---
title: "Get Medical Inquiry"
method: GET
path: "/api/v0/medical/inquiries/{id}"
---

# Get Medical Inquiry

`GET /api/v0/medical/inquiries/{id}`

## Path parameters

- `id` string, required

## Response `200`

Successful Response

- ExternalMedicalInquiry
  - `id` string, required — unique generated (uuid4) id for the inquiry
  - `status` 'SCHEDULED' | 'IN_PROGRESS' | 'SUCCESS' | 'UNSUCCESSFUL' | 'CANCELLED' | 'UNKNOWN', required — An enumeration.
  - `creation_ts` string, date-time, required — timestamp of when the inquiry was created
  - `summary` string — summary of the call results
  - `results` union — The output from the call containing the benefits or claims results.
    - ExternalClaimsQueryResults
      - `call_details` CallDetails[], required — The details of the placed calls including the call time in iso format, representative name, reference number, and transcript.
        - `call_end_time` string, date-time
        - `representative_name` string, required
        - `reference_number` string, required
        - `call_recording_url` string
        - `call_transcript_url` string
        - `call_transcript` string
        - `custom_answers` object
      - `status` 'NOT_FOUND' | 'UNPROCESSED' | 'APPROVED' | 'DENIED', required — An enumeration.
      - `similar_claim_dates` string[] — Similar claim dates of service in MM-DD-YYYY format, typically when the claim was not found.
      - `claims_info` ExternalClaimInfo[] — Details for matching claim(s) found during the inquiry.
        - `main_class` string — The claim info subtype, e.g. ClaimApprovedInfo, ClaimDeniedInfo, ClaimUnprocessedInfo.
        - `date_of_service` string — The date of service for the claim in MM-DD-YYYY format.
        - `claim_summary` string — A short summary of the claim status or outcome.
        - `date_received` string — The date the claim was received in MM-DD-YYYY format.
        - `date_processed_up_to` string — The date the claim was last processed or worked in MM-DD-YYYY format.
        - `turnaround_time` string — Expected turnaround time for an unprocessed claim.
        - `date_processed` string — The date the claim was processed in MM-DD-YYYY format.
        - `date_paid` string — The date the claim was paid in MM-DD-YYYY format.
        - `total_amount_paid` number — The total amount paid on the claim.
        - `adjustment_details` string — Adjustment or payment notes for the claim.
        - `code_details` ExternalClaimCodeDetails[] — Per-procedure-code payment details for the claim.
          - `procedure_code` string, required — The procedure code on the claim line.
          - `amount_paid` number — The amount paid for this procedure code.
          - `patient_responsibility` number — The patient responsibility for this procedure code.
          - `patient_applied_to_deductible` number — The amount applied to the patient deductible for this procedure code.
        - `claim_denial_reason` string — The reason the claim was denied.
        - `appeal_or_correction_info` string — Information about appealing or correcting the claim.
      - `claim_not_found_info` ExternalClaimNotFoundInfo
        - `patient_eligible_on_dos` boolean — Whether the patient was eligible on the date of service.
        - `mailing_address_or_payer_id` string — Claims mailing address or payer ID when no claim was found.
        - `timely_filing_limit` string — Timely filing limit information when no claim was found.
    - ExternalMedicalEligibilityQueryResults
      - `call_details` CallDetails[], required — The details of the placed calls including the call time in iso format, representative name, reference number, and transcript.
        - `call_end_time` string, date-time
        - `representative_name` string, required
        - `reference_number` string, required
        - `call_recording_url` string
        - `call_transcript_url` string
        - `call_transcript` string
        - `custom_answers` object
      - `plan_information` PlanInformation — Coerce custom_answers values to str when loading legacy or mixed JSON.
        - `is_active` boolean
        - `plan_type` 'HMO' | 'PPO' | 'POS' | 'EPO' | 'OAP' | 'MEDICAID' | 'HMO_POS' | 'OTHER' — An enumeration.
        - `plan_name` string
        - `effective_date` string, date
        - `termination_date` string, date
        - `is_calendar_year_plan` boolean
