Changelog

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October 1st 2024

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Prior Authorization

• Added a new ‘validating_outcome’ status to the prior authorization response. See the status descriptions and flow chart here

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July 25th 2024

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Benefit Verification

• Added diagnoses list to the benefit verification request. We recommend providing this field to improve the accuracy of the benefit verification.
• Added a new coverage_detail_code field to the drugs object in a benefit verification response. This field is only for reference purposes and can generally be ignored

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Prior Authorization

• Added an activity log list to the prior authorization response. You can use this to download the faxes we have sent and received into your own system.

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July 5th 2024

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Prior Authorization

• Added a mock_result property to allow for the submission of a mock result for testing purposes.
• Added insurance_content to the request body to allow for the submission of discrete insurance details.

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Benefit Verification

• Added insurance_content to the request body to allow for the submission of discrete insurance details.

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June 13th 2024

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Prior Authorization

Updates to the “Retrieve Prior Authorization” response

• Only include data.outcome.authorization_expiration for “Approval” result
• Add descriptions for data.outcome.result

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May 14th 2024

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Prior Authorization

Updates to the “Retrieve Prior Authorization” response

• Group data.outcome responses to show corresponding result, detail, and detail_code values.
• List and describe possible values for data.outcome.detail_code.

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May 13th 2024

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Prior Authorization

Updates to the “Retrieve Prior Authorization” response

• Updated possible values for the data.outcome.result field.
• Removed the data.submission field.
• Standardized naming of the date_created field in Evidence, Questionnaire, and Visit Notes.

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May 11th 2024

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Benefit Verification

• Removed the partially_completed status. We realized this was unnecessary and confusing. Now there is just pending, completed, and failed statuses.

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Prior Authorization

• Updated the top level statuses
• Renamed outcome.status to outcome.result ensure it’s not mixed up with the top level status

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Feb 29th 2024

• Updated quickstart page to more accurately reflect current API endpoints.

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Prior Authorization

• Updated prior authorization endpoint title from “Submit” to “Autofill”
• Removed coming soon from prior authorization endpoints
• Removed the option to send diagnosis description in the prior authorization request. For now we’ll just accept the diagnosis code.

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Benefit Verification

• Marked gender as required in the benefit verification endpoint documentation to match existing functionality of the API.
• Removed ‘coming soon’ from the insurance scanned content object. This is now live.

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Feb 25th 2024

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Benefit Verification

The following changes were made in the benefit verification endpoint:

• Added ‘call_fallback’ as a possible option for verification_method type
• Marked transcript and recording_url as nullable
• Marked street_line_2 as nullable in the patient and provider address objects

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Feb 21st 2024

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Benefit Verification

• The “Benefit Verification Updated” webhook payload now includes the full Benefit Verification object.

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Feb 13th 2024

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Benefit Verification Endpoint Updates

• Added structured copay information
• Added details of the upcoming insurance scanned_result object to the insurance body. This will start being returned soon.

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Prior Authorization Endpoint Updates

We made various updates to the prior authorization endpoint to match the benefit verification endpoint and make it production ready. You’ll soon be able to submit requests to it. In the meantime the spec as it now stands in the docs is accurate and will be supported.

• Moved insurance property from nested under patient to the top level to match the benefit verification endpoint. The structure has been updated to match the benefit verification endpoint.
• Added optional pharmacy property
• Updated prescription property
  • added required quantity property
  • made directions property required
  • added required strength property
  • added required dose_form property
  • added required dispense_unit property
  • added required route_of_administration property
• Added outcome and submission objects into the prior authorization response. These will also be made available via the webhook. These objects include details such as the prior authorization status, and a url to open the prior auth in the submission platform.
• Pushed support for arbitrary evidence files (PDFs, images, etc) to a future update. Currently we will support JSON formatted data, which can be unstructured text.

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May 17th 2024

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Prior Authorization

• Added an optional is_training_data field to the CreatePriorAuthRequest object to indicate whether the request is for training purposes.
  • If is_training_data is set to true, the request will not be processed.
  • If is_training_data is set to false or omitted, the request will be processed as normal.

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Misc

• Updated the following fields to enforce non-empty strings:
  • first_name in Patient and PatientInfo
  • last_name in Patient and PatientInfo
  • internal_id in Patient
  • first_name in Provider and ProviderInfo
  • last_name in Provider and ProviderInfo
  • npi in Provider and ProviderInfo
• Updated the following fields to be nullable:
  • phone in PatientInfo
  • phone in Provider and ProviderInfo

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July 3rd 2024

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Benefit Verification

• Added a new optional drug_history field to the CreateBenefitVerificationRequest object to allow for the submission of a patient’s drug history.
• Added a new optional insurance_content field to the CreateBenefitVerificationRequest object to allow for the submission of insurance details.
  • This field should be used if no insurance card image can be provided in insurance.

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July 5th 2024

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Misc

• Added a new not_specified option to the Gender enum.
  • This option should be used when the patient’s gender has not been provided.

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July 15th 2024

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Benefit Verifications

• Added new error codes for Benefit Verifications
  • Insurance Unable to Provide Information
  • Unable to Gather Benefits
  • Insurance Card OCR Failure
    • This error code replaces Insurance Card Member ID OCR Failure and covers a broader range of OCR failures.

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September 2nd 2024

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Prior Authorization

• Added a new other detail code for the data.outcome.detail_code field.

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September 8th 2024

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Prior Authorization

• Added a priority field to the CreatePriorAuthRequest object.

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September 27th 2024

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Benefit Verification

• Added a new optional use_patient_plan_fund_source_check field to the benefit verification creation endpoint.

  • This field controls whether the patient’s plan funding source should be checked during the benefit verification call.
  • If not provided, the default value is false.

• Updated the response for retrieving the status of a benefit verification to include a new patient_plan_fund_source field.

  • This field indicates the funding source of the patient’s plan and can have one of the following values:
    • commercial: The patient’s plan is commercial insurance.
    • government: The patient’s plan is government-funded.
    • question_not_asked: The patient’s plan funding source was not asked. Typically
    • unable_to_determine: The patient’s plan funding source was asked, but could not be determined.
  • The default value is question_not_asked.

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October 25th 2024

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Benefit Verification

• Added a new determination_details field to the benefit verification response for each drug that contains additional information about the determination.

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November 21st 2024

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Misc

• Added a new discrete_content field to insurance objects in GET /benefit-verification/{id} and GET /prior-authorization/{id}.
• Added validation to the insurance_content.rx_bin field in POST /benefit-verification and POST /prior-authorization.

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February 17th 2025

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Benefit Verification

• Added a new POST /benefit-verification/{id}/cancel endpoint to cancel a benefit verification request.
• Added support for per-BV priority levels.
• Added support for linking cancelled BVs to resubmitted BVs.