Coverage eligibility
Coverage eligibility is the pre-check a hospital desk runs before committing a patient to a cashless pathway.
APIs
| Call | Called by | Method and path | What it does |
|---|---|---|---|
| Provider: check coverage eligibility | Provider | POST /v1/coverageeligibility/check | Provider asks the payer, via NHCX, whether a beneficiary's policy is in force, what it covers and which documents a preauth will need. |
| Payer: send the coverage eligibility response | Payer | POST /v1/coverageeligibility/on_check | Payer returns the CoverageEligibilityResponse (policy in force, benefits, auth requirements) or an error to the provider through NHCX. |
Callbacks you host
The exchange posts these to the endpoint_url you registered. Answer each with HTTP 202 first.
| Path | Hosted by |
|---|---|
/v1/coverageeligibility/check | The payer |
/v1/coverageeligibility/on_check | The provider |
Base URLs
| Environment | Base URL |
|---|---|
| Sandbox, NHCX exchange. | https://apisbx.abdm.gov.in/hcx |
| Production. | https://apisprod.nha.gov.in/hcx |
Guides that use these calls
The whole specification, with a request you can send from the page, is the Coverage eligibility API reference.