POST
/
benefit-verification

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

Models a request to create a benefit verification.

drugs
object[]
required

Array of medications for which to perform the benefit verification.

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.

diagnoses
object[]

Clinical diagnoses for the patient in ICD-10 format. 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. This is optional if you provide insurance_content, but highly recommended to ensure best results.

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. If you provide both insurance and insurance_content, the values provided here will be used and the values extracted from insurance will be used as a fallback.

patient
object
required

Demographic information for the patient

provider
object
required

Details of the healthcare provider whose NPI number can be used for the benefit verification.

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.

mock_result
object

Specifies the simulated outcome for a completed verification. These values will be applied to all drugs in the request.

use_patient_plan_fund_source_check
boolean
default: false

Whether to check the patient's plan fund source during the benefit verification call.

Response

200 - application/json

Models the response received upon creating a benefit verification request.

status
default: success
Available options:
success
error
object
data
object

Represents the data contained in the response for a create benefit verification request.