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Works with your hospital's EHR

Eligibility and claim status, built into your hospital's EHR.

Payerkart plugs into your hospital's existing EHR through one API, backed by real clearinghouse connectivity. Staff verify coverage and track claims without leaving the screen they already work in — no separate payer logins, no re-typing patient details, and one integration that works across every payer.

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→ Works with your hospital's EHR
→ One schema, every payer
→ Live with a real practice today
+ Sample Community Hospital EHR
powered by Payerkart
Today's check-in queue eligibility checked automatically
08:00 Gonzalez, Maria Aetna verified
08:30 Carter, James UnitedHealthcare needs review
09:00 Patel, Aisha Cigna ID invalid
10:00 Nguyen, Linda Medicare Part B scheduled
Maria Gonzalez · Aetna active
Copay
$25.00
Deductible left
$1,100
Checked
<1 sec

Illustrative screen, sample data.

15 min → <1 sec per eligibility check, in live use at a Payerkart practice
Designed for real-time eligibility Purpose-built for payer workflows One schema across payers
The workflow

Two payer workflows. One API.

From checking coverage to tracking a claim to its final status, behind a single consistent schema — so switching payers never means switching integrations.

01 POST /v1/eligibility

Verify eligibility

Get active coverage, plan type, and cost-share details with one call — returned right inside the EHR screen your staff already use, with no separate lookup.

02 GET /v1/claims/:id

Track claim status

Poll or subscribe to status changes — submitted, in adjudication, paid, denied — with reason codes translated into plain language, not raw payer codes.

What you get back

Not just a pass/fail — the fields your front desk and billing team actually need.

An eligibility check returns the coverage details staff would otherwise look up and re-type by hand. A claim status check returns where the claim stands and, on a rejection, the specific reason — not a raw payer code someone has to go look up.

Coverage status
Active / inactive, as of the check
Plan & cost-share
Plan type, copay, deductible
Network status
In-network / out-of-network
Claim status
Submitted, in review, paid, denied
Denial reason
Plain-language explanation of why — not a raw payer code
What it looks like in practice

Sample result states

Verified
Member active — PPO Gold, $25 copay
Action needed
Coverage terminated as of 10/01
Action needed
Plan active, provider out-of-network
Paid
Claim adjudicated — $420 paid
Denied
Denied — DOB mismatch with payer record
Not found
No match — recheck member ID
The product in action

What your front desk sees.

Payerkart is an API first, so it shows up inside the EHR your staff already use. Below is a sample check-in screen: every patient in today's queue is checked, and the result lands next to the patient, with no payer portal in sight.

+ Sample Community Hospital EHR · illustrative
Front desk Admin API activity

Today's check-in queue

5 patients · 1 verified · 3 need attention
TimePatientPayer / member IDStatus
08:00 Gonzalez, Maria
Active PPO, routine follow-up Aetna
W284719035 verified
08:30 Carter, James
Coverage lapsed at year end UnitedHealthcare
INACTIVE-884512 needs review
09:00 Patel, Aisha
Card typo at registration Cigna
INVALID-U00917 member ID invalid
09:30 Kim, Robert
Payer clearinghouse outage BCBS of Texas
XJH55821 payer down, retry
10:00 Nguyen, Linda
Medicare, annual wellness Medicare Part B
1EG4TE5MK73 scheduled

Maria Gonzalez

Eligibility history
DOB1984-03-12 PayerAetna Member IDW284719035
Eligibility
Coverageactive
Plan dates2025-01-01 → open
Checkedjust now, in under a second
Copay
Office visit: $25.00
Deductible
Medical: $400 met of $1,500 · $1,100 remaining
Coverage by service
Office visit: covered
Emergency room: covered subject to $250 copay

Illustrative screen with sample data. The EHR view is the hospital's own; Payerkart supplies the result through the API.

Features

Everything behind the check, in detail.

Eligibility verification and claim status, plus the controls a hospital IT team and billing office need around them.

ELIGIBILITY

Real-time verification, one schema

Identify the patient by ID, or by name and date of birth plus payer details. You get coverage status, plan dates, copay, deductible (used and remaining) and coverage by service category in the same JSON for every payer. Synchronous, or async with a webhook or polling.

ELIGIBILITY

Errors a person can act on

A typo'd member ID, a payer outage, an inactive plan: each comes back as a structured code with a plain-language message, not raw EDI. Rate limits are documented and return clear 429 responses.

ELIGIBILITY

Overnight batch verification

Schedule tomorrow's appointment list to be checked overnight. Patients with inactive or expired coverage are flagged by API, webhook and the admin screen, so staff can follow up before the visit.

