Retrieve Clinical Qualification (On Roadmap)

Authorizations

Authorization

string

header

required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Path Parameters

string

required

Response

Successfully returned an clinical qualification.

Represents the response structure for a GET /prior-authorization/:id request.

This class extends the generic ApiResponse, specifically tailored to handle responses related to clinical qualifications. It primarily includes the data attribute, which holds detailed information about the benefit verification process and its results.

status

default:success

Available options:

success

error

ApiError · object

Show child attributes

error.title

string

required

error.description

string

required

error.code

string

required

data

Data · object

An instance of GetClinicalQualificationResponseData containing detailed information about the prior auth, or None if no such data is available.

Show child attributes

data.id

string

required

The ID of this clinical qualification

data.diagnoses

Diagnosis · object[]

required

Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'

Show child attributes

data.diagnoses.code

string

required

ICD-10 code for the diagnosis. i.e. 'E66.9'

data.patient

Patient · object

required

Demographic information for the patient

Show child attributes

data.patient.address

Address · object

required

The patient's postal address

Show child attributes

data.patient.address.street

string

required

Street address of residence.

Minimum string length: 1

data.patient.address.city

string

required

City of residence.

Minimum string length: 1

data.patient.address.state_province

string

required

State or province of residence.

Minimum string length: 1

data.patient.address.zip_postal_code

string

required

ZIP or postal code part of the address.

Minimum string length: 1

data.patient.address.country

string

required

Country of residence.

Minimum string length: 1

data.patient.address.street_line_2

string

Additional street address information.

data.patient.date_of_birth

string<date>

required

The patient's date of birth

data.patient.first_name

string

required

The patient's first name

Minimum string length: 1

data.patient.last_name

string

required

The patient's last name

Minimum string length: 1

data.patient.gender

enum<string>

required

The patient's gender

Available options:

male,

female,

other,

not_specified

data.patient.internal_id

string

required

Your internal ID for this patient. This is used for linking all of the requests for a given patient.

Minimum string length: 1

data.patient.email

string<email>

The patient's email address

data.patient.phone

string

The patient's phone number

data.insurance

InsuranceDocumentInfo · object[]

required

Array of insurance documents.

Show child attributes

data.insurance.scanned_content

Scanned Content · object

required

An object containing details that were extracted from the insurance card images provided in the creation request.

Show child attributes

data.insurance.scanned_content.client_name

string

The client/employer name.

data.insurance.scanned_content.group_number

string

The group number on the card.

data.insurance.scanned_content.member_name

string

The member name on the card.

data.insurance.scanned_content.member_number

string

The member number on the card.

data.insurance.scanned_content.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

data.insurance.scanned_content.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

data.insurance.scanned_content.rx_bin

string

The Rx BIN number on the card.

data.insurance.scanned_content.rx_group

string

The Rx group number on the card.

data.insurance.scanned_content.rx_pcn

string

The Rx PCN number on the card.

data.insurance.scanned_content.error

string

Error message if we were unable to extract information from the card.

data.insurance.discrete_content

Discrete Content · object

required

An object containing manually-provided insurance details from the creation request.

Show child attributes

data.insurance.discrete_content.client_name

string

The client/employer name.

data.insurance.discrete_content.group_number

string

The group number on the card.

data.insurance.discrete_content.member_name

string

The member name on the card.

data.insurance.discrete_content.member_number

string

The member number on the card.

data.insurance.discrete_content.payer_name

string

data.insurance.discrete_content.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

data.insurance.discrete_content.rx_bin

string

The Rx BIN number on the card.

data.insurance.discrete_content.rx_group

string

The Rx group number on the card.

data.insurance.discrete_content.rx_pcn

string

The Rx PCN number on the card.

data.insurance.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.

data.drugs

Drug · object[]

required

Information regarding the potential prescriptions this clinical qualification check should be run for

Show child attributes

data.drugs.days_supply

integer

required

The number of days the prescription will be expected to last.

data.drugs.quantity

integer

required

The quantity of the medication.

data.drugs.directions

string

required

Instructions on how the medication should be taken.

Minimum string length: 1

data.drugs.drug_name

string

required

The name of the medication.

Minimum string length: 1

data.drugs.strength

string

required

The strength of the medication.

