> ## Documentation Index > Fetch the complete documentation index at: https://docs.develophealth.ai/llms.txt > Use this file to discover all available pages before exploring further. # Retrieve Benefit Verification Retrieve details of a specific benefit verification request. ## OpenAPI ````yaml get /benefit-verification/{id} openapi: 3.1.0 info: title: Develop Health Public API description: Develop Health Public API version: '1.0' servers: - url: https://api.develophealth.ai security: [] paths: /benefit-verification/{id}: get: tags: - public-api summary: Get Benefit Verification Route operationId: get_benefit_verification_route_benefit_verification__id__get parameters: - name: id in: path required: true schema: type: string title: Id responses: '200': description: Successfully returned a benefit verification content: application/json: schema: $ref: '#/components/schemas/GetBenefitVerificationResponse' example: status: success data: id: bv_dj3wiu object: benefit_verification status: completed status_description: The verification was successful review_status: not_reviewed drugs: - name: Wegovy dosage: 0.25 mg quantity: 1 coverage: covered coverage_detail_code: insurer_reported_value prior_authorization_required: 'yes' copay: $30 for 28 days supply copay_options: - amount_cents: 3000 supply_duration_days: 28 determination_details: is_on_formulary: true - name: Ozempic dosage: 2.68 mg quantity: 1 coverage: covered coverage_detail_code: insurer_reported_value prior_authorization_required: 'yes' copay: $30 for 28 days supply copay_options: - amount_cents: 3000 supply_duration_days: 28 determination_details: is_on_formulary: true - name: Mounjaro dosage: 2.5 mg quantity: 1 coverage: covered coverage_detail_code: insurer_reported_value prior_authorization_required: 'yes' copay: $30 for 28 days supply copay_options: - amount_cents: 3000 supply_duration_days: 28 determination_details: is_on_formulary: true drug_history: currently_taking_drugs: - name: Metformin previously_taken_drugs: - name: Jardiance - name: Rybelsus diagnoses: - code: E66.9 - code: I10 patient: internal_id: 39dca4a2-8788-4fd6-9e31-15c56e454322 first_name: John last_name: Smith gender: male date_of_birth: '1980-01-01' address: street: 123 Main St, Apt 1 city: Los Angeles state_province: CA zip_postal_code: '94001' country: USA phone: 555-555-5555 provider: first_name: Jane last_name: Green address: street: 9071 E. Mississippi Ave city: Denver state_province: CO zip_postal_code: '80247' country: USA phone: '1231231234' fax: None npi: '0000000000' in_network_payers: [] entity: legal_name: Test Entity tax_id: '111223333' insurance: - scanned_content: client_name: Company group_number: '12345678' member_name: John Smith member_number: '12345678' payer_name: United plan_name: Plus Plan rx_bin: '123456' rx_group: ADV rx_pcn: FAC discrete_content: {} url: https://example.com/insurance_doc - scanned_content: error: Unable to extract information from card discrete_content: {} url: https://example.com/insurance_doc2 patient_coverage_status: covered verification_methods: - id: bva_23j3234 type: ai_call transcript: Call transcript recording_url: https://example.com/recording patient_plan_fund_source: question_not_asked patient_coverage_type: question_not_asked priority: 2 '422': description: Validation Error content: application/json: schema: $ref: '#/components/schemas/HTTPValidationError' security: - FronteggJWTAuthentication: [] components: schemas: GetBenefitVerificationResponse: properties: status: anyOf: - type: string enum: - success - type: string enum: - error title: Status default: success error: $ref: '#/components/schemas/ApiError' data: $ref: '#/components/schemas/GetBenefitVerificationResponseData' type: object title: GetBenefitVerificationResponse description: >- Represents the response structure for a benefit verification query in a healthcare context. This class extends the generic ApiResponse, specifically tailored to handle responses related to benefit verifications. It primarily includes the data attribute, which holds detailed information about the benefit verification process and its results. HTTPValidationError: properties: detail: items: $ref: '#/components/schemas/ValidationError' type: array title: Detail type: object title: HTTPValidationError ApiError: properties: title: type: string title: Title description: type: string title: Description code: type: string title: Code type: object required: - title - description - code title: ApiError GetBenefitVerificationResponseData: properties: id: type: string title: Id description: The ID of the benefit verification request. object: type: string enum: - benefit_verification title: Object description: >- The type of object the response is about, which is 'benefit_verification'. default: benefit_verification status: allOf: - $ref: '#/components/schemas/BenefitVerificationStatus' description: >- Benefit Verifications will always start in the pending state. Once the verification is complete, the status will change to completed or failed. If the verification is still in progress, the status will remain pending. status_description: type: string title: Status Description description: Provides additional information about the verification status. error: allOf: - $ref: '#/components/schemas/FailureDetails' title: Error description: Specific error information if the benefit verification failed review_status: allOf: - $ref: '#/components/schemas/ReviewStatus' description: >- The status on if this benefits investigation has been reviewed in the portal. Users of the portal can click the 'Mark as Reviewed' button to mark the benefits investigation as reviewed. drugs: items: $ref: '#/components/schemas/DrugCoverageInfo' type: array title: Drugs description: List of drug coverage information related to the verification. drug_history: allOf: - $ref: '#/components/schemas/DrugHistory' title: Drug History description: The patient's drug history diagnoses: items: $ref: '#/components/schemas/Diagnosis' type: array title: Diagnoses description: List of diagnoses for the patient. patient: allOf: - $ref: >- #/components/schemas/api__schemas__platform__public_api__common__PatientInfo title: Patient description: Demographic information for the patient provider: allOf: - $ref: '#/components/schemas/ProviderInfo' title: Provider description: >- Details of the healthcare provider whose NPI number can be used for the benefit verification. entity: allOf: - $ref: '#/components/schemas/EntityInfo' title: Entity description: >- 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: items: $ref: '#/components/schemas/InsuranceDocumentInfo' type: array title: Insurance description: Insurance information for the patient. pharmacy_benefit_manager_name: type: string title: Pharmacy Benefit Manager Name description: >- The name of the pharmacy benefit manager (PBM) responsible for the patient's coverage. E.g. 'OptumRx' or 'Express Scripts'. May be null if the PBM's name is not available. patient_coverage_status: allOf: - $ref: '#/components/schemas/PatientCoverageStatus' description: >- This field indicates the insurance coverage status of the patient. The options are: - **covered**: Indicates that the patient is covered by the insurance plan. - **patient_not_found**: Indicates that the patient could not be found in the insurance database. - **coverage_expired**: Implies that the patient's insurance coverage has expired. - **coverage_not_started**: Suggests that the patient's insurance coverage is in place but has not started yet. - **patient_not_covered_unspecified**: Used when the patient is not covered by the insurance plan, but the specific reason is not specified. - **unknown**: We were unable to determine the patient's insurance coverage status. verification_methods: items: $ref: '#/components/schemas/BenefitVerificationMethodInfo' type: array title: Verification Methods description: >- List of verification methods used to determine the coverage status of the drug. These will contain evidence from the verification procedure, such as a transcript of the phone conversation between the AI and the insurance provider. mock_result: allOf: - $ref: '#/components/schemas/MockResult' title: Mock Result description: >- Details of the mock result if one was used for this benefit verification. patient_plan_fund_source: allOf: - $ref: '#/components/schemas/PatientPlanFundSource' description: >- The source of the patient's plan funding. The options are: - 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. - unable_to_determine: The patient's plan funding source was asked, but could not be determined. default: question_not_asked patient_coverage_type: allOf: - $ref: '#/components/schemas/PatientCoverageType' description: |- The type of coverage the patient has. The options are: - medicare - medicare_advantage - tricare - medicaid - other - question_not_asked - unable_to_determine default: question_not_asked priority: allOf: - $ref: '#/components/schemas/Priority' description: >- The priority of the benefit verification request, as defined in the creation request. replaced_by: type: string title: Replaced By description: >- If this Benefit Verification was canceled and subsequently resubmitted, this field stores the ID of the new (replacement) Benefit Verification. replaces: type: string title: Replaces description: >- If this Benefit Verification was submitted as a replacement for a canceled one, this field stores the ID of the canceled Benefit Verification it replaces. triggered_by_pa_id: type: string title: Triggered By Pa Id description: >- The ID of the PA request that triggered this benefit verification, if