        - `is_provider_in_network` boolean
        - `is_primary_insurance` boolean
        - `is_provider_pcp` boolean
        - `has_other_insurance` boolean
        - `is_self_funded` boolean
        - `has_out_of_state_coverage` boolean
        - `referral_required` boolean
        - `referral_info` string
        - `out_of_network_benefits` string
        - `custom_answers` object
      - `maximums` Maximums — Coerce custom_answers values to str when loading legacy or mixed JSON.
        - `name` string
        - `individual_deductible` number
        - `individual_deductible_used` number
        - `individual_deductible_resets_each_calendar_year` boolean
        - `individual_out_of_pocket_maximum` number
        - `individual_out_of_pocket_maximum_used` number
        - `family_deductible` number
        - `family_deductible_used` number
        - `family_out_of_pocket_maximum` number
        - `family_out_of_pocket_maximum_used` number
        - `coverage_limit` number
        - `coverage_limit_remaining` number
        - `orthodontic_deductible` number
        - `orthodontics_deductible_used` number
        - `orthodontics_coverage_limit` number
        - `orthodontics_coverage_limit_remaining` number
        - `orthodontics_lifetime_maximum` number
        - `orthodontics_lifetime_maximum_used` number
        - `orthodontics_maximum_benefits_per_case` number
        - `periodontic_maximum` string
        - `periodontic_maximum_used` number
        - `implant_maximum` string
        - `implant_maximum_used` number
        - `custom_answers` object
        - `deductible_remaining` number — The amount of deductible remaining for the patient. Calculated as the minimum of the individual and family deductible remaining.
        - `out_of_pocket_maximum_remaining` number — The amount of out of pocket maximum remaining for the patient. Calculated as the minimum of the individual and family out of pocket maximum remaining.
      - `procedure_classes` object — A dict that maps from the different categories of procedures to their benefits. Categories will contain prior auth, deductibles, copay amounts, coinsurance percentages and any frequency limitations. See examples for more information
      - `procedure_codes` array[] — A list that contains a tuple of procedure code information and their benefits. For medical, procedure codes, if covered, will contain deductible information, copays, coinsurance, frequency limitations and whether or not prior authorization is needed. Coinsurance refers to the patient's portion of the payment.
        - unknown[]
          - unknown
      - `extra_info` ExtraMedicalInfo — Coerce custom_answers values to str when loading legacy or mixed JSON.
        - `benefit_max_per_year` string
        - `benefit_max_per_office_visit` string
        - `annual_max_number_of_visits` union
          - string
          - integer
          - number
        - `specialty_rx_benefits` boolean
        - `is_aba_autism_covered` boolean
        - `is_cotreatment_allowed` boolean
        - `authorization_submission_info` string
        - `is_copay_subject_to_out_of_pocket` boolean
        - `will_copay_be_waived_if_oop_is_met` boolean
        - `copay_for_home_visit` number
        - `copay_for_center_visit` number
        - `copay_for_telehealth_visit` number
        - `coinsurance_percentage_for_home_visit` number
        - `coinsurance_percentage_for_center_visit` number
        - `coinsurance_percentage_for_telehealth_visit` number
        - `is_deductible_waived_for_home_visit` boolean
        - `is_deductible_waived_for_center_visit` boolean
        - `is_deductible_waived_for_telehealth_visit` boolean
        - `is_aba_coverage_same_office_vs_home` boolean
        - `do_we_need_to_request_a_special_authorization_for_telehealth_in_addition_to_usual_aba_authorization` string
        - `is_telehealth_visit_covered` boolean
        - `how_is_telehealth_covered` string
        - `copay_structure_per_category_or_per_visit` string
        - `separate_copay_for_telehealth_and_codes_billed_together` string
        - `services_combined_with_other_therapies` string
        - `exclusions_on_policy_for_services` string
        - `is_combined_with_pt_ot` boolean
        - `visits_counted_as_one_if_same_day` boolean
        - `visit_limit_waived_with_asd_dx` boolean
        - `custom_answers` object
