Run Benefit Verification - Develop Health

Create Benefit Verification Route

curl --request POST \
  --url https://api.develophealth.ai/benefit-verification \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "priority": 3,
  "drugs": [
    {
      "name": "Wegovy",
      "dosage": "0.25 mg",
      "quantity": 1
    },
    {
      "name": "Ozempic",
      "dosage": "2.68 mg",
      "quantity": 1
    },
    {
      "name": "Mounjaro",
      "dosage": "2.5 mg",
      "quantity": 1
    }
  ],
  "drug_history": {
    "currently_taking_drugs": [
      {
        "name": "Metformin"
      }
    ],
    "previously_taken_drugs": [
      {
        "name": "Jardiance"
      },
      {
        "name": "Rybelsus"
      }
    ]
  },
  "diagnoses": [
    {
      "code": "E66.9"
    },
    {
      "code": "I10"
    }
  ],
  "insurance": [
    {
      "file_content": "iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg=="
    },
    {
      "file_content": "iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg=="
    }
  ],
  "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"
  },
  "mock_result": {
    "status": "completed",
    "case": "drugs_covered__prior_auth_required__has_copay"
  },
  "use_patient_plan_fund_source_check": false
}
'

{
  "status": "success",
  "data": {
    "id": "bv_sdkfj3f"
  }
}

POST

benefit-verification

Create Benefit Verification Route

curl --request POST \
  --url https://api.develophealth.ai/benefit-verification \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "priority": 3,
  "drugs": [
    {
      "name": "Wegovy",
      "dosage": "0.25 mg",
      "quantity": 1
    },
    {
      "name": "Ozempic",
      "dosage": "2.68 mg",
      "quantity": 1
    },
    {
      "name": "Mounjaro",
      "dosage": "2.5 mg",
      "quantity": 1
    }
  ],
  "drug_history": {
    "currently_taking_drugs": [
      {
        "name": "Metformin"
      }
    ],
    "previously_taken_drugs": [
      {
        "name": "Jardiance"
      },
      {
        "name": "Rybelsus"
      }
    ]
  },
  "diagnoses": [
    {
      "code": "E66.9"
    },
    {
      "code": "I10"
    }
  ],
  "insurance": [
    {
      "file_content": "iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg=="
    },
    {
      "file_content": "iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg=="
    }
  ],
  "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"
  },
  "mock_result": {
    "status": "completed",
    "case": "drugs_covered__prior_auth_required__has_copay"
  },
  "use_patient_plan_fund_source_check": false
}
'

{
  "status": "success",
  "data": {
    "id": "bv_sdkfj3f"
  }
}

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 available. 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 approximately 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.

Authorizations

Authorization

string

header

required

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

Body

application/json

Models a request to create a benefit verification.

drugs

CodedDrugInfo · object

required

Like DrugInfo, but more closely aligned with NCPDP standards. Helps reduce any confusion on the payer-side.

CodedDrugInfo · object[]
DrugInfo · object[]

Show child attributes

patient

Patient · object

required

Demographic information for the patient

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provider

Provider · object

required

Details of the healthcare provider whose NPI number can be used for the benefit verification.

Show child attributes

priority

enum<integer>

default:3

The priority of the benefit verification request, where 0 is most urgent and 3 is least urgent. This will determine the order in which the request is processed.

Available options:

0,

1,

2,

3

replaces

string

If this Benefit Verification is being submitted as a replacement for a canceled one, the ID of the canceled Benefit Verification it replaces.

drug_history

Drug History · object

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.

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diagnoses

Diagnosis · object[]

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

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insurance

InsuranceDocument · object[]

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.

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insurance_content

Insurance Content · object

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.

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entity

Entity · object

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.

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mock_result

Mock Result · object

Specifies the simulated outcome for a completed verification. These values will be applied to all drugs in the request.

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use_patient_plan_fund_source_check

boolean

default:false

Whether to check the patient's plan fund source during the benefit verification call.

Response

Successful creation of a benefit verification

Models the response received upon creating a benefit verification request.

status

default:success

Available options:

success

error

ApiError · object

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data

CreateBenefitVerificationResponseData · object

Represents the data contained in the response for a create benefit verification request.

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Changelog Retrieve Benefit Verification

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