Product Why Payerkart API Preview Security FAQ Blog

Payer infrastructure, API-first

One API for eligibility, claim status, and claim resubmission — backed by real clearinghouse connectivity.

Right now, checking coverage usually means signing into a payer's own web portal — a different one for nearly every payer — and typing the same patient name, date of birth, and insurance details in by hand. Payerkart replaces that portal-by-portal routine with a single API — one clearinghouse connection behind it, not a per-payer login — for eligibility, claim status, and resubmitting corrected claims, purpose-built around that workflow instead of adapted from something broader.

See API Preview

→ Built with a real RCM team

→ One schema, every payer

→ Early partners shape the API

Claim trace · sample output preview

09:41:02 eligibility.verify → member active 200

09:41:19 claims.status → rejected: dob mismatch action needed

09:44:51 claims.resubmit → corrected, in adjudication 202

Built for hospitals — integrated on top of your EHR

Designed for real-time eligibility Purpose-built for payer workflows One schema across payers

The workflow

Three payer workflows. One API.

From checking coverage to resubmitting a corrected claim, 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 — the same answer staff pull today by logging into a payer portal and entering patient details by hand, minus the manual 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.

03 POST /v1/claims/:id/resubmit

Resubmit corrected claims

A rejected claim comes back with the specific problem explained in plain language and a suggested fix — correct it and resubmit through the same call, tracked to a final status.

Why Payerkart

Built around the payer workflow, not bolted onto one.

Payerkart is a focused product: eligibility, claim status, and claim resubmission, 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.

One product, one problem

Payerkart exists to fix one thing: the fragmented, per-payer way eligibility and claims work happens today, where staff still sign into a different portal for every check.

Honest about where we are

We're in active development. What's on this page is the schema and workflow we're building toward — we'll say plainly what's live and what's still ahead.

Early partners shape the API

Book a demo and your workflow becomes part of what we build first — this is the stage where feedback changes the product.

API Preview — In Development

One integration, not one per payer.

This is a preview of the request shape we're building — one consistent schema for eligibility, claim status, and resubmission, regardless of the payer on the other end. Book a demo to talk through your use case and get notified when sandbox access opens.

—Consistent JSON in, JSON out, across payers
—Sandbox environment with test payers, opening to early partners
—Webhooks planned for 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 paid claim

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

Submit

File the claim through the same schema Payerkart routes to the payer.

Step 4

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, claim status, and resubmission, so you integrate once instead of hand-building the request formats and error handling yourself.

We're in active development. The API preview on this page shows the schema and workflow we're building toward, and we'll say plainly what's ready now versus what's still ahead. Book a demo and your use case becomes part of what we build first.

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 on the list for early sandbox access — no payer contracts to negotiate before your first request.