---
title: "Create Benefit Verification Route"
method: POST
path: "/benefit-verification"
tags: ["public-api"]
---

# Create Benefit Verification Route

`POST /benefit-verification`

## Request body

- CreateBenefitVerificationRequest — Models a request to create a benefit verification.
  - `priority` 0 | 1 | 2 | 3 — Represents a priority level. Lower numbers are higher priority. - CRITICAL: 0 - HIGH: 1 - MEDIUM: 2 - LOW: 3
  - `replaces` string — If this Benefit Verification is being submitted as a replacement for a canceled one, the ID of the canceled Benefit Verification it replaces.
  - `drugs` union, required — Array of medications for which to perform the benefit verification. Prefer coded drugs when NDCs are available.
    - CodedDrugInfo[]
      - `ndc` string, required — The NDC of the medication.
      - `quantity` integer, required — The quantity of the drug prescribed.
    - DrugInfo[]
      - `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.
  - `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[] — Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'
    - `code` string, required — ICD-10 code for the diagnosis. i.e. 'E66.9'
  - `insurance` ApiSchemasPlatformPublicApiBenefitVerificationInsuranceDocument[] — 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.
    - `file_content` string, required — The content of the insurance document, base64 encoded
  - `insurance_content` PartialInsuranceInfo
    - `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.
  - `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.
  - `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.
  - `use_patient_plan_fund_source_check` boolean — Whether to check the patient's plan fund source during the benefit verification call.

## Response `200`

Successful creation of a benefit verification

- CreateBenefitVerificationResponse — Models the response received upon creating a benefit verification request.
  - `status` union
    - 'success'
    - 'error'
  - `error` ApiError
    - `title` string, required
    - `description` string, required
    - `code` string, required
  - `data` CreateBenefitVerificationResponseData — Represents the data contained in the response for a create benefit verification request.
    - `id` string, required — A unique identifier for the benefit verification result.

## 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)