Retrieve Clinical Qualification (On Roadmap)
Authorizations
Bearer authentication header of the form Bearer <token>, where <token> is your auth token.
Path Parameters
Response
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.
An instance of GetClinicalQualificationResponseData containing detailed information about the prior auth, or None if no such data is available.
Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'
ICD-10 code for the diagnosis. i.e. 'E66.9'
Information regarding the potential prescriptions this clinical qualification check should be run for
The number of days the prescription will be expected to last.
Instructions on how the medication should be taken.
1The unit of measurement for the medication.
milliliter, liter, gram, milligram, microgram, unit, tablet, capsule, patch, inhaler, applicator, pack, vial, film The form of the medication.
tablet, capsule, suspension, cream, solution, ointment, suppository, inhaler, liquid, powder, injectable, patch, gel, lozenge, concentrate, film The name of the medication.
1The quantity of the medication.
The route of administration for the medication.
oral, subcutaneous, intravenous, intramuscular, topical, inhalation, nasal, ophthalmic, otic, rectal, vaginal, transdermal, buccal, sublingual The strength of the medication.
1An optional dictionary containing additional information related to the drug or future prescription.
The ID of this clinical qualification
Array of insurance documents.
An object containing manually-provided insurance details from the creation request.
The client/employer name.
The group number on the card.
The member name on the card.
The member number on the card.
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
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
The Rx BIN number on the card.
The Rx group number on the card.
The Rx PCN number on the card.
An object containing details that were extracted from the insurance card images provided in the creation request.
The client/employer name.
Error message if we were unable to extract information from the card.
The group number on the card.
The member name on the card.
The member number on the card.
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
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
The Rx BIN number on the card.
The Rx group number on the card.
The Rx PCN number on the card.
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.
Demographic information for the patient
The patient's postal address
City of residence.
1Country of residence.
1State or province of residence.
1Street address of residence.
1ZIP or postal code part of the address.
1Additional street address information.
The patient's date of birth
The patient's first name
1The patient's gender
male, female, other, not_specified Your internal ID for this patient. This is used for linking all of the requests for a given patient.
1The patient's last name
1The patient's email address
The patient's phone number
Details of the healthcare provider who created the prescription.
The provider's postal address.
City of residence.
1Country of residence.
1State or province of residence.
1Street address of residence.
1ZIP or postal code part of the address.
1Additional street address information.
The provider's first name.
1The provider's last name.
1The provider's NPI.
1The provider's fax number.
The provider's phone number.
The results of the clinical qualification for each of the drugs.
The drug this clinical qualification is for.
The number of days the prescription will be expected to last.
Instructions on how the medication should be taken.
1The unit of measurement for the medication.
milliliter, liter, gram, milligram, microgram, unit, tablet, capsule, patch, inhaler, applicator, pack, vial, film The form of the medication.
tablet, capsule, suspension, cream, solution, ointment, suppository, inhaler, liquid, powder, injectable, patch, gel, lozenge, concentrate, film The name of the medication.
1The quantity of the medication.
The route of administration for the medication.
oral, subcutaneous, intravenous, intramuscular, topical, inhalation, nasal, ophthalmic, otic, rectal, vaginal, transdermal, buccal, sublingual The strength of the medication.
1An optional dictionary containing additional information related to the drug or future prescription.
The status of the clinical qualification for this prescription.
pending, qualified, unqualified, unknown 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.
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.
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'
File asset containing the evidence.
Detailed content of the evidence, which varies based on the type of evidence.
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.
clinical_qualification Information about the pharmacy where the prescription will be filled.
Represents a postal address.
City of residence.
1Country of residence.
1State or province of residence.
1Street address of residence.
1ZIP or postal code part of the address.
1Additional street address information.
The name of the pharmacy.
1list of questionnaires. This is the best place to send structured Q&A format data, such as intake forms, etc.
The date and time when the questionnaire was answered. This is important for ensuring we have an accurate timeline of the patient's history.
A list of questions included in the questionnaire.
The answer to the question.
1The question to be answered.
1Optional 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.
list of visit notes.
The content of the visit note.
1The 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.
The title of the visit note. This is optional and can be used to give the note a meaningful name, such as 'Initial Consultation'.
1success