applicable. type: object required: - id - status - status_description - review_status - drugs - patient - provider - insurance - patient_coverage_status - verification_methods - priority title: GetBenefitVerificationResponseData description: >- Represents the data the data contained in the response for a get benefit verification request. ValidationError: properties: loc: items: anyOf: - type: string - type: integer type: array title: Location msg: type: string title: Message type: type: string title: Error Type type: object required: - loc - msg - type title: ValidationError BenefitVerificationStatus: type: string enum: - pending - failed - completed - cancelled title: BenefitVerificationStatus description: An enumeration. FailureDetails: properties: title: type: string title: Title description: A brief title summarizing the error. code: allOf: - $ref: '#/components/schemas/ClientErrorCode' description: >- A specific code identifying the error. This list will likely expand over time to provide more specific error codes. The following codes are currently supported: - **Unable to Route Call**: We were unable to determine the correct number to call using the insurance information provided. More information is required. - **Document Info Missing or Incorrect**: The insurance documents provided are missing information that is necessary to identify the patient. The information could be outdated or not present in the documentation. For example, the documents might be missing the member ID for the patient, or could have a medical only ID, or could have an out of date address. To fix this error you can try re-uploading documents that contain the information specified in the message for this error. - **Document Quality Error**: The insurance documents provided are not valid insurance documents or are low quality (blurry or low resolution) and therefore cannot be processed by our system. To fix this error you can try re-uploading higher quality documents. - **Insurance Card OCR Failure**: This error means we were unable to read the necessary information from the insurance card image provided. This could be due to the image being unclear. Please check the images provided and/or provide the information manually if possible. This is generally an issue that would be handled on your side, and may involve reaching out to the patient to get a better image of their insurance card. - **Insurance Unable to Provide Information**: The insurance company was unable to provide the information needed to determine the patient's coverage status. This could be due to various reasons such as the insurance representative being unable or unwilling to provide the necessary details, or issues during the call, like refusal to transfer to a supervisor. - **Patient Not Found**: The plan contact we called was unable to locate the patient in their system. We weren't able to identify a root cause issue with the documentation provided, but re-uploading additional documents may help. - **Unable to Gather Benefits**: We were unable to gather benefits from the insurance company. This could be due to a variety of reasons, such as the insurance company not being able to provide the information, or the information provided not being sufficient to determine the patient's coverage status. To fix this error, you can try providing insurace information manually and/or providing medication history. - **Internal Error**: There was an internal error during the benefit verification. - **Provider Not Authorized**: The NPI provided is not authorized to submit requests. To enable benefit verification requests for this provider, please complete the provider authorization process. - **Patient Consent Required**: Benefit verification could not be completed. The payer requires the patient to provide verbal consent during the call. detail_code: anyOf: - $ref: '#/components/schemas/ClientInsuranceDocumentErrorDetailCode' - $ref: '#/components/schemas/ClientOtherErrorDetailCode' title: Detail Code description: >- A more detailed code that can be used to identify the specific issue that caused the error. message: type: string title: Message description: >- A detailed message explaining the error, such as: 'We were unable to extract the member ID from the insurance card image provided, the image(s) my be unclear.' These messages may be unique to the specific benefit verification request. detail_message: type: string title: Detail Message description: >- A more detailed message that can be used to identify the specific issue that caused the error. type: object required: - title title: FailureDetails description: Represents status details about a failed benefit verification. ReviewStatus: type: string enum: - reviewed - not_reviewed title: ReviewStatus description: An enumeration. DrugCoverageInfo: properties: name: type: string title: Name description: The name of the drug. dosage: type: string title: Dosage description: The prescribed dosage of the drug. quantity: type: number title: Quantity description: The quantity of the drug prescribed. ndc: type: string title: Ndc description: >- The National Drug Code (NDC) of the drug. Read-only; this field is ignored on input and populated from the resolved drug data. readOnly: true nullable: true coverage: allOf: - $ref: '#/components/schemas/DrugCoverage' description: >- This field will start off as null and will be populated if the benefit verification is successfully completed. The drug coverage result nullable: true coverage_detail_code: allOf: - $ref: '#/components/schemas/CoverageDetailCode' description: >- This field will start off as null and will be populated if the benefit verification is successfully completed. The options are: - **insurer_reported_value**: This is the exact value that the insurer reported for the drug coverage. - **diagnoses_not_covered**: The drug is being reported as not covered due to this patient's specific diagnosis codes. - **quantity_limit_pa_required**: The drug is covered but exceeds the plan's dispense quantity limit, so prior authorization is required. nullable: true prior_authorization_required: allOf: - $ref: '#/components/schemas/DrugPriorAuthorizationRequirement' description: >- This field will start off as null and will be populated if the benefit verification is successfully completed. A not_applicable value will be returned if the drug is not covered by the insurance plan. nullable: true copay: type: string title: Copay description: >- This field will start off as null and will be populated if the benefit verification is successfully completed and a copay is received. nullable: true copay_options: items: $ref: '#/components/schemas/CopayOption' type: array title: Copay Options description: A structured representation of the copay options for the drug. nullable: true determination_details: allOf: - $ref: '#/components/schemas/DrugCoverageDeterminationDetails' title: Determination Details description: >- A collection of more granular details surrounding the drug coverage determination. nullable: false has_active_prior_auth: type: boolean title: Has Active Prior Auth description: >- Whether there is an active prior authorization for this drug. Only set if operating if explicitly requested by the original API call. nullable: true type: object required: - name - dosage - quantity title: DrugCoverageInfo description: Represents information about a specific drug. DrugHistory: properties: currently_taking_drugs: items: $ref: '#/components/schemas/DrugHistoryItem' type: array title: Currently Taking Drugs description: The drugs that the patient is currently taking. default: [] previously_taken_drugs: items: $ref: '#/components/schemas/DrugHistoryItem' type: array title: Previously Taken Drugs description: The drugs that the patient has previously taken. default: [] type: object title: DrugHistory description: Represents the history of drugs taken by a patient. Diagnosis: properties: code: type: string title: Code description: ICD-10 code for the diagnosis. i.e. 'E66.9' type: object required: - code title: Diagnosis description: Represents a medical diagnosis with a code and description. api__schemas__platform__public_api__common__PatientInfo: properties: internal_id: type: string minLength: 1 title: Internal Id description: >- Your internal ID for this patient. This is used for linking all of the requests for a given patient. first_name: type: string minLength: 1 title: First Name description: The first name of the patient. last_name: type: string minLength: 1 title: Last Name description: The last name of the patient. gender: allOf: - $ref: '#/components/schemas/Gender' description: The gender of the patient. date_of_birth: type: string format: date title: Date Of Birth description: The date of birth of the patient. address: allOf: - $ref: '#/components/schemas/Address' title: Address description: The address of the patient. phone: type: string title: Phone description: The contact phone number of the patient. email: type: string title: Email description: The contact email address of the patient. type: object required: - internal_id - first_name - last_name - gender - date_of_birth - address title: PatientInfo description: Contains information about a patient. ProviderInfo: properties: first_name: type: string minLength: 1 title: First Name description: The first name of the provider. last_name: type: string minLength: 1 title: Last Name description: The last name of the provider. address: allOf: - $ref: '#/components/schemas/Address' title: Address description: The address of the provider. phone: type: string title: Phone description: The contact phone number of the provider. fax: type: string title: Fax description: The contact fax number of the provider. npi: type: string minLength: 1 title: Npi description: The National Provider Identifier (NPI) of the provider. in_network_payers: items: type: string type: array title: In Network Payers description: >- 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 type: object required: - first_name - last_name - address - npi title: ProviderInfo description: Contains information about a healthcare provider. EntityInfo: properties: legal_name: type: string title: Legal Name description: >- The legal name of the entity. This is the name that the provider is associated with. tax_id: type: string title: Tax Id description: >- The tax identifier of the entity. This is the tax ID that the provider is associated with. type: object title: EntityInfo description: Contains information about a healthcare entity. InsuranceDocumentInfo: properties: scanned_content: allOf: - $ref: '#/components/schemas/ScannedContent' title: Scanned Content description: >- An object containing details that were extracted from the insurance card images provided in the creation request. discrete_content: allOf: - $ref: '#/components/schemas/PartialInsuranceInfo' title: Discrete Content description: >- An object containing manually-provided insurance details from the creation request. url: type: string title: Url description: >- 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. type: object required: - scanned_content - discrete_content title: InsuranceDocumentInfo PatientCoverageStatus: type: string enum: - patient_not_found - coverage_expired - coverage_not_started - covered - patient_not_covered_unspecified - human_unable_to_answer - missing_from_transcript - unknown title: PatientCoverageStatus description: An enumeration. BenefitVerificationMethodInfo: properties: id: type: string title: Id description: The ID of the verification method. type: type: string title: Type description: The type of the verification method. transcript: type: string title: Transcript description: The call transcript recording_url: type: string title: Recording Url description: The URL to the call recording type: object required: - id - type title: BenefitVerificationMethodInfo description: >- Represents the verification method used in a benefit verification response. MockResult: properties: status: $ref: '#/components/schemas/MockResultStatus' case: allOf: - $ref: '#/components/schemas/MockResultCase' description: >- 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. - **patient_consent_required**: Patient consent is required to proceed with the benefit verification. - **reverification__existing_pa**: Reverification case where an existing prior authorization is found. Coverage status and PA requirement will be N/A, with has_active_prior_auth set to true. - **reverification__no_existing_pa**: Reverification case where no existing prior authorization is found. Drug is covered, prior authorization required, with has_active_prior_auth set to false. type: object required: - status - case title: MockResult PatientPlanFundSource: type: string enum: - commercial - government - question_not_asked - unable_to_determine title: PatientPlanFundSource description: The source of the patient's plan funding. PatientCoverageType: type: string enum: - medicare - medicare_advantage - tricare - medicaid - other - question_not_asked - unable_to_determine title: PatientCoverageType description: The type of coverage the patient has. Priority: type: integer enum: - 0 - 1 - 2 - 3 title: Priority description: |- Represents a priority level. Lower numbers are higher priority. - CRITICAL: 0 - HIGH: 1 - MEDIUM: 2 - LOW: 3 ClientErrorCode: type: string enum: - Patient Not Found - Insurance Card OCR Failure - Insurance Unable to Provide Information - Document Quality Error - Document Info Missing or Incorrect - Unable to Route Call - Unable to Gather Benefits - Internal Error - Provider Not Authorized - Patient Consent Required title: ClientErrorCode description: An enumeration. ClientInsuranceDocumentErrorDetailCode: type: string enum: - incorrect_member_id - incorrect_dob - incorrect_address - incorrect_phone_number - missing_member_id - medical_only_member_id - name_mismatch title: ClientInsuranceDocumentErrorDetailCode description: An enumeration. ClientOtherErrorDetailCode: type: string enum: - missing_tax_id - incorrect_tax_id - incorrect_npi - patient_consent_required - patient_declined_consent - kaiser_prescriber_required - expired title: ClientOtherErrorDetailCode description: An enumeration. DrugCoverage: type: string enum: - covered - not_covered title: DrugCoverage description: An enumeration. CoverageDetailCode: type: string enum: - insurer_reported_value - diagnoses_not_covered - quantity_limit_pa_required title: CoverageDetailCode description: