> ## Documentation Index > Fetch the complete documentation index at: https://docs.verial.ai/llms.txt > Use this file to discover all available pages before exploring further. # Eligibility Check > Verify insurance eligibility through a clearinghouse simulator. ## User Prompt > "Set up an environment with a clearinghouse and test whether my agent can verify patient eligibility." ## Tool Call Sequence **Call:** `simulators` ```json theme={null} { "action": "create", "type": "Clearinghouse", "name": "Availity Clearinghouse" } ``` **Response:** ```json theme={null} { "id": "sim_ch_01", "type": "Clearinghouse", "name": "Availity Clearinghouse", "config": null, "createdAt": "2026-04-06T12:00:00Z" } ``` **What the agent learns:** The clearinghouse simulator is created. It will accept 270/271 eligibility transactions once provisioned in a playground. **Call 1:** `environments` ```json theme={null} { "action": "create", "name": "Eligibility Testing", "description": "Clearinghouse environment for verifying patient insurance eligibility" } ``` **Response:** ```json theme={null} { "id": "env_elig_01", "name": "Eligibility Testing", "description": "Clearinghouse environment for verifying patient insurance eligibility", "simulators": [], "createdAt": "2026-04-06T12:00:01Z" } ``` **Call 2:** `environments` ```json theme={null} { "action": "addSimulator", "id": "env_elig_01", "simulatorId": "sim_ch_01" } ``` **Response:** ```json theme={null} { "id": "env_elig_01", "name": "Eligibility Testing", "simulators": [ { "id": "sim_ch_01", "type": "Clearinghouse", "name": "Availity Clearinghouse" } ] } ``` **What the agent learns:** The environment is ready with the clearinghouse attached. The agent creates a dataset containing a FHIR patient bundle with insurance coverage information. **Call:** `datasets` ```json theme={null} { "action": "create", "name": "Eligibility Test Patient", "format": "fhir", "data": { "resourceType": "Bundle", "type": "collection", "entry": [ { "resource": { "resourceType": "Patient", "id": "pat-001", "name": [{ "family": "Chen", "given": ["Maria"] }], "birthDate": "1985-03-14", "gender": "female", "address": [{ "state": "CA", "postalCode": "90210" }] } }, { "resource": { "resourceType": "Coverage", "id": "cov-001", "status": "active", "beneficiary": { "reference": "Patient/pat-001" }, "payor": [{ "display": "BlueCross BlueShield" }], "subscriberId": "BCB-998877", "class": [ { "type": { "coding": [{ "code": "plan" }] }, "value": "PPO Gold" } ], "period": { "start": "2026-01-01", "end": "2026-12-31" } } } ] } } ``` **Response:** ```json theme={null} { "id": "ds_elig_01", "name": "Eligibility Test Patient", "format": "fhir", "resourceCount": 2, "createdAt": "2026-04-06T12:00:02Z" } ``` **What the agent learns:** The dataset includes a patient (Maria Chen) with active BlueCross PPO Gold coverage. This data will be loaded into the sandbox so the clearinghouse returns realistic eligibility responses. The agent provisions the environment, finds the sandbox, and loads the patient dataset. **Call 1:** `playgrounds` ```json theme={null} { "action": "create", "environmentId": "env_elig_01" } ``` **Response:** ```json theme={null} { "id": "pg_elig_01", "environmentId": "env_elig_01", "status": "Active", "sandboxes": [ { "id": "sbx_ch_01", "simulatorId": "sim_ch_01", "type": "Clearinghouse", "status": "Active", "endpoint": "https://ch.verial.dev/sbx_ch_01" } ], "createdAt": "2026-04-06T12:00:03Z" } ``` **Call 2:** `sandboxes` ```json theme={null} { "action": "list", "playgroundId": "pg_elig_01" } ``` **Response:** ```json theme={null} { "items": [ { "id": "sbx_ch_01", "simulatorId": "sim_ch_01", "type": "Clearinghouse", "status": "Active", "endpoint": "https://ch.verial.dev/sbx_ch_01", "datasets": [] } ] } ``` **Call 3:** `sandboxes` ```json theme={null} { "action": "addDataset", "id": "sbx_ch_01", "datasetId": "ds_elig_01" } ``` **Response:** ```json theme={null} { "id": "sbx_ch_01", "datasets": [ { "id": "ds_elig_01", "name": "Eligibility Test Patient" } ] } ``` **What the agent learns:** The playground is live and the clearinghouse sandbox now has the patient data loaded. When the agent-under-test queries eligibility for Maria Chen (subscriber BCB-998877), the clearinghouse will return active PPO Gold coverage. The agent defines the benchmark, task, and eval in sequence. **Call 1:** `benchmarks` ```json theme={null} { "action": "create", "name": "Eligibility Verification", "environmentId": "env_elig_01", "timeout": 120 } ``` **Response:** ```json theme={null} { "id": "bm_elig_01", "name": "Eligibility Verification", "environmentId": "env_elig_01", "timeout": 120, "tasks": [], "createdAt": "2026-04-06T12:00:04Z" } ``` **Call 2:** `tasks` ```json theme={null} { "action": "create", "benchmarkId": "bm_elig_01", "name": "Verify patient eligibility", "instruction": "Check insurance eligibility for patient Maria Chen (DOB 1985-03-14, subscriber ID BCB-998877) through the clearinghouse. Confirm whether coverage is active and retrieve the plan details." } ``` **Response:** ```json theme={null} { "id": "task_elig_01", "benchmarkId": "bm_elig_01", "name": "Verify patient eligibility", "instruction": "Check insurance eligibility for patient Maria Chen (DOB 1985-03-14, subscriber ID BCB-998877) through the clearinghouse. Confirm whether coverage is active and retrieve the plan details.", "criteria": [], "createdAt": "2026-04-06T12:00:05Z" } ``` **Call 3:** `criteria` ```json theme={null} { "action": "create", "taskId": "task_elig_01", "name": "eligibility-verified", "assertion": { "type": "x12-response", "spec": { "transaction": "271", "coverage_status": "active" } }, "weight": 1.0 } ``` **Response:** ```json theme={null} { "id": "crit_elig_01", "taskId": "task_elig_01", "name": "eligibility-verified", "weight": 1.0, "createdAt": "2026-04-06T12:00:06Z" } ``` **What the agent learns:** The benchmark is fully defined with one task and one criterion. The criterion checks that the agent-under-test successfully verified eligibility and received an active coverage response. ## Agent Response > Your eligibility check environment and benchmark are ready: > > | Resource | ID | Detail | > | ----------- | ------------- | ----------------------------------------------- | > | Environment | `env_elig_01` | Clearinghouse simulator attached | > | Dataset | `ds_elig_01` | Maria Chen, BCB PPO Gold, subscriber BCB-998877 | > | Playground | `pg_elig_01` | Active at `https://ch.verial.dev/sbx_ch_01` | > | Benchmark | `bm_elig_01` | 1 task, 1 criterion, 120s timeout | > > Point your agent at the clearinghouse endpoint and run the benchmark with `benchmark_runs` create to start testing. ## Summary | Metric | Value | | ------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Tool calls | **9** | | Tools used | `simulators`, `environments`, `datasets`, `playgrounds`, `sandboxes`, `benchmarks`, `tasks`, `criteria` | | Key technique | Load patient data into the sandbox before running benchmarks so the clearinghouse returns realistic eligibility responses. The create-then-link pattern (simulator, environment, addSimulator, playground, addDataset) builds up the simulation layer by layer. |