Minimum string length: 1

data.drugs.dose_form

enum<string>

required

The form of the medication.

Available options:

aerosol,

bar,

bead,

breadstick,

bulk,

capsule,

catheter,

cement,

cigarette,

cloth,

concentrate,

cone,

cream,

crystal,

culture,

dentifrice,

deposit,

device,

diaphragm,

disc,

douche,

dressing,

drops,

elixir,

emulsion,

enema,

extract,

film,

food,

foam,

gel,

generator,

globule,

graft,

gum,

implant,

infusion,

inhalant,

inhalation,

inhaler,

injectable,

injection,

insert,

irrigant,

irrigation,

jelly,

kit,

lens,

liner,

liniment,

lipstick,

liquid,

lollipop,

lotion,

lozenge,

miscellaneous,

mouthwash,

mucilage,

oil,

ointment,

packing,

paste,

pastille,

patch,

pellet,

pill,

plaster,

poultice,

powder,

resin,

ring,

rinse,

rod,

salve,

shampoo,

soap,

sol,

solution,

sponge,

spray,

stick,

strip,

suppository,

suspension,

suture,

swab,

syrup,

tablet,

tampon,

tape,

tea,

test,

tincture,

troche,

vaginal_suppository,

vaginal_tablet,

wafer,

wash,

wax

data.drugs.route_of_administration

enum<string>

required

The route of administration for the medication.

Available options:

auricular (otic),

otic,

buccal,

conjunctival,

cutaneous,

dental,

electro-osmosis,

endocervical,

endosinusial,

endotracheal,

enteral,

epidural,

extra-amniotic,

extracorporeal,

hemodialysis,

infiltration,

interstitial,

intra-abdominal,

intra-amniotic,

intra-arterial,

intra-articular,

intrabiliary,

intrabronchial,

intrabursal,

intracameral,

intracanalicular,

intracardiac,

intracartilaginous,

intracaudal,

intracavernous,

intracavitary,

intracerebral,

intracisternal,

intracorneal,

intracoronal, dental,

intracoronary,

intracorporus cavernosum,

intracranial,

intradermal,

intradiscal,

intraductal,

intraduodenal,

intradural,

intraepicardial,

intraepidermal,

intraesophageal,

intragastric,

intragingival,

intrahepatic,

intraileal,

intralesional,

intralingual,

intraluminal,

intralymphatic,

intramammary,

intramedullary,

intrameningeal,

intramuscular,

intranodal,

intraocular,

intraomentum,

intraovarian,

intrapericardial,

intraperitoneal,

intrapleural,

intraprostatic,

intrapulmonary,

intraruminal,

intrasinal,

intraspinal,

intrasynovial,

intratendinous,

intratesticular,

intrathecal,

intrathoracic,

intratubular,

intratumor,

intratympanic,

intrauterine,

intravascular,

intravenous,

intraventricular,

intravesical,

intravitreal,

iontophoresis,

irrigation,

laryngeal,

nasal,

nasogastric,

not applicable,

occlusive dressing technique,

ophthalmic,

oral,

oropharyngeal,

parenteral,

percutaneous,

periarticular,

peridural,

perineural,

periodontal,

rectal,

respiratory (inhalation),

inhalation,

retrobulbar,

soft tissue,

subarachnoid,

subconjunctival,

subcutaneous,

subgingival,

sublingual,

submucosal,

subretinal,

suprachoroidal,

topical,

transdermal,

transendocardial,

transmucosal,

transplacental,

transtracheal,

transtympanic,

ureteral,

urethral,

vaginal

data.drugs.extra

Extra · object

An optional dictionary containing additional information related to the drug or future prescription.

data.provider

Provider · object

required

Details of the healthcare provider who created the prescription.

Show child attributes

data.provider.address

Address · object

required

The provider's postal address.

Show child attributes

data.provider.address.street

string

Street address of residence.

data.provider.address.street_line_2

string

Additional street address information.

data.provider.address.city

string

City of residence.

data.provider.address.state_province

string

State or province of residence.

data.provider.address.zip_postal_code

string

ZIP or postal code part of the address.

data.provider.address.country

string

Country of residence.

data.provider.first_name

string

required

The provider's first name.

Minimum string length: 1

data.provider.last_name

string

required

The provider's last name.