An enumeration. DrugPriorAuthorizationRequirement: type: string enum: - 'yes' - 'no' - not_applicable title: DrugPriorAuthorizationRequirement description: An enumeration. CopayOption: properties: amount_cents: type: integer title: Amount Cents description: The amount of the copay in cents. supply_duration_days: type: integer title: Supply Duration Days description: The duration of the supply in days. Use null if unknown. type: object title: CopayOption DrugCoverageDeterminationDetails: properties: is_on_formulary: type: boolean title: Is On Formulary description: Whether the drug is on the formulary for the patient's plan. nullable: true is_explicit_plan_exclusion: type: boolean title: Is Explicit Plan Exclusion description: Whether the drug is explicitly excluded from the patient's plan. nullable: true is_prior_auth_acting_as_exception_request: type: boolean title: Is Prior Auth Acting As Exception Request description: >- Whether the prior authorization is acting as an exception request. This is only applicable if the drug is not on the formulary. nullable: true type: object title: DrugCoverageDeterminationDetails DrugHistoryItem: properties: name: type: string title: Name description: The name of the drug. type: object required: - name title: DrugHistoryItem description: Represents information about a currently or previously taken drug. Gender: type: string enum: - male - female - other - not_specified title: Gender description: An enumeration. Address: properties: street: type: string minLength: 1 title: Street description: Street address of residence. street_line_2: type: string title: Street Line 2 description: Additional street address information. city: type: string minLength: 1 title: City description: City of residence. state_province: type: string minLength: 1 title: State Province description: State or province of residence. zip_postal_code: type: string minLength: 1 title: Zip Postal Code description: ZIP or postal code part of the address. country: type: string minLength: 1 title: Country description: Country of residence. type: object required: - street - city - state_province - zip_postal_code - country title: Address description: Represents a postal address. ScannedContent: properties: client_name: type: string title: Client Name description: The client/employer name. group_number: type: string title: Group Number description: The group number on the card. member_name: type: string title: Member Name description: The member name on the card. member_number: type: string title: Member Number description: The member number on the card. payer_name: type: string title: Payer Name description: >- 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 plan_name: type: string title: Plan Name description: >- 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 rx_bin: type: string title: Rx Bin description: The Rx BIN number on the card. rx_group: type: string title: Rx Group description: The Rx group number on the card. rx_pcn: type: string title: Rx Pcn description: The Rx PCN number on the card. error: type: string title: Error description: >- Error message if we were unable to extract information from the card. type: object title: ScannedContent PartialInsuranceInfo: properties: client_name: type: string title: Client Name description: The client/employer name. group_number: type: string title: Group Number description: The group number on the card. member_name: type: string title: Member Name description: The member name on the card. member_number: type: string title: Member Number description: The member number on the card. payer_name: type: string title: Payer Name description: >- 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 plan_name: type: string title: Plan Name description: >- 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 rx_bin: type: string title: Rx Bin description: The Rx BIN number on the card. rx_group: type: string title: Rx Group description: The Rx group number on the card. rx_pcn: type: string title: Rx Pcn description: The Rx PCN number on the card. type: object title: PartialInsuranceInfo MockResultStatus: type: string enum: - completed - failed title: MockResultStatus description: An enumeration. MockResultCase: type: string enum: - drugs_covered__prior_auth_required__has_copay - drugs_covered__prior_auth_required__no_copay - drugs_covered__prior_auth_not_required__has_copay - drugs_covered__prior_auth_not_required__no_copay - drugs_not_covered__prior_auth_na__no_copay - patient_consent_required - reverification__existing_pa - reverification__no_existing_pa title: MockResultCase description: An enumeration. securitySchemes: FronteggJWTAuthentication: type: http scheme: bearer bearerFormat: JWT description: >- Bearer authentication header of the form `Bearer `, where `` is your auth token. ````