Healthcare Transaction Gateway
MedRelay provides a unified API for real-time healthcare claims processing, eligibility verification, prior authorization, and electronic remittance across commercial, Medicare, and Medicaid payers. We support both ANSI X12 EDI transaction sets and HL7 FHIR R4 for modern integrations.
Claims Submission
Submit professional (837P), institutional (837I), and dental (837D) claims in real-time. Receive synchronous claim acknowledgments and asynchronous adjudication results.
X12 837Eligibility Verification
Real-time patient eligibility and benefit verification against 1,400+ commercial and government payers. Average response time under 800ms.
X12 270/271Prior Authorization
Electronic prior authorization requests and status inquiries. Supports CMS Prior Authorization Rule (CMS-0057-F) requirements for Medicare Advantage plans.
FHIR Da Vinci PASRemittance & Payment
Retrieve electronic remittance advice (ERA) and reconcile payments. Automated posting of explanation of benefits (EOB) to practice management systems.
X12 835Supported Transaction Sets
MedRelay operates as a HIPAA-designated healthcare clearinghouse under 45 CFR § 162. All X12 transactions conform to the ANSI ASC X12 Version 5010A1 standard mandated by CMS.
| Transaction | X12 Set | Description | Direction |
|---|---|---|---|
| Healthcare Claim | 837P / 837I / 837D | Professional, institutional, and dental claim submission with ICD-10-CM/PCS and CPT/HCPCS coding | Provider → Payer |
| Claim Payment | 835 | Electronic remittance advice with CARC/RARC adjustment reason codes | Payer → Provider |
| Eligibility Inquiry | 270 / 271 | Real-time eligibility verification including copay, deductible, and out-of-pocket accumulator data | Bidirectional |
| Claim Status | 276 / 277 | Claim status inquiry and response with adjudication detail | Bidirectional |
| Prior Authorization | 278 | Health care services review request and response for pre-certification | Bidirectional |
| Enrollment | 834 | Benefit enrollment and maintenance for group health, dental, and vision plans | Sponsor → Payer |
| Premium Payment | 820 | Health plan premium payment and remittance | Sponsor → Payer |
Quick Start — Eligibility Check
Submit an eligibility verification request to confirm a patient's active coverage, copay obligations, and remaining deductible. This endpoint returns real-time responses from the patient's health plan.
Workers' Compensation & Disability
MedRelay supports workers' compensation first report of injury (FROI) and subsequent report of injury (SROI) transactions via IAIABC EDI Release 3.1. Disability claims for short-term (STD) and long-term (LTD) group disability plans are supported via our proprietary REST API, with FHIR-based integration planned for Q4 2026.
For insurance carriers writing group disability and workers' compensation policies, MedRelay provides bulk claims ingestion, automated ICD-10 validation, and real-time integration with state workers' compensation boards across all 50 states and the District of Columbia.
Payer Network
MedRelay maintains direct connections to over 1,400 commercial health plans, all state Medicaid programs, Medicare Parts A/B/C/D, TRICARE, and the Federal Employees Health Benefits (FEHB) program. Our clearinghouse processes over 2.1 billion healthcare transactions annually with a 99.97% uptime SLA.