--- title: "Get Benefit Verification Route" method: GET path: "/benefit-verification/{id}" tags: ["public-api"] --- # Get Benefit Verification Route `GET /benefit-verification/{id}` ## Path parameters - `id` string, required ## Response `200` Successfully returned a benefit verification - GetBenefitVerificationResponse — Represents the response structure for a benefit verification query in a healthcare context. This class extends the generic ApiResponse, specifically tailored to handle responses related to benefit verifications. It primarily includes the data attribute, which holds detailed information about the benefit verification process and its results. - `status` union - 'success' - 'error' - `error` ApiError - `title` string, required - `description` string, required - `code` string, required - `data` GetBenefitVerificationResponseData — Represents the data the data contained in the response for a get benefit verification request. - `id` string, required — The ID of the benefit verification request. - `object` 'benefit_verification' — The type of object the response is about, which is 'benefit_verification'. - `status` 'pending' | 'failed' | 'completed' | 'cancelled', required — An enumeration. - `status_description` string, required — Provides additional information about the verification status. - `error` FailureDetails — Represents status details about a failed benefit verification. - `title` string, required — A brief title summarizing the error. - `code` 'Patient Not Found' | 'Insurance Card OCR Failure' | 'Insurance Unable to Provide Information' | 'Document Quality Error' | 'Document Info Missing or Incorrect' | 'Unable to Route Call' | 'Unable to Gather Benefits' | 'Internal Error' | 'Provider Not Authorized' | 'Patient Consent Required' — An enumeration. - `detail_code` union — A more detailed code that can be used to identify the specific issue that caused the error. - 'incorrect_member_id' | 'incorrect_dob' | 'incorrect_address' | 'incorrect_phone_number' | 'missing_member_id' | 'medical_only_member_id' | 'name_mismatch' — An enumeration. - 'missing_tax_id' | 'incorrect_tax_id' | 'incorrect_npi' | 'patient_consent_required' | 'patient_declined_consent' | 'kaiser_prescriber_required' | 'expired' — An enumeration. - `message` string — A detailed message explaining the error, such as: 'We were unable to extract the member ID from the insurance card image provided, the image(s) my be unclear.' These messages may be unique to the specific benefit verification request. - `detail_message` string — A more detailed message that can be used to identify the specific issue that caused the error. - `review_status` 'reviewed' | 'not_reviewed', required — An enumeration. - `drugs` DrugCoverageInfo[], required — List of drug coverage information related to the verification. - `name` string, required — The name of the drug. - `dosage` string, required — The prescribed dosage of the drug. - `quantity` number, required — The quantity of the drug prescribed. - `ndc` string, nullable — The National Drug Code (NDC) of the drug. Read-only; this field is ignored on input and populated from the resolved drug data. - `coverage` 'covered' | 'not_covered' — An enumeration. - `coverage_detail_code` 'insurer_reported_value' | 'diagnoses_not_covered' | 'quantity_limit_pa_required' — An enumeration. - `prior_authorization_required` 'yes' | 'no' | 'not_applicable' — An enumeration. - `copay` string, nullable — This field will start off as null and will be populated if the benefit verification is successfully completed and a copay is received. - `copay_options` CopayOption[], nullable — A structured representation of the copay options for the drug. - `amount_cents` integer — The amount of the copay in cents. - `supply_duration_days` integer — The duration of the supply in days. Use null if unknown. - `determination_details` DrugCoverageDeterminationDetails - `is_on_formulary` boolean, nullable — Whether the drug is on the formulary for the patient's plan. - `is_explicit_plan_exclusion` boolean, nullable — Whether the drug is explicitly excluded from the patient's plan. - `is_prior_auth_acting_as_exception_request` boolean, nullable — Whether the prior authorization is acting as an exception request. This is only applicable if the drug is not on the formulary. - `has_active_prior_auth` boolean, nullable — Whether there is an active prior authorization for this drug. Only set if operating if explicitly requested by the original API call. - `drug_history` DrugHistory — Represents the history of drugs taken by a patient. - `currently_taking_drugs` DrugHistoryItem[] — The drugs that the patient is currently taking. - `name` string, required — The name of the drug. - `previously_taken_drugs` DrugHistoryItem[] — The drugs that the patient has previously taken. - `name` string, required — The name of the drug. - `diagnoses` Diagnosis[] — List of diagnoses for the patient. - `code` string, required — ICD-10 code for the diagnosis. i.e. 