Introducing our redesigned JSON Real-Time Eligibility Check API

We're releasing a redesigned version of our JSON Real-Time Eligibility Check API endpoint: POST https://healthcare.us.stedi.com/2026-06-01/eligibility-check.

The new endpoint's response format makes it easier to parse a patient's benefits.

The legacy JSON Real-Time Eligibility Check API endpoint returns responses in a structure that mirrors the X12 eligibility response. Benefits for different plans and different benefit types are intermixed in a flat benefitsInformation array. The array is "polymorphic": the fields in each entry change depending on the benefit type. The responses also use X12 codes, like C for a deductible or F for limitations, so you map each one to its meaning.

The new endpoint removes the polymorphism. It groups benefits by health plan. In each plan, it breaks the payer's benefit details out into separate typed objects: statuses (for example: ACTIVE_COVERAGE and INACTIVE), coPayment, coInsurance, deductible, and more. It spells values out: ACTIVE_COVERAGE instead of 1, IN_NETWORK instead of Y. Each benefit names the Service Type Code (STC) or procedure code it applies to.

{
  "payerId": "87726",
  "plans": [
    {
      "name": "Gold Plan HMO",
      "benefits": {
        "statuses": [
          {
            "status": "ACTIVE_COVERAGE",
            "coverageLevel": "INDIVIDUAL",
            "network": { "indicator": "IN_AND_OUT_OF_NETWORK" },
            "service": {
              "system": "STC",
              "value": "30",
              "definition": "Health Benefit Plan Coverage"
            }
          }
        ],
        "coPayment": [
          {
            "amount": "15",
            "coverageLevel": "INDIVIDUAL",
            "messages": ["SPECIALIST"],
            "network": { "indicator": "IN_NETWORK" },
            "service": {
              "system": "STC",
              "value": "96",
              "definition": "Professional (Physician)"
            },
            "timePeriod": "VISIT"
          }
        ]
      }
    }
  ],
  ...
}

To run checks with the new endpoint, you only need to provide the same information you use to run eligibility checks today: the payer ID, the provider's name and NPI, the patient's details, and the STC or procedure code you want benefits for.

Watch the 2026 Stedi Keynote announcement:

Test mode support

You can use the new endpoint to run pre-defined mock eligibility checks in test mode with a test API key. Mock eligibility checks are available on all Stedi accounts, including free sandbox accounts.

Existing integrations

We're not deprecating the legacy JSON Real-Time Eligibility Check API endpoint or any other functionality as part of this release.

This release doesn't introduce any breaking changes. Your existing integrations will continue working as they do today.

Availability and pricing

The new endpoint is available on all Stedi accounts.

Mock eligibility checks are free. Production eligibility checks are priced per transaction. For pricing, see our Pricing page.

For more details, see our announcement blog.