Eligibility and benefits

“Is this patient covered, and what will they owe?”

The Eligibility and benefits workflow answers coverage questions before care. Daybook sends the 270, reads the 271 and returns plain fields: whether coverage is active, the plan, and what is left of the deductible and out-of-pocket maximum. Run one check at a time or a whole schedule at once.

Build this with AIA brief with this workflow's endpoints, events and docs, ready for your assistant to scaffold the integration in your stack.

At a glance

Workflow: Eligibility and benefits
Stage: Before the visit, and again before billing
Primary users: Front desk, scheduling and billing teams
Core question: Is this patient covered, and what will they owe?
Transactions: X12 270 / 271
Volume: Real time, or batches up to 1,000
Consumption options: API · Webhooks · MCP

What this workflow enables

Verify coverage on the date of service in real time.
Read deductible, out-of-pocket, copay and coinsurance as numbers.
Check tomorrow's whole schedule in one batch.
Get told when a patient's coverage changes between visits.

Typical flow

Send the check
POST /v1/eligibility/checks with the payer, provider and patient.
Daybook runs the 270/271
Through the clearinghouse, and reads the 271 into fields.
Answer
Real-time checks answer in the response. Batches send eligibility.completed per patient.
Watch for changes
Re-checks that find different coverage send coverage.changed.

Step through it

Step 3 of 4: Answer, sends eligibility.completed

eligibility.completed

{
  "id": "evt_01JBXQ1A4C6E8G0J2M4P6R8T12",
  "type": "eligibility.completed",
  "created_at": "2026-10-29T06:00:00Z",
  "mode": "live",
  "data": {
    "id": "elig_01JBXQ0"
  }
}

Journeys in this workflow

Verify before the visitCheck every patient on tomorrow's schedule.

Estimate what the patient owesUse the remaining deductible and coinsurance.

Catch terminated coverageFind out before the claim is denied.

Escalate to a callWhen the 271 is unclear, start a payer call.

Use cases

What teams build on this workflow, each with a prompt you can paste into Claude, ChatGPT or Cursor.

Verify coverage before every visitTomorrow's schedule checked over 270/271 tonight, with inactive coverage flagged before the patient arrives.Catch terminated coverage on open claimsWhen a patient's coverage changes, your product flags their open claims and visits, and can call the payer to confirm.

APIs powering this workflow

POST/v1/eligibility/checksCheck eligibility

Events you receive

Subscribe to these with a webhook endpoint. Every event is signed; see Verifying signatures.

Event	Sent when
`eligibility.completed`	A batched check finished.
`coverage.changed`	A re-check found different coverage than the last one.

Example event

{
  "id": "evt_01JBXQ1A4C6E8G0J2M4P6R8T0W",
  "type": "coverage.changed",
  "created_at": "2026-10-29T06:00:00Z",
  "mode": "live",
  "data": {
    "id": "elig_01JBXQ0",
    "previous": {
      "active": true,
      "plan_name": "Bayline Choice PPO"
    },
    "current": {
      "active": false,
      "coverage_end": "2026-10-15"
    }
  }
}