Real-time eligibility checks

Use Stedi’s APIs to verify patient benefits in seconds.

Benefits of Stedi eligibility checks

Responsive support

Our support team has an average response time of less than 10 minutes during business hours.

Estimate patient responsibility

Create cost estimates for patient care, including co-pays and co-insurance.

Eliminate manual tasks

Replace web scraping and phone-call based workflows with a simple to use API that covers thousands of payers.

Manage coverage questions

Get accurate, up-to-date benefits data with APIs for COB, MBI Lookup, and Insurance Discovery.

Real-time and
batch APIs

Run eligibility checks in real time or as asynchronous batches using Stedi’s JSON-native APIs. We also support CAQH CORE SOAP and X12.

See the docs

eligibilityCheck.js

fetch(
  "https://healthcare.us.stedi.com/2026-06-01/eligibility-check",
  {
    method: "POST",
    body: JSON.stringify({
      payerId: "87726",
      provider: {
        name: { organization: "Doctors LLC" },
        npi: "1999999984",
      },
      subscriber: {
        name: { person: { firstName: "John", lastName: "Doe" } },
        dateOfBirth: "1970-01-01",
        memberId: "UHC202649",
      },
      encounter: {
        services: [{ system: "STC", value: "30" }],
      },
    }),
  }
).then((response) => response.json())

Agentic Discovery

Use the Stedi Agent to recover failed eligibility checks and find missing coverage in one automated workflow.

Learn more

Stedi MCP server

Run real-time eligibility checks and search payers with your AI agents.

mcp.json

{
  "mcpServers": {
    "stedi-healthcare": {
      "type": "http",
      "url": "https://mcp.us.stedi.com/2025-07-11/mcp",
      "headers": {
        "Authorization": "YOUR_STEDI_API_KEY"
      }
    }
  }
}
Joyful Health
“I’m really impressed with Stedi’s eligibility checks. The data comes back consistently and accurately. It’s by far the best eligibility product I’ve come across.”
– Eliana Berger
CEO at Joyful Health

How it works

Integrate with a modern, developer-friendly API

1. Submit a JSON request

Submit a JSON request to Stedi’s Eligibility Check API with provider and patient details. Submit batch checks using the API or CSV.

eligibilityCheck.js

fetch(
  "https://healthcare.us.stedi.com/2026-06-01/eligibility-check",
  {
    method: "POST",
    body: JSON.stringify({
      payerId: "87726",
      provider: {
        name: { organization: "Doctors LLC" },
        npi: "1999999984",
      },
      subscriber: {
        name: { person: { firstName: "John", lastName: "Doe" } },
        dateOfBirth: "1970-01-01",
        memberId: "UHC202649",
      },
      encounter: {
        services: [{ system: "STC", value: "30" }],
      },
    }),
  }
).then((response) => response.json())

2. Stedi routes the request

Stedi routes the request to the payer through the most reliable connection automatically.

eligibilityCheck.js

fetch(
  "https://healthcare.us.stedi.com/2026-06-01/eligibility-check",
  {
    method: "POST",
    body: JSON.stringify({
      payerId: "87726",
      provider: {
        name: { organization: "Doctors LLC" },
        npi: "1999999984",
      },
      subscriber: {
        name: { person: { firstName: "John", lastName: "Doe" } },
        dateOfBirth: "1970-01-01",
        memberId: "UHC202649",
      },
      encounter: {
        services: [{ system: "STC", value: "30" }],
      },
    }),
  }
).then((response) => response.json())

3. Stedi delivers the response

Stedi returns the payer’s response as JSON, with benefits grouped by plan and type.

benefitResponse.json

{
  "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",
            "network": { "indicator": "IN_NETWORK" },
            "service": {
              "system": "STC",
              "value": "96",
              "definition": "Professional (Physician)"
            },
            "timePeriod": "VISIT"
          }
        ]
      }
    }
  ]
}

Broad, reliable connectivity

Connect to thousands of payers with automatic failover

Our growing set of payers is covered by redundant connections. Stedi dynamically routes traffic to the most reliable connection, eliminating single points of failure.

Browse our network
Cube Therapy Billing
“We used Stedi to automate our eligibility workflow. What used to take 13 people two days now takes 15 minutes.”
– Tad Molden
Principal at Cube Therapy Billing

Manual eligibility checks and PDFs

Know what’s covered

Use the Stedi portal to run eligibility checks and review benefits. Download eligibility check PDFs using the Stedi portal or API.

Stedi portal eligibility check
Eligibility check PDF

Start processing eligibility checks today

Start free with a sandbox account. Upgrade to production when you’re ready. There are no monthly minimums or setup fees. You only pay for the transactions you use.
See our pricing.

Book a demoSign up free