'E66.9' - `patient` ApiSchemasPlatformPublicApiCommonPatientInfo, required — Contains information about a patient. - `internal_id` string, required — Your internal ID for this patient. This is used for linking all of the requests for a given patient. - `first_name` string, required — The first name of the patient. - `last_name` string, required — The last name of the patient. - `gender` 'male' | 'female' | 'other' | 'not_specified', required — An enumeration. - `date_of_birth` string, date, required — The date of birth of the patient. - `address` Address, required — Represents a postal address. - `street` string, required — Street address of residence. - `street_line_2` string — Additional street address information. - `city` string, required — City of residence. - `state_province` string, required — State or province of residence. - `zip_postal_code` string, required — ZIP or postal code part of the address. - `country` string — Country of residence. - `phone` string — The contact phone number of the patient. - `email` string — The contact email address of the patient. - `provider` ProviderInfo, required — Contains information about a healthcare provider. - `first_name` string, required — The first name of the provider. - `last_name` string, required — The last name of the provider. - `address` Address, required — Represents a postal address. - `street` string, required — Street address of residence. - `street_line_2` string — Additional street address information. - `city` string, required — City of residence. - `state_province` string, required — State or province of residence. - `zip_postal_code` string, required — ZIP or postal code part of the address. - `country` string — Country of residence. - `phone` string — The contact phone number of the provider. - `fax` string — The contact fax number of the provider. - `npi` string, required — The National Provider Identifier (NPI) of the 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` EntityInfo — Contains information about a healthcare entity. - `legal_name` string — The legal name of the entity. This is the name that the provider is associated with. - `tax_id` string — The tax identifier of the entity. This is the tax ID that the provider is associated with. - `insurance` InsuranceDocumentInfo[], required — Insurance information for the patient. - `scanned_content` ScannedContent, required - `client_name` string — The client/employer name. - `group_number` string — The group number on the card. - `member_name` string — The member name on the card. - `member_number` string — The member number on the card. - `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` 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` string — The Rx BIN number on the card. - `rx_group` string — The Rx group number on the card. - `rx_pcn` string — The Rx PCN number on the card. - `error` string — Error message if we were unable to extract information from the card. - `discrete_content` PartialInsuranceInfo, required - `client_name` string — The client/employer name. - `group_number` string — The group number on the card. - `member_name` string — The member name on the card. - `member_number` string — The member number on the card. - `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` 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` string — The Rx BIN number on the card. - `rx_group` string — The Rx group number on the card. - `rx_pcn` string — The Rx PCN number on the card. - `url` string — If applicable, the Base64 encoded insurance card image you send in the request is stored on our servers. A signed URL to the image is returned here. This URL has a short expiry time, so you should download the image immediately after receiving it if you want to view the asset. - `pharmacy_benefit_manager_name` string — The name of the pharmacy benefit manager (PBM) responsible for the patient's coverage. E.g. 'OptumRx' or 'Express Scripts'. May be null if the PBM's name is not available. - `patient_coverage_status` 'patient_not_found' | 'coverage_expired' | 'coverage_not_started' | 'covered' | 'patient_not_covered_unspecified' | 'human_unable_to_answer' | 'missing_from_transcript' | 'unknown', required — An enumeration. - `verification_methods` BenefitVerificationMethodInfo[], required — List of verification methods used to determine the coverage status of the drug. These will contain evidence from the verification procedure, such as a transcript of the phone conversation between the AI and the insurance provider. - `id` string, required — The ID of the verification method. - `type` string, required — The type of the verification method. - `transcript` string — The call transcript - `recording_url` string — The URL to the call recording - `mock_result` MockResult - `status` 'completed' | 'failed', required — An enumeration. - `case` 'drugs_covered__prior_auth_required__has_copay' | 'drugs_covered__prior_auth_required__no_copay' | 'drugs_covered__prior_auth_not_required__has_copay' | 'drugs_covered__prior_auth_not_required__no_copay' | 'drugs_not_covered__prior_auth_na__no_copay' | 'patient_consent_required' | 'reverification__existing_pa' | 'reverification__no_existing_pa', required — An enumeration. - `patient_plan_fund_source` 'commercial' | 'government' | 'question_not_asked' | 'unable_to_determine' — The source of the patient's plan funding. - `patient_coverage_type` 'medicare' | 'medicare_advantage' | 'tricare' | 'medicaid' | 'other' | 'question_not_asked' | 'unable_to_determine' — The type of coverage the patient has. - `priority` 0 | 1 | 2 | 3, required — Represents a priority level. Lower numbers are higher priority. - CRITICAL: 0 - HIGH: 1 - MEDIUM: 2 - LOW: 3 - `replaced_by` string — If this Benefit Verification was canceled and subsequently resubmitted, this field stores the ID of the new (replacement) Benefit Verification. - `replaces` string — If this Benefit Verification was submitted as a replacement for a canceled one, this field stores the ID of the canceled Benefit Verification it replaces. - `triggered_by_pa_id` string — The ID of the PA request that triggered this benefit verification, if applicable. ## Other responses - `422` — Validation Error --- [API](https://skmtc.net/develophealth/apis/develop-health-public-api.md) · [All operations](https://skmtc.net/develophealth/apis/develop-health-public-api/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/develophealth/develop-health-public-api/revisions/1684e1dda9be/schema)