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HealthGenX Medicaid Eligibility API
Introduction

API Reference

The Medicaid Eligibility API is organized around REST. Our API has predictable resource-oriented URLs, accepts form-encoded request bodies, returns JSON-encoded responses, and uses standard HTTP response codes, authentication, and verbs.

You can use the Medicaid Eligibility API in test mode, which does not affect your live data or your eligibility checks. The API key you use to authenticate the request determines whether the request is live mode or test mode.

The Medicaid Eligibility API differs for every account as we release new versions and tailor functionality. Log in to see docs customized to your version of the API, with your test key and data.

Base URL: https://healthgenxsolutions.com:7000

Authentication

The Medicaid Eligibility API uses API keys to authenticate requests.

Test mode secret keys have the prefix test_ and live mode secret keys have the prefix prod_.

Your API keys carry many privileges, so be sure to keep them secure! Do not share your secret API keys in publicly accessible areas such as GitHub, client-side code, and so forth.

Authentication to the API is performed via HTTPS Authentication. Provide your API key as the basic auth username value. You do not need to provide a password.

Errors

HealthGenX uses conventional HTTP response codes to indicate the success or failure of an API request. In general: Codes in the 2xx range indicate success. Codes in the 4xx range indicate an error that failed given the information provided (e.g., a required parameter was omitted, a charge failed, etc.). Codes in the 5xx range indicate an error with HealthGenX’s servers (these are rare).

Some 4xx errors that could be handled programmatically (e.g., a card is declined) include an error code that briefly explains the error reported.

Handling Errors

Our Client libraries raise exceptions for many reasons, invalid parameters, authentication errors, and network unavailability. We recommend writing code that gracefully handles all possible API exceptions.

There are certain situations where Postman application would not yield results, we recommend switching to CURL in its place.

Metadata

Queryable Medicaid Eligibility API objects—including the createfile270, importfile271, import271SQL, import270SQL—have a metadata parameter. You can use this parameter to attach key-value data to these HealthGenX objects.

Versioning

When backwards-incompatible changes are made to the API, a new, dated version is released. The current version is 1.2. Read our API upgrades guide to see our API changelog and to learn more about backwards compatibility.

All requests use your account API settings. The changelog lists every available version.

createfile270

POST /api/medicaideligibility/createfile270

To create a 270 file, you create a createfile270 object based on the HealthGenX standard 270 file template.

Parameters- parameters should not include any spacings

filename*

The filename has to be an actual file and must use the encoding type multipart/form-data.

Has to be a csv template with the headers as follows:

Lname – members last name

First- members first name

Cin – the Medicaid CIN number for the member in the standard format (ex., AB12345C)

Id – a unique identifier per member, such as a system defined member ID.

Dob – members date of birth in the format mm/dd/yyyy

apikey*

This is the API key that is provided to you by HealthGenX and is unique to each client.

TSN*

The TSN is an unique identifier for the institution that is checking eligibility through ePaces.

eligibility_date*

This is the date for which the user would like to check for the eligibility of their member(s). The eligibility date needs to be the current date or any date prior to the current date.

organization*

This is the name of the organization that is checking eligibility in ePaces.

organizationid*

The organization ID is the unique identifier for the organization parameter as provided by ePaces.

providertype*

This is a unique identifier provided by ePaces to each organization.

importfile271

POST /api/medicaideligibility/importfile271

Import a valid asterisk delimited 271 file that is received from ePaces after uploading the 270. The resulting output from the API is a structured csv file based on the data in the 271 output.

Parameters

filename*

The filename has to be an actual file and must use the encoding type multipart/form-data.

apikey*

This is the API key that is provided to you by HealthGenX and is unique to each client.

import271SQL

POST /api/medicaideligibility/import271SQL

This allows you to automatically import the 271 asterisk delimited file into a Microsoft SQL Server database. The information will be structured to include the 271 output data elements. The username/login that is applied to the API MUST be able to create triggers and tables. The default name for the table that is created is tbl_HGNX_271_import and cannot be changed. In the event the table is not present in the database, the API will automatically create the table. If the table already exists for subsequent API transactions, it will append the new data to the table as long as it is not the same file name that was previously uploaded. The API does not hold or save any user credentials for the associated Microsoft SQL server account.

Parameters

filename*

The filename has to be an actual file and must use the encoding type multipart/form-data.

apikey*

This is the API key that is provided to you by HealthGenX and is unique to each client.

host*

This is the location of your Microsoft SQL Server database.

port*

This is the assigned port for your Microsoft SQL Server database.

database*

This is the database where you would like to create the 271 table output.

username*

This is the credential you use to access your Microsoft SQL Server database.

password*

This is your password to access your Microsoft SQL Server database connected to the username parameter.

schema*

This is the Microsoft SQL Server database schema you would like to place the 271 data table inside.

import270SQL

/api/medicaideligibility/import270SQL

This allows you to automatically import the 270 csv templated file into a Microsoft SQL Server database. The username/login that is applied to the API MUST be able to create triggers and tables. The default name for the table that is created is tbl_HGNX_270_import and cannot be changed. In the event the table is not present in the database, the API will automatically create the table. If the table already exists for subsequent API transactions, it will append the new data to the table as long as it is not the same file name that was previously uploaded. The API does not hold or save any user credentials for the associated Microsoft SQL server account.

Parameters

filename*

The filename has to be an actual file and must use the encoding type multipart/form-data.

apikey*

This is the API key that is provided to you by HealthGenX and is unique to each client.

host*

This is the location of your Microsoft SQL Server database.

port*

This is the assigned port for your Microsoft SQL Server database.

database*

This is the database where you would like to create the 270 table output.

username*

This is the credential you use to access your Microsoft SQL Server database.

password*

This is your password to access your Microsoft SQL Server database connected to the username parameter.

schema*

This is the Microsoft SQL Server database schema you would like to place the 270 data table inside.