Insurance Verification API
Add real-time eligibility to your app, portal, or CRM. Send a member and payer, receive a verified VOB with coverage status, plan, and accumulators in seconds, then route next steps in your workflow. Admissions and billing get clean data without leaving your system.
Used by providers who track census, admit after hours, and need clean handoffs across locations.
Clean endpoints, clear results
Create an OAuth client and authenticate to get a bearer token. Call the eligibility endpoint with patient and insurance details. Receive a structured response with coverage, payer and plan, reference number, and time verified. Register a callback URL to receive results as they complete. No screen scraping. No manual re-entry. See the full endpoint reference in our developer documentation.
Advantages of Using an Insurance Verification API
Faster decisions in your product
Run eligibility in your app and show active or inactive coverage the moment a record is created. Admissions and care teams move forward with confidence while interest is high.
Seamless integration across payers
Use one connection to access a broad payer footprint and present consistent results in your UI. Keep intake and billing in a single workflow with clear, reliable fields.
Fewer errors and cleaner data
Eliminate copy and paste between systems. Send member and payer details once and receive a structured response with plan, status, and key amounts that reduce rework and denials.
Higher productivity for teams
Automate when verifications run and who gets notified. Route results to admissions and billing so follow ups happen quickly and staff time goes to decisions, not portals.
“Before the API, eligibility lived in one system and our workflow lived in another, and people were the bridge. Now verification happens inside the tools our team already uses. Nothing gets re-typed, nothing falls through, and admissions moves at the speed of the phone call instead of the speed of a portal.”
— Geoff Spillias, Treatment Center Founder/CEO200
Verifications a month run through our integration now, and nobody on my team touches a portal for any of them.
Keep momentum for developers and ops
Your product already runs the day. The VerifyTX API drops eligibility into that flow with clear objects, stable IDs, and helpful errors. Register a callback URL on your OAuth client to receive results as they complete. Schedule batch runs for census checks, and mirror tags like active patients so teams see the same status everywhere.
Simple integration
Add eligibility to your product with a clear request and response flow. Your app sends member and payer details and receives a structured result your teams can use right away.
Results you can act on
See coverage status, payer and plan, key accumulators, a reference number, and the time verified. Show the right details in your UI so intake and billing move forward confidently.
Each eligibility check returns a VOB (Verification of Benefits) object with coverage, payer, and plan detail, the same object your developers will see throughout the endpoint reference.
Alerts that keep teams in sync
Deliver results into your workflow and notify the right people. Highlight when something changes since the last check so follow ups happen without delay.
Security and compliance
HIPAA aligned controls with encryption, role based access, and full audit logging. Keep PHI protected while giving teams the visibility they need.
Every request runs over HTTPS with structured JSON responses and clear error codes, including a documented 401 Unauthorized response for missing or invalid tokens.
Frequently Asked Questions
Why should we use the VerifyTX Insurance Verification API?
One connection brings real-time eligibility into your product so teams can qualify during the first touch. Each check returns a structured VOB with the essentials admissions and billing act on: coverage status, plan, network, and key accumulators. And when you need more than eligibility, facility lookup and claim status run on the same API and the same auth.
How broad is your payer footprint?
We cover over 1,800 payers across Medicare, Medicaid, and commercial plans. Coverage varies by region and product. We share an up to date payer list during onboarding.
We already have our own payer codes. How do we map to yours?
We provide a current payer directory and help you align codes during setup. As payer networks change, we help you keep mapping current so requests stay accurate.
What parts of VerifyTX are available through the API?
Real-time eligibility verification is the flagship: each check returns a structured VOB with coverage status, payer and plan details, and key amounts, plus a reference number and time verified. You can trigger batch runs and receive notifications when results are ready. The same connection also supports in-network facility lookup and claim status; see the VerifyTX Platform API for the full surface.
How are results delivered to our app?
Your product requests a verification and receives a structured response you can display in your UI. Register a callback URL on your OAuth client and results post to it as they complete, so the right people act quickly.
Do developers get a sandbox?
Yes. You get mock data to build and test against, so you can develop without touching production or needing a separate environment.
How do we get started?
Request access. We set up your account, share documentation, and walk your team through the build and test plan.
Is the API secure and HIPAA aligned?
Yes. Data is encrypted in transit and at rest, access is permissioned, and all activity is logged for audit. Every request runs over HTTPS with structured JSON responses and clear error codes, including a documented 401 Unauthorized for auth issues.
Is eligibility the only thing the API does?
No. Eligibility is the flagship endpoint, but the same connection covers in-network facility lookup and real-time claim status, each returning its own structured object. See the VerifyTX Platform API for the full surface.
Bring eligibility into your product
Join 30,000+ users using VerifyTX to power real time verification in their apps and CRMs