> ## 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. # Run Benefit Verification 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. ## OpenAPI ````yaml post /benefit-verification 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: post: tags: - public-api summary: Create Benefit Verification Route operationId: create_benefit_verification_route_benefit_verification_post requestBody: content: application/json: schema: allOf: - $ref: '#/components/schemas/CreateBenefitVerificationRequest' title: Data examples: - 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 required: true responses: '200': description: Successful creation of a benefit verification content: application/json: schema: $ref: '#/components/schemas/CreateBenefitVerificationResponse' example: status: success data: id: bv_sdkfj3f '422': description: Validation Error content: application/json: schema: $ref: '#/components/schemas/HTTPValidationError' security: - FronteggJWTAuthentication: [] components: schemas: CreateBenefitVerificationRequest: properties: priority: allOf: - $ref: '#/components/schemas/Priority' description: >- 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. default: 3 gte: 0 lte: 3 replaces: type: string title: Replaces description: >- If this Benefit Verification is being submitted as a replacement for a canceled one, the ID of the canceled Benefit Verification it replaces. drugs: anyOf: - items: $ref: '#/components/schemas/CodedDrugInfo' type: array maxItems: 7 minItems: 1 - items: $ref: '#/components/schemas/DrugInfo' type: array maxItems: 7 minItems: 1 title: Drugs description: >- Array of medications for which to perform the benefit verification. Prefer coded drugs when NDCs are available. drug_history: allOf: - $ref: '#/components/schemas/DrugHistory' title: Drug History description: >- 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. diagnoses: items: $ref: '#/components/schemas/Diagnosis' type: array title: Diagnoses description: Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9' insurance: items: $ref: >- #/components/schemas/api__schemas__platform__public_api__benefit_verification__InsuranceDocument type: array title: Insurance description: >- 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_content: allOf: - $ref: '#/components/schemas/PartialInsuranceInfo' title: Insurance Content description: >- 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. 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. mock_result: allOf: - $ref: '#/components/schemas/MockResult' title: Mock Result description: >- Specifies the simulated outcome for a completed verification. These values will be applied to all drugs in the request. 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 type: object required: - drugs - patient - provider title: CreateBenefitVerificationRequest description: Models a request to create a benefit verification. CreateBenefitVerificationResponse: properties: status: anyOf: - type: string enum: - success - type: string enum: - error title: Status default: success error: $ref: '#/components/schemas/ApiError' data: $ref: '#/components/schemas/CreateBenefitVerificationResponseData' type: object title: CreateBenefitVerificationResponse description: >- Models the response received upon creating a benefit verification request. HTTPValidationError: properties: detail: items: $ref: '#/components/schemas/ValidationError' type: array title: Detail type: object title: HTTPValidationError Priority: type: integer enum: - 0 - 1 - 2 - 3 title: Priority description: |- Represents a priority level. Lower numbers are higher priority. - CRITICAL: 0 - HIGH: 1 - MEDIUM: 2 - LOW: 3 CodedDrugInfo: properties: ndc: type: string pattern: >- ^(\d{5}-?\d{4}-?\d{2}|\d{4,5}-\d{3,4}-\d{1,2}|\d{5}-?\d{4}|\d{4,5}-\d{3,4})$ title: Ndc description: The NDC of the medication. examples: - 00169-4505-14 - 0169-4505-14 - 169450514 - 00169-4505 - 0169-4505 - 1694505 quantity: type: integer title: Quantity description: The quantity of the drug prescribed. examples: - 1 type: object required: - ndc - quantity title: CodedDrugInfo description: >- Like DrugInfo, but more closely aligned with NCPDP standards. Helps reduce any confusion on the payer-side. DrugInfo: 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 type: object required: - name - dosage - quantity title: DrugInfo 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__benefit_verification__InsuranceDocument: properties: file_content: type: string title: File Content description: The content of the insurance document, base64 encoded type: object required: - file_content title: InsuranceDocument description: Represents an insurance document. 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 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. 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 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 CreateBenefitVerificationResponseData: properties: id: type: string title: Id description: A unique identifier for the benefit verification result. type: object required: - id title: CreateBenefitVerificationResponseData description: >- Represents the data contained in the response for a create 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 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. 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. ````