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Python
import requests

url = 'https://api.simplex.sh/pa_verify_member'
headers = {
    'X-API-Key': 'your_api_key_here',
    'Content-Type': 'application/json'
}
data = {
    'credential_name': 'my_availity_creds',
    'payer_id': 'bcbs_tx',
    'member_id': 'WLR482913057',
    'patient_first_name': 'Michael',
    'patient_last_name': 'Chen',
    'patient_dob': '1985-03-14'
}

response = requests.post(url, headers=headers, json=data)
result = response.json()
print(f"Coverage: {result['coverage_status']}")
print(f"Plan: {result['plan_name']}")
print(f"Group: {result['group_number']}")
{
  "succeeded": true,
  "member_id": "<string>",
  "patient_first_name": "<string>",
  "patient_last_name": "<string>",
  "payer_name": "<string>",
  "coverage_status": "active",
  "patient_dob": "<string>",
  "plan_name": "<string>",
  "group_number": "<string>",
  "effective_date": "2023-12-25",
  "termination_date": "2023-12-25"
}
Always verify the member before submitting a prior auth. This confirms the member ID is valid, the patient is covered, and the plan is active — avoiding submission rejections.
Member verification results are payer-specific. Always pass the payer_id for the payer you intend to submit the prior auth to.

Authorizations

X-API-Key
string
header
required

Simplex API Key

Body

application/json
credential_name
string
required

The name of the stored credential to authenticate with the portal.

payer_id
string
required

The payer to verify against (e.g. "bcbs_tx", "anthem_bcbs").

member_id
string
required

The member's insurance ID number.

patient_first_name
string
required

Patient first name.

patient_last_name
string
required

Patient last name.

patient_dob
string<date>
required

Patient date of birth in YYYY-MM-DD format.

Response

200 - application/json

Verify member response

succeeded
boolean
required

Whether the verification was successful.

member_id
string
required

Confirmed member ID.

patient_first_name
string
required

Patient first name as registered with the payer.

patient_last_name
string
required

Patient last name as registered with the payer.

payer_name
string
required

Full payer name (e.g. "Blue Cross Blue Shield of Texas").

coverage_status
enum<string>
required

Current coverage status.

Available options:
active,
inactive,
terminated
patient_dob
string

Patient date of birth.

plan_name
string

Insurance plan name.

group_number
string

Insurance group number.

effective_date
string<date>

Coverage effective date (YYYY-MM-DD).

termination_date
string<date>

Coverage termination date, if applicable (YYYY-MM-DD).