Updates to the “Retrieve Prior Authorization” response
data.outcome.authorization_expiration
for “Approval” resultdata.outcome.result
Updates to the “Retrieve Prior Authorization” response
data.outcome
responses to show corresponding result
, detail
, and detail_code
values.data.outcome.detail_code
.Updates to the “Retrieve Prior Authorization” response
data.outcome.result
field.data.submission
field.date_created
field in Evidence, Questionnaire, and Visit Notes.The following changes were made in the benefit verification endpoint:
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.
is_training_data
field to the CreatePriorAuthRequest
object to indicate whether the request is for training purposes.
is_training_data
is set to true
, the request will not be processed.is_training_data
is set to false
or omitted, the request will be processed as normal.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
phone
in PatientInfo
phone
in Provider
and ProviderInfo
drug_history
field to the CreateBenefitVerificationRequest
object to allow for the submission of a patient’s drug history.insurance_content
field to the CreateBenefitVerificationRequest
object to allow for the submission of insurance details.
insurance
.not_specified
option to the Gender
enum.
Insurance Unable to Provide Information
Unable to Gather Benefits
Insurance Card OCR Failure
Insurance Card Member ID OCR Failure
and
covers a broader range of OCR failures.other
detail code for the data.outcome.detail_code
field.priority
field to the CreatePriorAuthRequest
object.Added a new optional use_patient_plan_fund_source_check
field to the benefit verification creation endpoint.
false
.Updated the response for retrieving the status of a benefit verification to include a new patient_plan_fund_source
field.
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. Typicallyunable_to_determine
: The patient’s plan funding source was asked, but could not be determined.question_not_asked
.determination_details
field to the benefit verification response for each drug that contains additional information about the determination.discrete_content
field to insurance objects in GET /benefit-verification/{id}
and GET /prior-authorization/{id}
.insurance_content.rx_bin
field in POST /benefit-verification
and POST /prior-authorization
.POST /benefit-verification/{id}/cancel
endpoint to cancel a benefit verification request.