Eligibility Requests
Eligibility Requests (FHIRCoverageEligibilityRequest) are used to check whether a patient’s insurance covers specific services. ClinikAPI simplifies the most common fields — for advanced scenarios, use the FHIR passthrough.
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Check insurance eligibility and benefits for patients.
CoverageEligibilityRequest) are used to check whether a patient’s insurance covers specific services. ClinikAPI simplifies the most common fields — for advanced scenarios, use the FHIR passthrough.
const { data: request } = await clinik.eligibilityRequests.create({
status: 'active',
purpose: ['benefits'],
patientId: 'pt_abc123',
insurerId: 'org_ins_bluecross',
providerId: 'Practitioner/prac_dr456',
servicedDate: '2024-06-15',
insurance: [
{ focal: true, coverageId: 'cov_primary789' },
],
});
const { data: preAuth } = await clinik.eligibilityRequests.create({
status: 'active',
purpose: ['auth-requirements'],
patientId: 'pt_abc123',
insurerId: 'org_ins_bluecross',
providerId: 'Practitioner/prac_surgeon456',
servicedPeriod: {
start: '2024-07-01',
end: '2024-07-01',
},
insurance: [
{ focal: true, coverageId: 'cov_primary789' },
],
item: [
{ category: 'surgical', productOrService: '27447' },
],
});
const { data: discovery } = await clinik.eligibilityRequests.create({
status: 'active',
purpose: ['discovery'],
patientId: 'pt_abc123',
insurerId: 'org_ins_bluecross',
});
// All requests for a patient
const { data } = await clinik.eligibilityRequests.search({
patientId: 'pt_abc123',
});
// Filter by date range
const { data: recent } = await clinik.eligibilityRequests.search({
patientId: 'pt_abc123',
dateFrom: '2024-01-01',
dateTo: '2024-06-30',
});
| Purpose | Description |
|---|---|
auth-requirements | Check authorization requirements |
benefits | Check benefit coverage |
discovery | Discover available coverage |
validation | Validate coverage is active |