Experian Health API
Experian Health is software used by hospitals, health systems, and physician practices to verify insurance, find coverage for self-pay patients, manage prior authorizations, submit and track claims, and collect payments. With an unofficial API, you can check eligibility in real tim
What is Experian Health?
Experian Health provides patient access and revenue cycle management solutions used by providers to streamline registration, verify coverage, manage authorizations, submit claims, and facilitate patient payments. Product areas commonly include eligibility (270/271), coverage discovery, identity verification, prior authorizations (278), claim management (837), remittances (835), patient estimates, and denials management. Experian Health workflows often sit alongside leading EHRs (e.g., Epic, Cerner/Oracle Health) and clearinghouses.
Core product areas include:
- Eligibility and benefits verification (EDI 270/271)
- Coverage Discovery for self-pay and underinsured patients
- Prior Authorization management (278, payer portals)
- Claim submission and tracking (837P/I), payer connectivity
- Remittance and denial management (835, CARC/RARC)
- Patient financial estimates and payments
- Identity verification and registration QA
Common data entities:
- Patients and guarantors
- Providers and facilities (NPI, taxonomy, addresses)
- Payers and plans (payer IDs, group numbers, network indicators)
- Eligibility inquiries and responses (service type, copay, coinsurance, deductible)
- Coverage discovery candidates (policy numbers, effective dates)
- Authorizations (diagnosis/procedure codes, units, dates, status)
- Claims (headers, line items, modifiers, submission channels)
- Remittances (835 postings, payments, adjustments, denial codes)
- Estimates and out-of-pocket calculations
The Experian Health Integration Challenge
Organizations rely on Experian Health daily, but turning portal-based workflows into automated pipelines is hard:
- Payer-specific rules: Benefit structures, service type codes, authorization criteria, and denial logic vary widely by payer/plan
- Strong enterprise security: SSO/MFA and network controls complicate headless automation for revenue cycle teams
- Portal-first delivery: Key authorization and claim workflows often live in web apps or batch exports, not unified public APIs
- EDI/batch interfaces: 270/271, 278, 837, and 835 flows involve SFTP/clearinghouse windows, batching constraints, and delivery confirmations
- Attachments and audit: Prior auth requests can require clinical attachments and strict audit trails; claims need compliance-grade provenance
How Supergood Creates Experian Health APIs
Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.
- Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
- Maintains session continuity with automated refresh and change detection
- Normalizes eligibility, coverage, authorization, claim, and remittance objects across payer variations
- Aligns with customer entitlements and licensing constraints to ensure compliant access
- Bridges EDI and SFTP/clearinghouse flows with signed URL retrieval and delivery for artifacts (270/271, 278, 837, 835)
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your Experian Health product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened Experian Health adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as Experian Health evolves.
API Endpoints
Authentication
/sessionsEstablish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.
Eligibility
/eligibility/inquiriesSubmit an eligibility and benefits inquiry (akin to 270) for a patient and provider. Returns normalized benefit details (271).
Prior Authorizations
/authorizationsCreate a prior authorization request with diagnosis/procedure details and requested units/date range. Supports attachments when required.
Claims
/claimsAssemble an 837P/I claim with normalized headers and service lines. Supergood can route the generated file to the configured submission channel (clearinghouse, payer gateway).
Remittances
/remittancesRetrieve normalized ERA (835) remittance summaries for payment posting and reconciliation.
Use Cases
Patient Access & Eligibility Automation
- Trigger real-time eligibility checks for scheduled appointments - Surface network status, copay, coinsurance, and deductible remaining - Keep payer/plan data in sync with your EHR and practice management system
Coverage Discovery & Financial Clearance
- Run discovery for self-pay or underinsured patients - Confirm discovered policy details before service - Drive pre-service workflows to reduce charity care and bad debt
Prior Authorization Orchestration
- Create and submit prior auth requests with CPT/HCPCS and ICD-10 codes - Attach clinical documents where required and track statuses - Alert schedulers when approvals arrive or additional info is needed
Claims Generation & Remittance Reconciliation
- Assemble 837P/I claims with payer-specific formatting - Submit via clearinghouse/state/payer gateways and track statuses - Pull 835 remittances to reconcile payments and analyze denials
Audit & Compliance
- Export machine-readable trails for eligibility checks, auth decisions, claims submissions, and remittance postings - Maintain compliant reason codes and evidence for payer reviews
Technical Specifications
Authentication
Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
Response format
JSON with consistent resource schemas and pagination
Rate limits
Tuned for enterprise throughput while honoring licensing and usage controls
Session management
Automatic reauth and cookie/session rotation with health checks
Data freshness
Near real-time retrieval of eligibility, authorization, claim, and remittance artifacts
Security
Encrypted transport, scoped tokens, and audit logging; respects Experian Health entitlements and compliance requirements
Webhooks
Optional asynchronous delivery for authorization decisions, claim generation, and remittance updates
Latency
Sub-second responses for list/detail queries under normal load
Throughput
Designed for high-volume eligibility and batch claims pipelines
Reliability
Retry logic, backoff, and idempotency keys minimize duplicate actions
Adaptation
Continuous monitoring for UI/API changes with rapid adapter updates
Frequently asked questions
Supergood supports workflows across commonly used Experian Health tools and portals (e.g., eligibility, coverage discovery, prior authorization, claim submission, remittance/denials), subject to your licensing and entitlements. We scope exact coverage during integration assessment.
We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For EDI/batch flows, we manage SFTP timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically, along with normalized 270/271, 278, and 835 artifacts.
Yes. You can assemble 837P/I claims with payer-specific formatting, route submissions via your configured channel (clearinghouse or payer gateway), and pull ERA 835 summaries to reconcile postings and analyze denials.