{
"status": "error",
"error": {
"title": "Rate Limit Exceeded",
"description": "The request exceeds the organization's configured API rate limit. Retry after the duration specified by Retry-After.",
"code": "rate_limit_exceeded"
}
}
{
"status": "error",
"error": {
"title": "Service Unavailable",
"description": "The service is temporarily unavailable. Retry the request shortly.",
"code": "service_unavailable"
}
}
{
"status": "error",
"error": {
"title": "Rate Limit Exceeded",
"description": "The request exceeds the organization's configured API rate limit. Retry after the duration specified by Retry-After.",
"code": "rate_limit_exceeded"
}
}
{
"status": "error",
"error": {
"title": "Service Unavailable",
"description": "The service is temporarily unavailable. Retry the request shortly.",
"code": "service_unavailable"
}
}
Create an asynchronous verification for up to seven medications. Follow
Create a benefit verification
for a complete request example, input recommendations, and sandbox testing.Provide at least one of insurance (card images) or insurance_content
(structured details). Prefer member ID with Rx BIN, PCN, and group. See
insurance inputs
for alternatives when Rx codes are missing.
Store the returned data.id. A successful response means the verification was
accepted. Retrieve the result with
GET /benefit-verification/{id}
or receive a webhook event
when it completes or fails. See statuses and error codes
for exact states, request errors, and workflow failures.
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.
The requested processing mode. standard uses standard processing, realtime prefers real-time processing with standard fallback, and realtime_only requires real-time processing without fallback.
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. Provide at least one card unless insurance_content contains at least one nonblank field.
Insurance information for the patient. Required with at least one nonblank field unless insurance contains at least one card. An empty object or an object containing only null or blank values does not satisfy this requirement. 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 legal entity associated with the provider. The entity and its legal_name and tax_id fields are optional at API intake. Some payers require these details to complete verification, so missing information can cause a later verification failure. Supply them when available.
Specifies the simulated outcome for a completed verification. The selected case determines the individual drug results. This field is only accepted for sandbox organizations.
Represents the data contained in the response for a create benefit verification request.
Show child attributes
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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","uniqueKey":"insurance_content.payer_name","typeLabel":"string"},"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","uniqueKey":"insurance_content.plan_name","typeLabel":"string"},"rx_bin":{"type":"string","title":"Rx Bin","description":"The Rx BIN number on the card.","uniqueKey":"insurance_content.rx_bin","typeLabel":"string"},"rx_group":{"type":"string","title":"Rx Group","description":"The Rx group number on the card.","uniqueKey":"insurance_content.rx_group","typeLabel":"string"},"rx_pcn":{"type":"string","title":"Rx Pcn","description":"The Rx PCN number on the card.","uniqueKey":"insurance_content.rx_pcn","typeLabel":"string"}},"uniqueKey":"insurance_content","typeLabel":"Insurance Content · object"},"entity":{"type":"object","title":"Entity","description":"The legal entity associated with the provider. The entity and its legal_name and tax_id fields are optional at API intake. Some payers require these details to complete verification, so missing information can cause a later verification failure. Supply them when available.","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.","uniqueKey":"entity.legal_name","typeLabel":"string"},"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.","uniqueKey":"entity.tax_id","typeLabel":"string"}},"uniqueKey":"entity","typeLabel":"Entity · object"},"mock_result":{"type":"object","title":"Mock Result","description":"Specifies the simulated outcome for a completed verification. The selected case determines the individual drug results. 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The options are: \n- **drugs_covered__prior_auth_required__has_copay**: Drug is covered, prior authorization required, and there is a copay.\n- **drugs_covered__prior_auth_required__no_copay**: Drug is covered, prior authorization required, but there is no copay.\n- **drugs_covered__prior_auth_not_required__has_copay**: Drug is covered, no prior authorization required, and there is a copay.\n- **drugs_covered__prior_auth_not_required__no_copay**: Drug is covered, no prior authorization required, and there is no copay.\n- **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.\n- **patient_consent_required**: Patient consent is required to proceed with the benefit verification.\n- **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.\n- **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.\n- **drugs_not_checked**: Every drug returns not_checked coverage and only its name, dosage, quantity, and NDC.\n- **mixed_checked_and_not_checked**: The first drug is covered, requires prior authorization, and has a copay. Remaining drugs return not_checked coverage and only their name, dosage, quantity, and NDC. Requires at least two drugs.","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","drugs_not_checked","mixed_checked_and_not_checked"],"isRequired":true,"uniqueKey":"mock_result.case","typeLabel":"enum\u003cstring>"}},"uniqueKey":"mock_result","typeLabel":"Mock Result · object"},"use_patient_plan_fund_source_check":{"type":"boolean","title":"Use Patient Plan Fund Source Check","description":"Whether to check the patient's plan fund source during the benefit verification call.","default":false,"uniqueKey":"use_patient_plan_fund_source_check","typeLabel":"boolean"}},"uniqueKey":"","typeLabel":"Data · object"},"examples":{"Example":{"title":"Example","value":{"priority":3,"preferred_processing_mode":"standard","drugs":[{"ndc":"00169-4505-14","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. 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