Minimum string length: 1

data.provider.npi

string

required

The provider's NPI.

Minimum string length: 1

data.provider.fax

string

The provider's fax number.

data.provider.internal_id

string

Your internal ID for this provider. This is used for linking all of the requests for a given provider.

data.provider.phone

string

The provider's phone number.

data.results

ClinicalQualificationResult · object[]

required

The results of the clinical qualification for each of the drugs.

Show child attributes

data.results.drug

Drug · object

required

The drug this clinical qualification is for.

Show child attributes

data.results.drug.days_supply

integer

required

The number of days the prescription will be expected to last.

data.results.drug.quantity

integer

required

The quantity of the medication.

data.results.drug.directions

string

required

Instructions on how the medication should be taken.

Minimum string length: 1

data.results.drug.drug_name

string

required

The name of the medication.

Minimum string length: 1

data.results.drug.strength

string

required

The strength of the medication.

Minimum string length: 1

data.results.drug.dose_form

enum<string>

required

The form of the medication.

Available options:

aerosol,

bar,

bead,

breadstick,

bulk,

capsule,

catheter,

cement,

cigarette,

cloth,

concentrate,

cone,

cream,

crystal,

culture,

dentifrice,

deposit,

device,

diaphragm,

disc,

douche,

dressing,

drops,

elixir,

emulsion,

enema,

extract,

film,

food,

foam,

gel,

generator,

globule,

graft,

gum,

implant,

infusion,

inhalant,

inhalation,

inhaler,

injectable,

injection,

insert,

irrigant,

irrigation,

jelly,

kit,

lens,

liner,

liniment,

lipstick,

liquid,

lollipop,

lotion,

lozenge,

miscellaneous,

mouthwash,

mucilage,

oil,

ointment,

packing,

paste,

pastille,

patch,

pellet,

pill,

plaster,

poultice,

powder,

resin,

ring,

rinse,

rod,

salve,

shampoo,

soap,

sol,

solution,

sponge,

spray,

stick,

strip,

suppository,

suspension,

suture,

swab,

syrup,

tablet,

tampon,

tape,

tea,

test,

tincture,

troche,

vaginal_suppository,

vaginal_tablet,

wafer,

wash,

wax

data.results.drug.route_of_administration

enum<string>

required

The route of administration for the medication.

Available options:

auricular (otic),

otic,

buccal,

conjunctival,

cutaneous,

dental,

electro-osmosis,

endocervical,

endosinusial,

endotracheal,

enteral,

epidural,

extra-amniotic,

extracorporeal,

hemodialysis,

infiltration,

interstitial,

intra-abdominal,

intra-amniotic,

intra-arterial,

intra-articular,

intrabiliary,

intrabronchial,

intrabursal,

intracameral,

intracanalicular,

intracardiac,

intracartilaginous,

intracaudal,

intracavernous,

intracavitary,

intracerebral,

intracisternal,

intracorneal,

intracoronal, dental,

intracoronary,

intracorporus cavernosum,

intracranial,

intradermal,

intradiscal,

intraductal,

intraduodenal,

intradural,

intraepicardial,

intraepidermal,

intraesophageal,

intragastric,

intragingival,

intrahepatic,

intraileal,

intralesional,

intralingual,

intraluminal,

intralymphatic,

intramammary,

intramedullary,

intrameningeal,

intramuscular,

intranodal,

intraocular,

intraomentum,

intraovarian,

intrapericardial,

intraperitoneal,

intrapleural,

intraprostatic,

intrapulmonary,

intraruminal,

intrasinal,

intraspinal,

intrasynovial,

intratendinous,

intratesticular,

intrathecal,

intrathoracic,

intratubular,

intratumor,

intratympanic,

intrauterine,

intravascular,

intravenous,

intraventricular,

intravesical,

intravitreal,

iontophoresis,

irrigation,

laryngeal,

nasal,

nasogastric,

not applicable,

occlusive dressing technique,

ophthalmic,

oral,

oropharyngeal,

parenteral,

percutaneous,

periarticular,

peridural,

perineural,

periodontal,

rectal,

respiratory (inhalation),

inhalation,

retrobulbar,

soft tissue,

subarachnoid,

subconjunctival,

subcutaneous,

subgingival,

sublingual,

submucosal,

subretinal,

suprachoroidal,

topical,

transdermal,

transendocardial,

transmucosal,

transplacental,

transtracheal,

transtympanic,

ureteral,

urethral,

vaginal

data.results.drug.extra

Extra · object

An optional dictionary containing additional information related to the drug or future prescription.

data.results.status

enum<string>

required

The status of the clinical qualification for this prescription.

