Bearer authentication header of the form Bearer <token>, where <token> is your auth token.
Data · object
*
Required
object
Models a request to create a benefit verification.
Add Example Value
drugs
Drugs · array
*
drugs
Required
array
Array of medications for which to perform the benefit verification.
drug_history
Drug History · object
drug_history
object
The patient's drug history. Although not a required field, this will increase the completion rate of your benefit verifications by 5%-10% if you provide it.
currently_taking_drugs
Currently Taking Drugs · array
currently_taking_drugs
array
The drugs that the patient is currently taking.
previously_taken_drugs
Previously Taken Drugs · array
previously_taken_drugs
array
The drugs that the patient has previously taken.
diagnoses
Diagnoses · array
diagnoses
array
Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'
insurance
Insurance · array
insurance
array
Insurance information for the patient. We will extract the required information from the insurance card images you provide. Please provide both the front and the back of the card.
insurance_content
Insurance Content · object
insurance_content
object
Insurance information for the patient. Values provided here will be used in combination with those extracted from any insurance cards provided. We recommend providing this information when available to ensure best results.
client_name
Client Name · string
client_name
string
The client/employer name.
group_number
Group Number · string
group_number
string
The group number on the card.
member_name
Member Name · string
member_name
string
The member name on the card.
member_number
Member Number · string
member_number
string
The member number on the card.
payer_name
Payer Name · string
payer_name
string
The payer name on the card. This field is not normalized, so the same plan may have different names depending on the way it appears on the card. i.e. 'United Healthcare', 'United', 'United Health' could all appear
plan_name
Plan Name · string
plan_name
string
The plan name on the card. This field is not normalized, so the same plan may have different names depending on the way it appears on the card
rx_bin
Rx Bin · string
rx_bin
string
The Rx BIN number on the card.
rx_group
Rx Group · string
rx_group
string
The Rx group number on the card.
rx_pcn
Rx Pcn · string
rx_pcn
string
The Rx PCN number on the card.
patient
Patient · object
*
patient
Required
object
Demographic information for the patient
internal_id
Internal Id · string
*
internal_id
Required
string
Your internal ID for this patient. This is used for linking all of the requests for a given patient.
first_name
First Name · string
*
first_name
Required
string
The first name of the patient.
last_name
Last Name · string
*
last_name
Required
string
The last name of the patient.
gender
Gender · enum<string>
*
gender
Required
enum<string>
The gender of the patient.
date_of_birth
Date Of Birth · string
*
date_of_birth
Required
string
The date of birth of the patient.
address
Address · object
*
address
Required
object
The address of the patient.
street
Street · string
*
street
Required
string
Street address of residence.
street_line_2
Street Line 2 · string
street_line_2
string
Additional street address information.
city
City · string
*
city
Required
string
City of residence.
state_province
State Province · string
*
state_province
Required
string
State or province of residence.
zip_postal_code
Zip Postal Code · string
*
zip_postal_code
Required
string
ZIP or postal code part of the address.
country
Country · string
*
country
Required
string
Country of residence.
phone
Phone · string
phone
string
The contact phone number of the patient.
email
Email · string
email
string
The contact email address of the patient.
provider
Provider · object
*
provider
Required
object
Details of the healthcare provider whose NPI number can be used for the benefit verification.
first_name
First Name · string
*
first_name
Required
string
The first name of the provider.
last_name
Last Name · string
*
last_name
Required
string
The last name of the provider.
address
Address · object
*
address
Required
object
The address of the provider.
street
Street · string
*
street
Required
string
Street address of residence.
street_line_2
Street Line 2 · string
street_line_2
string
Additional street address information.
city
City · string
*
city
Required
string
City of residence.
state_province
State Province · string
*
state_province
Required
string
State or province of residence.
zip_postal_code
Zip Postal Code · string
*
zip_postal_code
Required
string
ZIP or postal code part of the address.
country
Country · string
*
country
Required
string
Country of residence.
phone
Phone · string
phone
string
The contact phone number of the provider.
npi
Npi · string
*
npi
Required
string
The National Provider Identifier (NPI) of the provider.
in_network_payers
In Network Payers · array
in_network_payers
array
List of insurance payers that the provider is in-network with. This is optional and no longer seems to have much of an impact on the verification process. You can omit this if it is not readily available information
entity
Entity · object
entity
object
A large proportion (20%+) of payers will often ask for information on the legal entity that the provider is associated with. Without this information the benefit verification will fail. Although this is currently optional it will be required in the future. We highly recommend providing this information.
legal_name
Legal Name · string
legal_name
string
The legal name of the entity. This is the name that the provider is associated with.
tax_id
Tax Id · string
tax_id
string
The tax identifier of the entity. This is the tax ID that the provider is associated with.
mock_result
Mock Result · object
mock_result
object
Specifies the simulated outcome for a completed verification. These values will be applied to all drugs in the request.
status
MockResultStatus · enum<string>
*
status
Required
enum<string>
An enumeration.
case
MockResultCase · enum<string>
*
case
Required
enum<string>
The case to simulate for the benefit verification. The options are:
drugs_covered__prior_auth_required__has_copay: Drug is covered, prior authorization required, and there is a copay.
drugs_covered__prior_auth_required__no_copay: Drug is covered, prior authorization required, but there is no copay.
drugs_covered__prior_auth_not_required__has_copay: Drug is covered, no prior authorization required, and there is a copay.
drugs_covered__prior_auth_not_required__no_copay: Drug is covered, no prior authorization required, and there is no copay.
drugs_not_covered__prior_auth_na__no_copay: Drug is not covered, prior authorization not applicable (because the drug is not covered), and there is no copay.
Checks if multiple drugs are covered by a patient’s insurance plan. You’ll receive details including whether the drug is covered, if a prior authorization is required, and copay information if availble.
