Collective Health API
Collective Health is an independent third-party administrator (TPA) that unifies medical, pharmacy, dental, and vision plan administration, claims adjudication, eligibility, and member navigation for self-funded employers in one platform. An unofficial API lets you programmatically pull members, eligibility, claims, billing, payments, and program utilization data—and push updates like eligibility changes and partner-program enrollments back into Collective Health.
What is Collective Health?
Collective Health is an independent third-party administrator (TPA) that brings plan administration, cost management, and member support together in a single platform for self-funded employers. It administers medical, pharmacy, dental, and vision plans, adjudicates claims, manages eligibility, consolidates billing and payments, and connects members to care through navigation and advocacy—while integrating a broad ecosystem of clinical point solutions on top of one data engine.
Core product areas include:
- Collective TPA (plan administration, claims adjudication, payments, and reporting across medical, pharmacy, dental, and vision)
- Navigation & Advocacy (member app with care guidance and complex-care support)
- Benefits Hub (integrated access to ancillary partners and benefits in one place)
- My Collective member portal and the Collective AI (CAI) tools for member navigation and operational workflows
- Partner ecosystem connecting 200+ partner integrations across 30+ clinical categories
Common data entities:
- Members, Dependents, Eligibility Records, Enrollment Files
- Medical, Pharmacy, Dental, and Vision Claims, EOBs, Adjudication Results
- Invoices, Payments, Disbursements, Billing Accounts
- Plans, Networks, Benefit Designs, Accumulators (deductibles, out-of-pocket)
- Program Partners, Utilization Events, Care Navigation Cases
The Collective Health Integration Challenge
Employers and partners run mission-critical benefits workflows on Collective Health, but turning portal- and file-driven processes into API-driven automation is non-trivial:
- No public developer API: Collective Health is delivered through employer and member portals plus partner integrations, with no general-purpose published API for customers to build against
- File-based eligibility and claims exchange: Eligibility and claims often move via scheduled EDI/flat-file feeds rather than real-time endpoints, adding latency and reconciliation overhead
- Partner-program gating: Many capabilities flow through the 200+ partner ecosystem, each requiring its own integration agreement before data access
- PHI and compliance sensitivity: Member, claims, and eligibility data is regulated PHI, so any automation must respect HIPAA controls, audit trails, and minimum-necessary access
- Authentication complexity: Employer and partner logins commonly involve SSO and MFA, which complicate headless automation
- Multi-line normalization: Medical, pharmacy, dental, and vision each carry distinct claim formats, codes, and accumulator logic that must be reconciled for a unified view
How Supergood Creates Collective Health APIs
Supergood reverse-engineers Collective Health's authenticated employer and member portal flows to deliver a resilient, real-time API layer for your account—without waiting on a public API or partner gate.
- Handles username/password, SSO, and MFA (SMS, email, TOTP) securely in a managed session
- Maintains session continuity with automated refresh and change detection
- Normalizes responses across medical, pharmacy, dental, and vision so you integrate once and rely on consistent member, claim, and eligibility objects
- Respects HIPAA-aligned controls with encrypted credentials, scoped access, and audit logging
Use Collective Health with AI agents: Collective Health MCP Server →
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your plans, lines of coverage, and authentication model.
- Supergood Generates and Validates Your API
We deliver a production-ready Collective Health adapter tailored to your account configuration and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as Collective Health evolves.
API Endpoints
Authentication
/authenticateAuthenticate to a Collective Health account using username/password, SSO, or MFA and obtain a session token for downstream calls.
Members
/membersList members and dependents with filters for employer group, plan, and eligibility status.
Eligibility
/eligibilityRetrieve eligibility records and accumulators across medical, pharmacy, dental, and vision coverage.
Eligibility
/update_eligibilityPush eligibility additions, terminations, and demographic changes back into the plan administration system.
Claims
/claimsPull medical, pharmacy, dental, and vision claims with adjudication status, EOB details, and date filters.
Billing
/billingRetrieve invoices, payments, and disbursements across consolidated billing accounts.
Use Cases
Sync eligibility and member data with HRIS
- Push eligibility additions, terminations, and life-event changes from your HRIS into Collective Health - Pull current member and dependent records to reconcile against payroll and benefits systems - Detect and resolve eligibility discrepancies before they create claim denials
Stream claims into analytics and cost-management tools
- Pull medical, pharmacy, dental, and vision claims into a single warehouse for cost and utilization analysis - Feed adjudicated claim and EOB data to BI, actuarial, and stop-loss reporting - Flag high-cost claimants and care-navigation opportunities downstream
Automate billing and payment reconciliation
- Sync invoices, payments, and disbursements from consolidated billing into general ledger and AR systems - Match plan funding against claims and administrative fees - Surface billing discrepancies and outstanding balances to finance teams
Power member navigation and partner programs
- Pull member benefits, accumulators, and program utilization to drive personalized navigation experiences - Trigger partner-program enrollments and updates across the integrated ecosystem - Surface care gaps and program eligibility to advocacy and engagement tools
Technical Specifications
Authentication
Username/password, SSO, and MFA (SMS, email, TOTP) handled in a managed session
Connectivity
Authenticated employer and member portal flows; no dependence on a public API or partner-gate access
Response format
Normalized JSON across member, eligibility, claims, billing, and program objects
Rate limits
Adaptive throttling tuned to your account to avoid platform-side limits
Session management
Automatic session refresh, MFA replay handling, and credential rotation
Data freshness
Near real-time pulls for eligibility and claims with optional scheduled batch syncs
Security
Encrypted credential vault, scoped access tokens, HIPAA-aligned controls, and audit logging
Webhooks
Event-style callbacks for eligibility changes, claim status updates, and billing events
Latency
Sub-second reads on cached entities; multi-second writes when posting eligibility and enrollment changes
Throughput
Horizontally scaled workers sized to multi-line claims and eligibility volume
Reliability
Retry, backoff, and idempotency keys for eligibility and billing transactions
Adaptation
Continuous monitoring of Collective Health portal and partner-ecosystem changes
Frequently asked questions
Collective Health is delivered primarily through employer and member portals and partner integrations, without a general-purpose public developer API. Supergood works against your authenticated account surfaces to provide a programmatic API layer regardless.
Yes. Supergood normalizes member, eligibility, and claims data across all four lines so you integrate once and rely on consistent objects across medical, pharmacy, dental, and vision.
Member, claims, and eligibility data is treated as regulated PHI. Supergood uses encrypted credential storage, scoped access, minimum-necessary data handling, and audit logging aligned with HIPAA controls.
Yes. Beyond reads, the API supports writing eligibility additions, terminations, and demographic updates back into the plan administration system, so you can keep enrollment in sync from your HRIS.
No. Supergood operates against your existing authenticated Collective Health account. Partner-specific agreements are only required when you want to consume third-party services brokered through the partner ecosystem.