API Documentation
Changelog
July 25th 2024
Benefit Verification
- Added diagnoses list to the benefit verification request. We recommend providing this field to improve the accuracy of the benefit verification.
- Added a new coverage_detail_code field to the drugs object in a benefit verification response. This field is only for reference purposes and can generally be ignored
Prior Authorization
- Added an activity log list to the prior authorization response. You can use this to download the faxes we have sent and received into your own system.
July 5th 2024
Prior Authorization
- Added a mock_result property to allow for the submission of a mock result for testing purposes.
- Added insurance_content to the request body to allow for the submission of discrete insurance details.
Benefit Verification
- Added insurance_content to the request body to allow for the submission of discrete insurance details.
June 13th 2024
Prior Authorization
Updates to the “Retrieve Prior Authorization” response
- Only include
data.outcome.authorization_expiration
for “Approval” result - Add descriptions for
data.outcome.result
May 14th 2024
Prior Authorization
Updates to the “Retrieve Prior Authorization” response
- Group
data.outcome
responses to show correspondingresult
,detail
, anddetail_code
values. - List and describe possible values for
data.outcome.detail_code
.
May 13th 2024
Prior Authorization
Updates to the “Retrieve Prior Authorization” response
- Updated possible values for the
data.outcome.result
field. - Removed the
data.submission
field. - Standardized naming of the
date_created
field in Evidence, Questionnaire, and Visit Notes.
May 11th 2024
Benefit Verification
- Removed the partially_completed status. We realized this was unnecessary and confusing. Now there is just pending, completed, and failed statuses.
Prior Authorization
- Updated the top level statuses
- Renamed outcome.status to outcome.result ensure it’s not mixed up with the top level status
Feb 29th 2024
- Updated quickstart page to more accurately reflect current API endpoints.
Prior Authorization
- Updated prior authorization endpoint title from “Submit” to “Autofill”
- Removed coming soon from prior authorization endpoints
- Removed the option to send diagnosis description in the prior authorization request. For now we’ll just accept the diagnosis code.
Benefit Verification
- Marked gender as required in the benefit verification endpoint documentation to match existing functionality of the API.
- Removed ‘coming soon’ from the insurance scanned content object. This is now live.
Feb 25th 2024
Benefit Verification
The following changes were made in the benefit verification endpoint:
- Added ‘call_fallback’ as a possible option for verification_method type
- Marked transcript and recording_url as nullable
- Marked street_line_2 as nullable in the patient and provider address objects
Feb 21st 2024
Benefit Verification
- The “Benefit Verification Updated” webhook payload now includes the full Benefit Verification object.
Feb 13th 2024
Benefit Verification Endpoint Updates
- Added structured copay information
- Added details of the upcoming insurance scanned_result object to the insurance body. This will start being returned soon.
Prior Authorization Endpoint Updates
We made various updates to the prior authorization endpoint to match the benefit verification endpoint and make it production ready. You’ll soon be able to submit requests to it. In the meantime the spec as it now stands in the docs is accurate and will be supported.
- Moved insurance property from nested under patient to the top level to match the benefit verification endpoint. The structure has been updated to match the benefit verification endpoint.
- Added optional pharmacy property
- Updated prescription property
- added required quantity property
- made directions property required
- added required strength property
- added required dose_form property
- added required dispense_unit property
- added required route_of_administration property
- Added outcome and submission objects into the prior authorization response. These will also be made available via the webhook. These objects include details such as the prior authorization status, and a url to open the prior auth in the submission platform.
- Pushed support for arbitrary evidence files (PDFs, images, etc) to a future update. Currently we will support JSON formatted data, which can be unstructured text.
May 17th 2024
Prior Authorization
- Added an optional
is_training_data
field to theCreatePriorAuthRequest
object to indicate whether the request is for training purposes.- If
is_training_data
is set totrue
, the request will not be processed. - If
is_training_data
is set tofalse
or omitted, the request will be processed as normal.
- If
Misc
- Updated the following fields to enforce non-empty strings:
first_name
inPatient
andPatientInfo
last_name
inPatient
andPatientInfo
internal_id
inPatient
first_name
inProvider
andProviderInfo
last_name
inProvider
andProviderInfo
npi
inProvider
andProviderInfo
- Updated the following fields to be nullable:
phone
inPatientInfo
phone
inProvider
andProviderInfo
July 3rd 2024
Benefit Verification
- Added a new optional
drug_history
field to theCreateBenefitVerificationRequest
object to allow for the submission of a patient’s drug history. - Added a new optional
insurance_content
field to theCreateBenefitVerificationRequest
object to allow for the submission of insurance details.- This field should be used if no insurance card image can be provided in
insurance
.
- This field should be used if no insurance card image can be provided in
July 5th 2024
Misc
- Added a new
not_specified
option to theGender
enum.- This option should be used when the patient’s gender has not been provided.
July 15th 2024
Benefit Verifications
- Added new error codes for Benefit Verifications
Insurance Unable to Provide Information
Unable to Gather Benefits
Insurance Card OCR Failure
- This error code replaces
Insurance Card Member ID OCR Failure
and covers a broader range of OCR failures.
- This error code replaces
September 2nd 2024
Prior Authorization
- Added a new
other
detail code for thedata.outcome.detail_code
field.