Overview

Provided a valid request, this endpoint submits a new real-time transaction for processing.
The response is JSON and includes the raw x12-271 response string so clients can extract the payer's original EDI response if needed.
Real-time response time is driven primarily by payer and clearinghouse latency. The downstream clearinghouse timeout is 2 minutes to accommodate slower payer connectivity and heavy-volume periods.
If your organization is enrolled in deduplication, that feature is evaluated before clearinghouse submission. Deduplication is customer-configurable, including the lookback window and whether prior-month requests are excluded. When a duplicate is found, the clearinghouse is skipped and the transaction sourceType is duplicate.

Coverage Discovery Integration

If you are enrolled in Coverage Discovery at the time of the request and your configured discovery conditions are met, the Coverage Discovery workflow will be started automatically. Common examples include real-time responses with status.value of ineligible or patient_unknown, or response-side HMO plan information that qualifies an HMO discovery path. In this scenario, the response link header contains one or more related Coverage Discovery task resource paths, e.g.:
</coverage-discovery/0716e3e8-87ee-11ee-b9d1-0242ac120002>; title="coverage discovery - Task 1"; rel="related", </coverage-discovery/0e565a58-87ee-11ee-b9d1-0242ac120002>; title="coverage discovery - Task 2"; rel="related"
Parse this header as RFC 8288-style link values. When more than one discovery task is created, multiple related links may be returned in the same header.
When discovery is triggered from this JSON real-time endpoint, the submitted request body is used as the canonicalEligibilityRequest later referenced by Coverage Discovery. If response-side facts are needed, the normalized real-time response body is used as canonicalEligibilityResponse.
Each related resource can be retrieved through the /coverage-discovery/{id} endpoint.
If conditions are not met, the link response header will not contain any related /coverage-discovery references.

Callback Solution With Consolidated Real-Time Eligibility and Coverage Discovery Responses

If you are enrolled in the consolidated callback capability, you may receive the Real-Time Eligibility (RTE) response together with the Coverage Discovery response.
When enabled, the abbreviated eligibility transaction will be included in the corresponding Coverage Discovery record.

⚠️ Note: This integrated response is only available via callback and only if your organization is enrolled in this capability.

Refer to the /coverage-discovery/{id} response examples for data model references.