscar Health
Oxford
Humana
Medica
Kaiser

For payers not listed above, the API will return a 400 error status with a list of currently supported payers.

POST

eligibility

cURL

curl --request POST \
  --url https://api.clarionhealth.com/v1/eligibility \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "patient": {
    "first_name": "John",
    "last_name": "Doe",
    "date_of_birth": "1990-01-01",
    "member_id": "X12345678",
    "customer_patient_id": "1234567890"
  },
  "insurance": {
    "payer_id": "87726"
  },
  "provider": {
    "organization_name": "Acme Medical Center",
    "npi": "1234567890"
  },
  "webhook_url": "https://your-domain.com/webhooks-url",
  "webhook_secret": "your_webhook_secret_here"
}
'

import requests

url = "https://api.clarionhealth.com/v1/eligibility"

payload = {
    "patient": {
        "first_name": "John",
        "last_name": "Doe",
        "date_of_birth": "1990-01-01",
        "member_id": "X12345678",
        "customer_patient_id": "1234567890"
    },
    "insurance": { "payer_id": "87726" },
    "provider": {
        "organization_name": "Acme Medical Center",
        "npi": "1234567890"
    },
    "webhook_url": "https://your-domain.com/webhooks-url",
    "webhook_secret": "your_webhook_secret_here"
}
headers = {
    "Authorization": "Bearer <token>",
    "Content-Type": "application/json"
}

response = requests.post(url, json=payload, headers=headers)

print(response.text)

const options = {
  method: 'POST',
  headers: {Authorization: 'Bearer <token>', 'Content-Type': 'application/json'},
  body: JSON.stringify({
    patient: {
      first_name: 'John',
      last_name: 'Doe',
      date_of_birth: '1990-01-01',
      member_id: 'X12345678',
      customer_patient_id: '1234567890'
    },
    insurance: {payer_id: '87726'},
    provider: {organization_name: 'Acme Medical Center', npi: '1234567890'},
    webhook_url: 'https://your-domain.com/webhooks-url',
    webhook_secret: 'your_webhook_secret_here'
  })
};

fetch('https://api.clarionhealth.com/v1/eligibility', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://api.clarionhealth.com/v1/eligibility",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "POST",
  CURLOPT_POSTFIELDS => json_encode([
    'patient' => [
        'first_name' => 'John',
        'last_name' => 'Doe',
        'date_of_birth' => '1990-01-01',
        'member_id' => 'X12345678',
        'customer_patient_id' => '1234567890'
    ],
    'insurance' => [
        'payer_id' => '87726'
    ],
    'provider' => [
        'organization_name' => 'Acme Medical Center',
        'npi' => '1234567890'
    ],
    'webhook_url' => 'https://your-domain.com/webhooks-url',
    'webhook_secret' => 'your_webhook_secret_here'
  ]),
  CURLOPT_HTTPHEADER => [
    "Authorization: Bearer <token>",
    "Content-Type: application/json"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"strings"
	"net/http"
	"io"
)

func main() {

	url := "https://api.clarionhealth.com/v1/eligibility"

	payload := strings.NewReader("{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}")

	req, _ := http.NewRequest("POST", url, payload)

	req.Header.Add("Authorization", "Bearer <token>")
	req.Header.Add("Content-Type", "application/json")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

HttpResponse<String> response = Unirest.post("https://api.clarionhealth.com/v1/eligibility")
  .header("Authorization", "Bearer <token>")
  .header("Content-Type", "application/json")
  .body("{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}")
  .asString();

require 'uri'
require 'net/http'

url = URI("https://api.clarionhealth.com/v1/eligibility")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Post.new(url)
request["Authorization"] = 'Bearer <token>'
request["Content-Type"] = 'application/json'
request.body = "{\n  \"patient\": {\n    \"first_name\": \"John\",\n    \"last_name\": \"Doe\",\n    \"date_of_birth\": \"1990-01-01\",\n    \"member_id\": \"X12345678\",\n    \"customer_patient_id\": \"1234567890\"\n  },\n  \"insurance\": {\n    \"payer_id\": \"87726\"\n  },\n  \"provider\": {\n    \"organization_name\": \"Acme Medical Center\",\n    \"npi\": \"1234567890\"\n  },\n  \"webhook_url\": \"https://your-domain.com/webhooks-url\",\n  \"webhook_secret\": \"your_webhook_secret_here\"\n}"

response = http.request(request)
puts response.read_body

{
  "id": 123,
  "status": "in-progress",
  "created_at": "2023-11-07T05:31:56Z",
  "customer_patient_id": "1234567890"
}

{
  "error": "Bad Request",
  "message": "Bad Request",
  "statusCode": 400
}

Authorizations

Authorization

string

header

required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Body

application/json

patient

object

required

Show child attributes

insurance

object

required

Show child attributes

provider

object

required

Show child attributes

webhook_url

string<uri>

Optional webhook URL where eligibility check results will be sent. If provided, you'll receive a POST request with the eligibility check data when the check completes.

Example:

"https://your-domain.com/webhooks-url"

webhook_secret

string

Optional secret token for webhook authentication. If provided, webhook payloads will be sent with an 'Authorization: Bearer {secret}' header. Do not include the 'Bearer' prefix when providing the secret.

Example:

"your_webhook_secret_here"

Response

Eligibility check submitted successfully. The check is being processed asynchronously. You will receive a webhook notification when the check completes. You can also poll the GET endpoint to check status.

integer

required

Unique identifier for this eligibility check request

status

enum<string>

required

Current status of the eligibility check

Available options:

in-progress

created_at

string<date-time>

Timestamp when the request was created

customer_patient_id

string | null

The customer-provided patient identifier, if provided will be returned in every other response for this eligibility check.

Example:

"1234567890"

Quickstart

Health

Assistants

Calls

Sequences

Sequence Definitions

Phone Numbers

Webhooks

Verification of Benefits

Submit Eligibility Check

Authorizations

Body

Response