> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# 2026-07-27

This release adds three Elation Billing tables to the Hosted Database: two that cover insurance eligibility from different angles, and one that tracks how a claim moves through the clearinghouse. It also converts the guarantor flag on `patient_guarantor` to a boolean.

## New Tables

| Table                           | Description                                                                                                                                             |
| ------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------- |
| insurance\_eligibility\_check   | Individual insurance eligibility verification checks sent to a payer through the ClaimMD clearinghouse, and the result of each.                         |
| patient\_insurance\_eligibility | Eligibility and coverage detail for a patient's insurance - eligibility status and check date, Medicare code, and the coverage window.                  |
| clearinghouse\_transaction      | Lifecycle events for a claim as it moves through the ClaimMD clearinghouse - submitted, acknowledged, accepted or rejected, ERA received, crossed over. |

## Schema Changes

| Table              | Column      | Change                                                           |
| ------------------ | ----------- | ---------------------------------------------------------------- |
| patient\_guarantor | `guarantor` | Renamed to `is_guarantor` and changed from a number to a boolean |

***

## Release Highlights

**insurance\_eligibility\_check**

A verification request sent to a payer through the ClaimMD clearinghouse, together with its outcome. `is_eligible` carries the payer's determination (`true` = active or eligible coverage, `false` = inactive) and is the source of the eligibility status carried on `patient_insurance`. `is_internal` separates checks triggered by an internal Elation pathway, such as EHR insurance sync or agentic billing, from those a billing user ran. Join to `patient` and `patient_insurance` for the patient and the policy that were checked. See the [Insurance Eligibility Check article](/articles/hdb/insurance-eligibility-check) for example queries.

**patient\_insurance\_eligibility**

The eligibility and coverage fields the `patient_insurance` policy record does not carry - eligibility status and the date it was last checked, the Medicare Secondary Payer value code, and the coverage start and end dates, keyed to a patient's insurance. The two eligibility tables answer different questions: `insurance_eligibility_check` records each individual check as it happened, while `patient_insurance_eligibility` records the resulting state for the policy. Note that `is_active` marks the current, non-superseded record rather than coverage being in effect - use `coverage_start` and `coverage_end` for that. See the [Patient Insurance Eligibility article](/articles/hdb/patient-insurance-eligibility) for example queries.

**clearinghouse\_transaction**

Each lifecycle event for a claim as it moves through ClaimMD, giving you the claim's full path over time. `type` is the normalized lifecycle category (for example `SUBMITTED`, `ACKNOWLEDGED`, `accepted`, `DENIED`, `REJECTED`, `ERA RECEIVED`, `CROSSOVER`) and `status` is the detailed, human-readable message for the same event, which usually names the payer. `claimmd_id` is the identifier the clearinghouse assigned, useful for tracing a transaction back to ClaimMD, and is not a Hosted Database key. See the [Clearinghouse Transaction article](/articles/hdb/clearinghouse-transaction) for example queries.

**`patient_guarantor.guarantor` is now the boolean `is_guarantor`**

The `guarantor` column on `patient_guarantor` was a number holding 0 or 1. It is now a boolean named `is_guarantor`. `true` means the patient has a distinct responsible party on file and the `resp_*` fields are populated; `false` means the patient is their own guarantor or none is recorded, and the `resp_*` fields are blank. Queries that referenced `guarantor` need updating:

```sql theme={null}
select *
from patient_guarantor
where is_guarantor
  and is_deleted = false
```

See the [Patient Guarantor article](/articles/hdb/patient-guarantor) for example queries.

<Info>
  These tables are present only for practices on the Elation Billing product. If your practice is not on Elation Billing, they are not created in your Hosted Database.
</Info>

*If you have any questions about this topic please reach out to [Elation Support Portal](/articles/support-portal-introduction) with the subject line HDB - \<your\_question>*