Sohar

Over the last few years new federal and state regulations have reshaped how healthcare organisations handle pricing transparency. Hospitals and payers are now required to provide clear, upfront cost information and patients increasingly expect it before care is delivered.

That's where Sohar's Cost Estimate API comes in. Launched in beta today, the Cost Estimate API makes it simple to generate real-time, itemised patient cost estimates - combining verified eligibility, network data, and pricing logic into a single, automated workflow. We're opening access to anyone who wants to start building with it - if you'd like access, we'd love to hear from you.

Once you've verified coverage and confirmed the provider is in-network, the final question is simple: "What will this cost the patient?". The Cost Estimate API answers that - programmatically.

How the Cost Estimate API Works

You pass the API a Verification ID along with provider, network and service-line details.

The response returns payer-paid amounts, patient responsibility and adjustments for each billing code - a complete cost breakdown that can be shown to staff or patients.

Example Request

curl --request POST \
  --url https://api.soharhealth.com/v1/cost-estimate \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "verificationId": "fb701ac1-1246-4860-b1ec-bd916b97a990",
    "tin": "123456789",
    "networkStatus": "inn",
    "tier": 1,
    "lines": [
      { "code": "90837", "contractedRate": 100 },
      { "code": "99213", "contractedRate": 80 }
    ]
  }'

Example Response

{
  "requestId": "0880d50e-7258-4d1d-98cd-ed49e75e18e6",
  "paidAmount": 180,
  "patientResponsibility": 120,
  "lines": [
    {
      "code": "90837",
      "adjustments": [
        { "reasonCode": "1", "amount": 50 },
        { "reasonCode": "2", "amount": 30 }
      ]
    },
    {
      "code": "99213",
      "adjustments": [
        { "reasonCode": "1", "amount": 25 },
        { "reasonCode": "3", "amount": 15 }
      ]
    }
  ]
}

What You Get Back

Each Cost Estimate response includes:

Patient responsibility: Expected out-of-pocket cost
Paid amount: Expected payer reimbursement
Line items: Adjustments per billing code, including reason codes and amounts

With this data, developers can power patient-facing price transparency tools, pre-service estimate workflows and internal financial reporting and payment counseling.

Best Practices

Always verify first: Use a valid verificationId with complete.eligible status.
Include network context: Provide networkStatus and tier for accurate results.
Refresh periodically: Deductibles and accumulators shift - re-estimate monthly or when benefits change.
Surface reason codes: Display adjustment details to explain why costs are what they are.

Note: At present, the contracted rate is a required input for each line item. In future releases, Sohar will automatically populate contracted rates based on payer, provider, and billing code - so developers can generate estimates without manually managing fee schedules.

Why It Matters

The push for pricing transparency isn't just regulatory - it's transforming patient expectations. Patients want to understand their coverage and cost before care. Providers want to give that clarity without complex payer integrations.

Sohar's Cost Estimate API makes that possible - combining verified benefits, network data, and pricing logic into a single, standardised response. For patients, it's clarity. For providers, it's compliance and efficiency.

Where This Fits in Flows

Verification → Network Status → Cost Estimate: Confirm coverage, in-network status, and cost before scheduling
Discovery → Verification → Cost Estimate: Go from minimal patient info to full price transparency

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