Please be aware that since this endpoint initiates a real-time, AI call, response times may vary. To accommodate
efficient testing, we’ve implemented the mock_result argument, allowing for the simulation of responses from the
endpoint. When this argument is provided, we’ll (almost) instantly complete the benefit verification with results to match the case that you provide.
You’ll receive the webhook containing the full benefit verification payload.
For specifics on which cases you can mock, please refer to the mock_result property in the API specification below.
When in production, you should expect approxately 1 business day before a benefit verification is completed. You’ll need to subscribe to the benefit_verification.updated webhook event in order to receive the final response.
Try to provide as many of the fields as possible to improve the accuracy and completion rate of the benefit verification. If you have any questions on the importance of certain fields please reach out to us and we can help clarify.
Authorizations
Authorization
string
headerrequired
Bearer authentication header of the form Bearer <token>, where <token> is your auth token.
Body
application/json
drugs
object[]
required
Array of medications for which to perform the benefit verification.
drugs.name
string
required
The name of the drug.
drugs.dosage
string
required
The prescribed dosage of the drug.
drugs.quantity
number
required
The quantity of the drug prescribed.
drug_history
object
The patient's drug history. Although not a required field, this will increase the completion rate of your benefit verifications by 5%-10% if you provide it.
drug_history.currently_taking_drugs
object[]
The drugs that the patient is currently taking.
drug_history.currently_taking_drugs.name
string
required
The name of the drug.
drug_history.previously_taken_drugs
object[]
The drugs that the patient has previously taken.
drug_history.previously_taken_drugs.name
string
required
The name of the drug.
diagnoses
object[]
Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'
diagnoses.code
string
required
ICD-10 code for the diagnosis. i.e. 'E66.9'
insurance
object[]
Insurance information for the patient. We will extract the required information from the insurance card images you provide. Please provide both the front and the back of the card.
insurance.file_content
string
required
The content of the insurance document, base64 encoded
insurance_content
object
Insurance information for the patient. Values provided here will be used in combination with those extracted from any insurance cards provided. We recommend providing this information when available to ensure best results.
insurance_content.client_name
string
The client/employer name.
insurance_content.group_number
string
The group number on the card.
insurance_content.member_name
string
The member name on the card.
insurance_content.member_number
string
The member number on the card.
insurance_content.payer_name
string
The payer name on the card. This field is not normalized, so the same plan may have different names depending on the way it appears on the card. i.e. 'United Healthcare', 'United', 'United Health' could all appear
insurance_content.plan_name
string
The plan name on the card. This field is not normalized, so the same plan may have different names depending on the way it appears on the card
insurance_content.rx_bin
string
The Rx BIN number on the card.
insurance_content.rx_group
string
The Rx group number on the card.
insurance_content.rx_pcn
string
The Rx PCN number on the card.
patient
object
required
Demographic information for the patient
patient.internal_id
string
required
Your internal ID for this patient. This is used for linking all of the requests for a given patient.
patient.first_name
string
required
The first name of the patient.
patient.last_name
string
required
The last name of the patient.
patient.gender
enum<string>
required
The gender of the patient.
Available options:
male,
female,
other,
not_specified
patient.date_of_birth
string
required
The date of birth of the patient.
patient.address
object
required
The address of the patient.
patient.address.street
string
required
Street address of residence.
patient.address.street_line_2
string
Additional street address information.
patient.address.city
string
required
City of residence.
patient.address.state_province
string
required
State or province of residence.
patient.address.zip_postal_code
string
required
ZIP or postal code part of the address.
patient.address.country
string
required
Country of residence.
patient.phone
string
The contact phone number of the patient.
patient.email
string
The contact email address of the patient.
provider
object
required
Details of the healthcare provider whose NPI number can be used for the benefit verification.
provider.first_name
string
required
The first name of the provider.
provider.last_name
string
required
The last name of the provider.
provider.address
object
required
The address of the provider.
provider.address.street
string
required
Street address of residence.
provider.address.street_line_2
string
Additional street address information.
provider.address.city
string
required
City of residence.
provider.address.state_province
string
required
State or province of residence.
provider.address.zip_postal_code
string
required
ZIP or postal code part of the address.
provider.address.country
string
required
Country of residence.
provider.phone
string
The contact phone number of the provider.
provider.npi
string
required
The National Provider Identifier (NPI) of the provider.
provider.in_network_payers
string[]
List of insurance payers that the provider is in-network with. This is optional and no longer seems to have much of an impact on the verification process. You can omit this if it is not readily available information
entity
object
A large proportion (20%+) of payers will often ask for information on the legal entity that the provider is associated with. Without this information the benefit verification will fail. Although this is currently optional it will be required in the future. We highly recommend providing this information.
entity.legal_name
string
The legal name of the entity. This is the name that the provider is associated with.
entity.tax_id
string
The tax identifier of the entity. This is the tax ID that the provider is associated with.
mock_result
object
Specifies the simulated outcome for a completed verification. These values will be applied to all drugs in the request.
mock_result.status
enum<string>
required
An enumeration.
Available options:
completed
mock_result.case
enum<string>
required
The case to simulate for the benefit verification. The options are:
drugs_covered__prior_auth_required__has_copay: Drug is covered, prior authorization required, and there is a copay.
drugs_covered__prior_auth_required__no_copay: Drug is covered, prior authorization required, but there is no copay.
drugs_covered__prior_auth_not_required__has_copay: Drug is covered, no prior authorization required, and there is a copay.
drugs_covered__prior_auth_not_required__no_copay: Drug is covered, no prior authorization required, and there is no copay.
drugs_not_covered__prior_auth_na__no_copay: Drug is not covered, prior authorization not applicable (because the drug is not covered), and there is no copay.