ELIGIBILITY

Insurance card scan

For front desks without their own capture flow, upload a photo or PDF of the card. Payer, member ID and plan details are extracted for you to confirm before the check runs.

CLAIM STATUS

Status you can read

Look up where any claim stands. When a payer rejects or asks for follow-up, the code is translated into a plain explanation and suggested fix, for example "the date of birth is missing or doesn't match the payer's records."

CLAIM STATUS

Remittance detail

Payment and remittance data linked to each claim comes back in the same standardized schema, so billing doesn't have to read raw remittance files.

INTEGRATION

Fits your EHR through adapters

A standard adapter contract connects Payerkart to your EHR or integration engine. It works with your hospital's EHR: eClinicalWorks was the first adapter, and adding another EHR doesn't change the core API. If an EHR push fails, results stay available through the API with retry options.

ADMIN

Keys, usage and health in one place

Hospital admins manage scoped API keys, see usage, and watch adapter status (active adapter, last successful push, failures). A sandbox with test keys and canned responses lets IT test before go-live.

AUDIT & SECURITY

Every check logged

Each eligibility and claim status request is recorded with who made it, when, and for which patient or claim. The audit log is searchable by API key, patient, date and endpoint. Access is role-based and enforced on the server, and retries with backoff mean an outage never fails silently.

Why Payerkart

Built around the payer workflow, not bolted onto one.

Payerkart is a focused product: eligibility verification and claim status, behind one schema and one clearinghouse connection. It isn't a general-purpose healthcare API stretched to cover payers as an afterthought — the whole product is built around the handful of requests every hospital front desk and billing team has to make to a payer, and making them consistent regardless of which payer is on the other end.

01
One product, one problem
Payerkart exists to fix one thing: the fragmented, manual way eligibility and claims work happens today, by connecting your hospital's EHR to every payer through one API.
02
Already live, not a concept
Payerkart is running in production today, cutting a 15-minute portal check down to under a second for a live practice. We'll keep saying plainly what's live versus what's still being built out.
03
Built with the teams who use it
Payerkart is shaped by real front-desk and billing workflows. Book a demo and tell us yours — feedback from the teams using it directly drives what we build next.
API Preview — Live

One integration, not one per payer.

This is the actual request shape running in production — one consistent schema for eligibility verification and claim status, regardless of the payer on the other end. Book a demo to talk through your use case and get sandbox access.

  • —Consistent JSON in, JSON out, across payers
  • —Sandbox with test keys and canned payer responses, so you can integrate before go-live
  • —Webhooks or polling for async results and claim status changes
  • —Idempotent writes, versioned endpoints from day one
eligibility.sh — preview 
curl https://api.payerkart.com/v1/eligibility \
  -H "Authorization: Bearer $PAYERKART_KEY" \
  -H "Content-Type: application/json" \
  -d '{
    "patient": { "member_id": "W12345678" },
    "payer": "auto-detect",
    "service_type": "office_visit"
  }'

→ 200 OK
{ "status": "active", "plan": "PPO Gold", "copay": 25 }

From first call to final status

Step 1

Connect

Generate an API key and point requests at one endpoint — no per-payer setup.

Step 2

Verify

Check eligibility and confirm coverage details before care is delivered.

Step 3

Track

Poll status or get a webhook the moment adjudication changes.

Security & compliance

Handled like the healthcare data it is

Payerkart is built around HIPAA-aligned data handling — encryption in transit and at rest, scoped access, and full audit logs on every request.

✓Encrypted in transit & at rest
✓Scoped, revocable API keys
✓Full request audit logs
✓BAAs available on request

Frequently asked

No — Payerkart is built on top of an established clearinghouse connection, not instead of one. What's new is the layer above it: one consistent API and schema for eligibility verification and claim status, so you integrate once instead of hand-building the request formats and error handling yourself.

Yes — Payerkart is live in production, already verifying eligibility and tracking claim status for a practice today, cutting what used to be a 15-minute portal check down to under a second. Book a demo to see it on your own workflow.

Payerkart connects to commercial and government payers across the US. New payers are added on an ongoing basis; check the docs for current coverage before going live.

No. You can start in the sandbox with test payers immediately, and Payerkart's existing payer relationships mean you don't negotiate connections one by one.

Yes. Data is encrypted in transit and at rest, access is scoped per API key, every request is logged, and a BAA is available for teams that need one.

Pricing is usage-based and scales with the workflows you run. Reach out through Start Building to get a plan sized to your volume.

Ready to talk payer infrastructure?

Book a demo to see how Payerkart fits your workflow and get sandbox access — no payer contracts to negotiate before your first request.

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© 2026 Payerkart, a product of Blue Matrix Connect. Healthcare payer infrastructure.
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