Checks if multiple drugs are covered by a patient’s insurance plan. You’ll receive details including whether the drug is covered, if a prior authorization is required, and copay information if availble.
Please be aware that since this endpoint initiates a real-time, AI call, response times may vary. To accommodate
efficient testing, we’ve implemented the mock_result argument, allowing for the simulation of responses from the
endpoint. When this argument is provided, we’ll (almost) instantly complete the benefit verification with results to match the case that you provide.
You’ll receive the webhook containing the full benefit verification payload.
For specifics on which cases you can mock, please refer to the mock_result property in the API specification below.
When in production, you should expect approxately 1 business day before a benefit verification is completed. You’ll need to subscribe to the benefit_verification.updated webhook event in order to receive the final response.
Try to provide as many of the fields as possible to improve the accuracy and completion rate of the benefit verification. If you have any questions on the importance of certain fields please reach out to us and we can help clarify.
List of insurance payers that the provider is in-network with. This is optional and no longer seems to have much of an impact on the verification process. You can omit this if it is not readily available information
The patient's drug history. Although not a required field, this will increase the completion rate of your benefit verifications by 5%-10% if you provide it.
A large proportion (20%+) of payers will often ask for information on the legal entity that the provider is associated with. Without this information the benefit verification will fail. Although this is currently optional it will be required in the future. We highly recommend providing this information.
Insurance information for the patient. We will extract the required information from the insurance card images you provide. Please provide both the front and the back of the card. This is optional if you provide insurance_content, but highly recommended to ensure best results.
Insurance information for the patient. Values provided here will be used in combination with those extracted from any insurance cards provided. We recommend providing this information when available to ensure best results. If you provide both insurance and insurance_content, the values provided here will be used and the values extracted from insurance will be used as a fallback.
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 case to simulate for the benefit verification. The options are:
drugs_covered__prior_auth_required__has_copay: Drug is covered, prior authorization required, and there is a copay.
drugs_covered__prior_auth_required__no_copay: Drug is covered, prior authorization required, but there is no copay.
drugs_covered__prior_auth_not_required__has_copay: Drug is covered, no prior authorization required, and there is a copay.
drugs_covered__prior_auth_not_required__no_copay: Drug is covered, no prior authorization required, and there is no copay.
drugs_not_covered__prior_auth_na__no_copay: Drug is not covered, prior authorization not applicable (because the drug is not covered), and there is no copay.