  - `request` ExternalMedicalInquiryRequest, required
    - `type` 'CLAIMS_STATUS' | 'BENEFITS' | 'UNKNOWN', required — An enumeration.
    - `desired_completion_date` string, required — The requested completion date of the inquiry in MM-DD-YYYY format. Calls will typically be completed by the morning of the requested completion date, but in some cases may be completed earlier.
    - `patient_name` string, required — name of the patient
    - `dob` string, required — date of birth of the patient in MM-DD-YYYY format
    - `member_id` string, required — member id of the patient
    - `group_id` string — group id of the patient
    - `insurance_in_network` boolean — whether or not the provider is in-network. If it is not known, leave this field blank and it will be determined.
    - `npi` string — (deprecated, use billing_npi and rendering_npi instead) Ten digit NPI of the provider
    - `billing_npi` string — Ten digit NPI of the billing provider
    - `rendering_npi` string — Ten digit NPI of the rendering provider
    - `tax_id` string, required — Nine digit tax id of the provider
    - `external_id` string — An identifier which you can define and pass in with your creation request. This is useful for tracking a specific subgroup of inquiries. For instance, you can assign a unique external id to all inquiries for a specific provider on your platform.
    - `practice_billing_address` string — The billing address of the practice. If omitted, the address will be determined from the NPI.
    - `diagnosis_codes` string[] — Any diagnosis codes for the patient. If omitted, a general diagnosis code will be used.
    - `claims_date_of_service` string — The date of service for the claim in MM-DD-YYYY format. Only used for claims inquiries.
    - `claim_number` string — The claim number for the inquiry if provided by the user. Only used for claims inquiries.
    - `additional_info` string — Any additional information about the inquiry that is not covered by the other fields. This can be used to pass in any additional information for the request. Please check with the Health Harbor team before using this field as it may not be incorporated into the inquiry unless we are already aware of it.
    - `call_script_id` string — Optional ID of a call script belonging to your team. Use for eligibility/benefits inquiries to control which questions are asked. You can find call script IDs on the Accounts page in the dashboard. When provided, it must be a script your team created. For eligibility search, either benefits queries or this field may satisfy the requirement—see Health Harbor documentation.
    - `insurance` string — The insurance provider for the patient. You must provide the name of the insurance provider or the payor id in order for the insurance to be identified.
    - `benefits_query` ExternalMedicalEligibilitySearchQuery[] — The specific set of benefits to query. These are customized for each customer. Contact alan@healthharbor.co for details.
    - `benefits_codes` string[] — Codes processed for a CODE_LOOKUP_BENEFITS or a CODE_LOOKUP_PRIOR_AUTH benefits inquiry.
    - `benefits_form_name` string — The name of a custom form for your providers. Contact alan@healthharbor.co for details.
    - `is_specialist` boolean — The type of provider making the inquiry. If the provider is a specialist, set this to True. If the provider is a general PCP, set this to False.
    - `place_of_service` string — Where the service will be performed. This is typically one of a few places: the doctors office or telehealth See this page for the full list: https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets
    - `billed_amount` number — The billed amount for the claim. Value should be a float with 2 decimal places. Only used for claims inquiries.
    - `insurance_payor_id` string — The payor id for the insurance. Usually five characters. For example, one payor id for Aetna is 60054. You must provide the name of the insurance provider or the payor id in order for the insurance to be identified.
    - `insurance_phone_number` string — The phone number used for identifying the insurance. This is optional, but highly recommended as it helps identify the provider more accurately in the cases of third party administrators (TPAs).

## Other responses

- `422` — Validation Error

---

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