---
updatedAt: 2026-08-07T16:25:02.000Z
agentTools:
  projectIndex: https://docs.elationhealth.com/llms.txt
---

# Create Eligibility

Create eligibility information for a patient insurance

# OpenAPI definition

```json
{
  "components": {
    "schemas": {
      "CreateInsuranceEligibility": {
        "properties": {
          "group_id": {
            "description": "ID that matches the group record in Elation system",
            "type": "integer"
          },
          "group_name": {
            "description": "Name of the group / organization. group_npi field is required if this is populated.",
            "type": "string"
          },
          "group_npi": {
            "description": "NPI of the group / organization. group_name field is required if this is populated.",
            "type": "string"
          }
        },
        "type": "object"
      },
      "EligibilityDetails": {
        "properties": {
          "coinsurance": {
            "description": "Coinsurance percentage value as a decimal (e.g. 0.25).",
            "format": "decimal",
            "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
            "type": "string"
          },
          "coinsurance_ambiguous": {
            "type": "boolean"
          },
          "copay": {
            "description": "copayment amount in dollars.",
            "format": "double",
            "type": [
              "number",
              "null"
            ]
          },
          "copay_ambiguous": {
            "description": "If true, the given copay value may not be accurate and the full eligibility report will need to be referenced for better details.",
            "type": "boolean"
          },
          "deductible": {
            "description": "Deductible amount in dollars.",
            "format": "decimal",
            "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
            "type": "string"
          },
          "deductible_ambiguous": {
            "type": "boolean"
          },
          "deductible_remaining": {
            "description": "Remaining deductible amount in dollars.",
            "format": "decimal",
            "pattern": "^-?\\d{0,8}(?:\\.\\d{0,2})?$",
            "type": "string"
          },
          "deductible_remaining_ambiguous": {
            "type": "boolean"
          },
          "errors": {
            "description": "Error messages showing reason for failed eligibility check.",
            "items": {
              "additionalProperties": {},
              "type": "object"
            },
            "type": "array"
          }
        },
        "type": "object"
      },
      "EligibilityStatusEnum": {
        "description": "* `active` - active\n* `inactive` - inactive\n* `error` - error",
        "enum": [
          "active",
          "inactive",
          "error"
        ],
        "type": "string"
      },
      "InsuranceEligibility": {
        "properties": {
          "eligibility_check_timestamp": {
            "description": "Eligibility check timestamp in ISO format.",
            "format": "date-time",
            "type": "string"
          },
          "eligibility_details": {
            "$ref": "#/components/schemas/EligibilityDetails"
          },
          "eligibility_status": {
            "allOf": [
              {
                "$ref": "#/components/schemas/EligibilityStatusEnum"
              }
            ],
            "description": "Status of eligibility check.\n\n* `active` - active\n* `inactive` - inactive\n* `error` - error"
          },
          "patient_id": {
            "description": "Patient's id in Elation system.",
            "type": "integer"
          },
          "patient_insurance_id": {
            "description": "Patient's insurance id in Elation system.",
            "type": "integer"
          },
          "practice_id": {
            "description": "Practice's id in Elation system.",
            "type": "integer"
          }
        },
        "type": "object"
      }
    },
    "securitySchemes": {
      "oauth2": {
        "flows": {
          "clientCredentials": {
            "scopes": {
              "act_as_user": "Impersonate a provider via X-On-Behalf-Of (combinable with apiv2 or system scopes)",
              "apiv2": "Full access to the API",
              "system/{resource_name}.read": "Read access to a specific resource",
              "system/{resource_name}.write": "Write access to a specific resource"
            },
            "tokenUrl": "/api/2.0/oauth2/token/"
          }
        },
        "type": "oauth2"
      }
    }
  },
  "info": {
    "contact": {
      "name": "Elation Health",
      "url": "https://www.elationhealth.com/"
    },
    "description": "Elation Health API v2.0",
    "title": "[Premium] Patient Insurance API",
    "version": "2.0.0"
  },
  "openapi": "3.1.0",
  "paths": {
    "/api/2.0/patient_insurances/{id}/eligibility/": {
      "post": {
        "description": "Create eligibility information for a patient insurance",
        "operationId": "patient_insurances_eligibility_create",
        "parameters": [
          {
            "description": "The id of the patient insurance",
            "in": "path",
            "name": "id",
            "required": true,
            "schema": {
              "type": "integer"
            }
          }
        ],
        "requestBody": {
          "content": {
            "application/json": {
              "schema": {
                "$ref": "#/components/schemas/CreateInsuranceEligibility"
              }
            }
          }
        },
        "responses": {
          "200": {
            "content": {
              "application/json": {
                "schema": {
                  "$ref": "#/components/schemas/InsuranceEligibility"
                }
              }
            },
            "description": ""
          }
        },
        "security": [
          {
            "oauth2": []
          }
        ],
        "summary": "Create Eligibility",
        "tags": [
          "Insurance Eligibility"
        ],
        "x-el8-docs-category": "[Premium] Patient Insurance API",
        "x-el8-docs-versions": [
          "2.1",
          "2.0"
        ]
      }
    }
  },
  "servers": [
    {
      "description": "Sandbox Server",
      "url": "https://sandbox.elationemr.com"
    },
    {
      "description": "Production Server",
      "url": "https://api.app.elationemr.com"
    }
  ],
  "x-readme": {
    "proxy-enabled": true
  }
}
```