How to Read Patient Insurance Coverage from EHRs with

Unified.to’s Healthcare API allows products to retrieve patient insurance coverage details from ten EHR systems through a single method call, standardizing payer, plan, group, member ID, policyholder, coverage dates, status, and priority into a common Coverage object. The service is intended to support intake, eligibility, billing, claims, authorization, and cost-estimation workflows by accessing insurance information already recorded during EHR registration, reducing the need for patients or staff to re-enter it. Customers authorize their own EHR connections, and applications can retrieve a patient’s coverage in real time, filter for active plans valid on the date of service, and select primary coverage by priority. Field availability differs by EHR, while MEDITECH’s FHIR API does not support coverage and returns a 501 response; an empty result instead indicates no coverage is on file. Coverage is read-only, and while SMART on FHIR and Veradigm support incremental updates and virtual webhooks, other supported systems generally require real-time reads when insurance data is needed. Unified.to states that requests are executed directly against the customer’s EHR, it does not retain patient records, and eligibility must still be verified separately through a payer or clearinghouse service.

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