Skip to main content

​
Eligibility Requests

Eligibility Requests (FHIR 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.

​
Check Benefits

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' },
  ],
});

​
Pre-Authorization Check

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' },
  ],
});

​
Discovery Request

const { data: discovery } = await clinik.eligibilityRequests.create({
  status: 'active',
  purpose: ['discovery'],
  patientId: 'pt_abc123',
  insurerId: 'org_ins_bluecross',
});

​
Search Eligibility Requests

// 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 Codes

PurposeDescription
auth-requirementsCheck authorization requirements
benefitsCheck benefit coverage
discoveryDiscover available coverage
validationValidate coverage is active