MediRec Eligibility API

Verify Insurance Eligibility in Real Time

Stop losing revenue to eligibility errors. MediRec's Eligibility API gives your practice instant access to patient coverage details — copays, deductibles, network status and more — before every single visit.

Eligibility Response Active
Patient
Sarah Johnson   DOB 1985-03-14
Payer
BlueCross BlueShield   In-Network ✓
Deductible
$1,500 / $500 met
Copay (Office)
$30
Coinsurance
20%
Out-of-Pocket Max
$4,000
transaction_id: "270-1b3e2f"
response_time: "312ms"
standard: "ANSI X12 271"
Real-time 270/271 transactions
🏥 Multi-payer network coverage
🔒 HIPAA compliant by design
🔗 REST API — EHR-ready integration
Everything you need to verify coverage right
From basic active/inactive checks to granular benefit details — get the full picture before the patient walks in the door.

Real-time Verification

Submit a 270 request and receive a 271 response in milliseconds. No batch delays, no waiting — instant answers at the point of scheduling.

📋

Complete Benefit Details

Retrieve copays, deductibles, coinsurance, out-of-pocket maximums, and benefit limits by service category — structured and easy to parse.

🔄

Auto Pre-Visit Checks

Trigger eligibility checks automatically 24–48 hours before scheduled appointments. Catch coverage issues before they reach the front desk.

🏷️

Network Status

Instantly know if a provider is in-network or out-of-network for each specific plan. Avoid surprise billing and help patients make informed decisions.

🛡️

Denial Prevention

Identify missing authorizations, expired coverage, and ineligible services before you submit a claim. Reduce denials at the source, not after the fact.

📂

Audit-Ready History

Every verification is logged with timestamp, provider, location, and user. Maintain complete compliance records and resolve disputes with confidence.

Three steps from request to insight
A simple REST API call is all it takes. No complex EDI setup required on your end.
1

Send the request

POST patient demographics and payer info to our API endpoint. We handle the ANSI X12 270 transaction formatting and EDI routing automatically.

2

We query the payer

Our infrastructure connects directly to the payer in real time via the Stedi EDI network, retrieving live eligibility data from the source of truth.

3

Get structured results

Receive a clean JSON response with all coverage details — benefits, deductibles, network status — ready to display or store in your EHR workflow.

Stop leaving revenue on the table
Eligibility errors are one of the top causes of claim denials. Fixing them upstream — before the visit — protects your revenue cycle and your patients' experience.

Fewer surprise denials

Know exactly what's covered before service delivery. Stop finding out about benefit limits after you've already submitted the claim.

Less staff time on hold

Eliminate manual phone calls to insurance companies. Your front desk staff can focus on patients instead of navigating payer IVR systems.

Faster patient collections

Inform patients of their exact cost responsibility at check-in. Reduce accounts receivable days and increase point-of-service collections.

Built for EHR workflows

Designed to embed natively into MediRec — trigger eligibility checks from scheduling, patient registration, or clinical workflows without leaving the EHR.

60+
hours/week saved on manual eligibility calls per practice
35%
average reduction in eligibility-related claim denials
$15
potential savings per transaction vs. manual verification
<1s
average response time for real-time eligibility queries

Ready to integrate eligibility into MediRec?

Explore the full API reference and start verifying patient coverage today.