Eligibility checks API for healthcare - Stedi

Real-time eligibility checks

Use Stedi's APIs to verify patient benefits in seconds

Active Coverage

Jane S Doe

Complete Care Management

Services

Deductibles

Limitations

Responsive support

Our support team has an average response time of less than 10 minutes during business hours.

Estimate patient responsibility

Create cost estimates for patient care, including co-pays and co-insurance.

Eliminate manual tasks

Replace web scraping and phone-call based workflows with a simple to use API that covers thousands of payers.

Manage coverage questions

Get accurate, up-to-date benefits data with APIs for COB, MBI Lookup, and Insurance Discovery.

Real-time and batch APIs

Run eligibility checks in real time or as asynchronous batches using Stedi's JSON-native APIs. We also support CAQH CORE SOAP and X12.

See the docs

eligibilityCheck.js
fetch("https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission", {
  method: "POST",
  body: JSON.stringify({
    "controlNumber": "123456789",
    "encounter": {
      "serviceTypeCodes": [\
        "MH"\
      ]
    },
    "externalPatientId": "UAA111222333",
    "provider": {
      "npi": "1999999984",
      "organizationName": "ACME Health Services"
    },
    "subscriber": {
      "dateOfBirth": "19000101",
      "firstName": "Jane",
      "lastName": "Doe",
      "memberId": "123456789"
    },
    "tradingPartnerServiceId": "AHS"
  })
});

Stedi Agent

Use AI-powered automation to recover failed eligibility checks.

Stedi MCP server

Run real-time eligibility checks and search payers with your AI agents.

mcp.json
{
  "mcpServers": {
    "stedi-healthcare": {
      "type": "http",
      "url": "https://mcp.us.stedi.com/2025-07-11/mcp",
      "headers": {
        "Authorization": "YOUR_STEDI_API_KEY"
      }
    }
  }
}

“I’m really impressed with Stedi’s eligibility checks. The data comes back consistently and accurately. It's by far the best eligibility product I've come across.”
— Eliana Berger CEO at Joyful Health

How it works

Integrate with a modern, developer-friendly API

Submit

Route

Deliver

Submit a JSON request

Submit a JSON request to Stedi’s Eligibility Check API with provider and patient details. Submit batch checks using the API or CSV.

checkEligibility.js
fetch(
  "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3",
  {
    controlNumber: "123456789",
    tradingPartnerServiceId: "CIGNA",
    provider: { organizationName: "Doctors LLC", npi: "7921017274" },
    subscriber: {
      firstName: "John",
      lastName: "Doe",
      dateOfBirth: "19870521",
      memberId: "0000000000",
    },
    encounter: {
      dateOfService: "20240322",
      serviceTypeCodes: ["30"],
    },
  }
).then((response) => response.json());

Broad, reliable connectivity

Connect to thousands of payers with automatic failover

Our growing set of payers is covered by redundant connections. Stedi dynamically routes traffic to the most reliable connection, eliminating single points of failure.

Browse our network

"We used Stedi to automate our eligibility workflow. What used to take 13 people two days now takes 15 minutes."
— Tad Molden Principal at Cube Therapy Billing

Manual eligibility checks and PDFs

Know what’s covered

Use the Stedi portal to run eligibility checks and review benefits. Download eligibility check PDFs using the Stedi portal or API.

Start processing eligibility checks today

Start free with a sandbox account. Upgrade to production when you're ready. There are no monthly minimums or setup fees. You only pay for the transactions you use.

See our pricing.

Book a demo

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