Available options:

pending,

qualified,

unqualified,

unknown

data.results.unqualified_reasons

UnqualifiedReason · object[]

If the status is ineligible, the reason(s) why. More structured fields will be added to this model in the future.

Show child attributes

data.results.unqualified_reasons.description

string

required

Reason for ineligibility. This is a free text field that could include any text.

data.object

enum<string>

default:clinical_qualification

The type of object. This will always be 'clinical_qualification', from this endpoint, but this can be helpful for differentiating between different types of objects when parsing webhook responses.

Available options:

clinical_qualification

data.evidence

ResponseEvidenceItem · object[]

A collection of evidence items supporting the authorization request. Any other supporting evidence that doesn't fit into one of the explicitly declared fields above can be added here.

Show child attributes

data.evidence.date_created

string<date-time>

required

The date and time (if available) when the evidence was created. This is important for ensuring we have an accurate timeline of the patient's history.

data.evidence.title

string

required

Title of the evidence. This will be shown to users in the platform UI so it's recommended to give it a name that would be meaningful to them, such as 'Intake Form'

data.evidence.asset

Asset · object

File asset containing the evidence.

Show child attributes

data.evidence.asset.url

string

required

The URL where the asset can be accessed.

Minimum string length: 1

data.evidence.asset.file_type

enum<string>

required

MIME type of the file. e.g. application/pdf

Available options:

application/pdf,

application/msword,

text/plain,

application/vnd.ms-excel

data.evidence.content

Content · object

Detailed content of the evidence, which varies based on the type of evidence.

data.pharmacy

Pharmacy · object

Information about the pharmacy where the prescription will be filled.

Show child attributes

data.pharmacy.name

string

required

The name of the pharmacy.

Minimum string length: 1

data.pharmacy.address

Address · object

required

Represents a postal address.

Show child attributes

data.pharmacy.address.street

string

required

Street address of residence.

Minimum string length: 1

data.pharmacy.address.city

string

required

City of residence.

Minimum string length: 1

data.pharmacy.address.state_province

string

required

State or province of residence.

Minimum string length: 1

data.pharmacy.address.zip_postal_code

string

required

ZIP or postal code part of the address.

Minimum string length: 1

data.pharmacy.address.country

string

required

Country of residence.

Minimum string length: 1

data.pharmacy.address.street_line_2

string

Additional street address information.

data.questionnaires

Questionnaire · object[]

list of questionnaires. This is the best place to send structured Q&A format data, such as intake forms, etc.

Show child attributes

data.questionnaires.questions

Question · object[]

required

A list of questions included in the questionnaire.

Show child attributes

data.questionnaires.questions.answer

string

required

The answer to the question.

Minimum string length: 1

data.questionnaires.questions.question

string

required

The question to be answered.

Minimum string length: 1

data.questionnaires.questions.choices

string[]

Optional list of choices for the question. If provided, the answer must be one of the choices. It's important to include this list of choices for any multiple choice question. This allows our AI to know what a user has effectively said 'no' to by picking another option. I.e. for a question 'Do you have any of the following conditions: Diabetes, Heart Disease, Cancer, None of the above' if the user answers 'None of the above' we can infer that they don't have any of those conditions. Without the choices list we would have no way of knowing that.

data.questionnaires.date_created

string<date-time>

required

The date and time when the questionnaire was answered. This is important for ensuring we have an accurate timeline of the patient's history.

data.visit_notes

VisitNote · object[]

list of visit notes.

Show child attributes

data.visit_notes.content

string

required

The content of the visit note.

Minimum string length: 1

data.visit_notes.date_created

string<date-time>

required

The date and time (if available) when the visit note was created. This is important for ensuring we have an accurate timeline of the patient's history.

data.visit_notes.title

string

The title of the visit note. This is optional and can be used to give the note a meaningful name, such as 'Initial Consultation'.

Minimum string length: 1

API Documentation

Authorizations

Path Parameters

Response