Experian Health

Supergood | Experian Health API

Alex Klarfeld

Alex Klarfeld

— 6 min read
Supergood | Experian Health API

Programmatically access eligibility and benefits verification, coverage discovery, prior authorization workflows, claim submission, and remittance reconciliation in Experian Health with a stable REST API. Supergood builds and operates production-grade, unofficial Experian Health integrations so your team can automate critical patient access and revenue cycle pipelines without heavy custom engineering.

In plain English: 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 time, discover hidden coverage, assemble and submit authorizations, create 837P/I claims, and reconcile 835 remittances—end to end.

If you’re a healthcare tech startup working on billing, practice management, or provider services, integrating your stack with Experian Health unlocks concrete data flows and features:

  • Pull: Patient demographics, payer and plan metadata, eligibility responses, discovered coverage candidates, authorization statuses, claim submission artifacts, remittance summaries (835), denial reasons (CARC/RARC)
  • Push: New/updated patient records, eligibility inquiries tied to appointments, prior authorization requests with diagnosis/procedure codes and attachments, claims for professional/institutional billing
  • Build: Financial clearance at scheduling/check-in, authorization-aware scheduling, automated claims assembly for 837P/I, real-time reimbursement dashboards and denials analytics

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)

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

Available Endpoints

Authentication

POST /sessions: Establish 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.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {
      "type": "totp",
      "code": "123456"
    }
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_81c3e2",
    "name": "RCM Admin",
    "entitlements": ["eligibility", "coverage", "authorizations", "claims", "remittances"]
  }
}

Eligibility

POST /eligibility/inquiries: Submit an eligibility and benefits inquiry (akin to 270) for a patient and provider. Returns normalized benefit details (271).

Body fields

  • patient: object (name, dob, memberId)
  • payerId: string
  • provider: object (npi, taxonomy, name)
  • serviceTypeCode: string (e.g., "30" for General Medical)
  • dateOfService: ISO 8601 date
curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/eligibility/inquiries \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patient": {
      "firstName": "Jordan",
      "lastName": "Patel",
      "dob": "1992-07-14",
      "memberId": "A123456789"
    },
    "payerId": "payer_bcbs_tx",
    "provider": {
      "npi": "1234567890",
      "taxonomy": "207Q00000X",
      "name": "BrightCare Family Practice"
    },
    "serviceTypeCode": "30",
    "dateOfService": "2026-01-24"
  }'

Example response

{
  "inquiryId": "elig_7fd910",
  "status": "successful",
  "coverage": {
    "planName": "Blue Advantage",
    "groupNumber": "GRP-77821",
    "effectiveDate": "2025-01-01",
    "terminationDate": null,
    "inNetwork": true
  },
  "benefits": [
    {"serviceTypeCode": "30", "copay": 25.0, "coinsurance": 0.2, "deductibleRemaining": 450.0},
    {"serviceTypeCode": "98", "copay": 40.0, "coinsurance": 0.1, "deductibleRemaining": 300.0}
  ],
  "messages": [],
  "createdAt": "2026-01-24T10:11:32Z"
}

Prior Authorizations

POST /authorizations: Create a prior authorization request with diagnosis/procedure details and requested units/date range. Supports attachments when required.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/authorizations \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patient": {
      "id": "pt_91b303",
      "firstName": "Jordan",
      "lastName": "Patel",
      "dob": "1992-07-14"
    },
    "payerId": "payer_bcbs_tx",
    "provider": {"npi": "1234567890", "facilityId": "fac_2201"},
    "diagnoses": ["M25.561"],
    "procedures": [
      {"code": "97110", "modifiers": ["GP"], "units": 12}
    ],
    "startDate": "2026-01-26",
    "endDate": "2026-03-26",
    "placeOfService": "11",
    "urgency": "standard",
    "attachments": [
      {"type": "clinical_note", "signedUrl": "https://download.experian.example/signed/abc123"}
    ],
    "referenceId": "scheduler-req-88271"
  }'

Example response

{
  "authorizationId": "auth_4b77e2",
  "status": "pending",
  "submittedAt": "2026-01-24T10:22:05Z",
  "reviewUrl": "https://download.experian.example/signed/review-456de...",
  "referenceId": "scheduler-req-88271"
}

Claims

POST /claims: Assemble an 837P/I claim with normalized headers and service lines. Supergood can route the generated file to the configured submission channel (clearinghouse, payer gateway).

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_bcbs_tx",
    "billingProvider": {
      "npi": "1234567890",
      "taxonomy": "Family Medicine",
      "name": "BrightCare Family Practice",
      "billingAddress": {
        "line1": "100 Care Way",
        "city": "Austin",
        "region": "TX",
        "postalCode": "78701"
      }
    },
    "patient": {
      "id": "pt_91b303",
      "memberId": "A123456789",
      "relationship": "self"
    },
    "lines": [
      {"code": "99213", "modifiers": [], "units": 1, "chargeAmount": 145.0, "diagnosisPointers": ["A"]},
      {"code": "97110", "modifiers": ["GP"], "units": 2, "chargeAmount": 120.0, "diagnosisPointers": ["A"]}
    ],
    "diagnoses": [{"pointer": "A", "code": "M25.561"}],
    "submissionChannel": "clearinghouse",
    "referenceId": "claim-batch-jan24"
  }'

Example response

{
  "claimId": "clm_8a21f0",
  "status": "queued",
  "edi": {"format": "837P", "size": 38902},
  "submissionChannel": "clearinghouse",
  "createdAt": "2026-01-24T10:29:41Z",
  "reviewUrl": "https://download.experian.example/signed/edi-837p-xyz...",
  "referenceId": "claim-batch-jan24"
}

Remittances

GET /remittances: Retrieve normalized ERA (835) remittance summaries for payment posting and reconciliation.

Query parameters

  • claimId: string
  • payerId: string
  • fromDate: ISO 8601 date
  • toDate: ISO 8601 date

Example response

{
  "items": [
    {
      "remittanceId": "era_51d9c7",
      "claimId": "clm_8a21f0",
      "status": "paid",
      "paymentAmount": 210.50,
      "allowedAmount": 230.00,
      "patientResponsibility": 34.50,
      "checkNumber": "9175523",
      "paymentDate": "2026-02-02",
      "adjustments": [
        {"carc": "CO-45", "amount": 24.50, "description": "Charge exceeds fee schedule"},
        {"rarc": "N520", "description": "Service not payable under contract"}
      ]
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Get full API Specs →

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

Performance Characteristics

  • 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

Getting Started

  1. Schedule Integration Assessment

Book a 30-minute session to confirm your Experian Health product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened Experian Health adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as Experian Health evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which Experian Health products can this integration cover?

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.

Q: How are MFA, SSO, and batch interfaces handled for automation?

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.

Q: Can I generate claims and track remittances directly?

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.

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