Eligibility

What is it?

You can verify a patient’s coverage in real-time and access a wealth of other detailed information, such as copay and coinsurance details across different services, to allow for a more granular understanding of a member's insurance coverage.

Why is it useful?

Verifying a member's insurance coverage and benefits is a critical step in helping a member get care. The process of checking a patient’s insurance is often quite arduous, requiring photocopying a patient’s insurance card and calling the insurance carrier directly to verify benefits. H1 Health Eligibility Check makes this process a breeze.

How does it work?

1. You submit a request through the /eligibility endpoint with relevant parameters (patient name, patient DOB, member ID, and insurance carrier)
2. H1 makes a request to the payer for information on that patient's insurance coverage.
3. H1 returns coverage summary in a standard JSON format including plan information, progress on deductible and out-of-pocket, specialist copay, and coinsurance.

FAQs

• How can I check whether H1's Eligibility endpoint supports a specific carrier?
  -> You can use the insurance_partners endpoint to check available carriers. If you don't see the carrier you're looking for, please reach out to us at [email protected]!