Retrieve Prior Authorization

Prior Authorization Statuses

Below are the possible statuses for a prior authorization request, along with a description of each status.

Status Descriptions

processing: The prior authorization request has been received and is currently being processed. This is the initial status indicating that the system is handling the request. Generally it will only be in this state for up to a few minutes.
not_submitted: The prior authorization request will not be submitted. For example, when the eligibility check is enabled and the check returns as error.
awaiting_review: Processing has completed and the AI answers have been generated. The prior authorization will remain in this state until submitted by a user in the platform.
awaiting_outcome: The request has been submitted to the payer or pharmacy benefit manager and is awaiting an outcome.
validating_outcome: An outcome has been received but requires additional validation by the Develop Health team to ensure accuracy before finalizing the result back to you. This is a short lived status that occurs in some cases, and should generally be resolved in a few hours or less. If an issue is found during validation, the prior authorization will be transitioned back to the awaiting_outcome status while our team corrects the issue. You should wait until receiving a completed/failed status before relaying any outcomes to the patient.
completed: The prior authorization process has completed, with an approval or denial determination, or an “other” outcome (e.g. patient coverage inactive).
cancelled: The prior authorization request has been cancelled by the user, and no further processing will occur.

See the diagram below for a visual representation of the status workflow.

Authorizations

Authorization

string

header

required

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

Path Parameters

string

required

Response

Successfully returned a prior authorization

Represents the response structure for a GET /prior-authorization/:id request.

This class extends the generic ApiResponse, specifically tailored to handle responses related to prior authorizations. It primarily includes the data attribute, which holds detailed information about the benefit verification process and its results.

status

default:success

Available options:

success

error

ApiError · object

Show child attributes

error.title

string

required

error.description

string

required

error.code

string

required

data

Data · object

Contains the data from your prior authorization request, or None if an error occurred.

Show child attributes

data.id

string

required

The ID of this prior authorization

data.url

string

required

The URL where the Prior Authorization can be viewed.

data.status

enum<string>

required

The current status of the prior auth request.

Available options:

failed,

not_submitted,

processing,

awaiting_review,

awaiting_outcome,

validating_outcome,

completed,

cancelled

data.diagnoses

Diagnosis · object[]

required

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

Show child attributes

data.diagnoses.code

string

required

ICD-10 code for the diagnosis. i.e. 'E66.9'

data.patient

Patient · object

required

Demographic information for the patient

Show child attributes

data.patient.address

Address · object

required

The patient's postal address

Show child attributes

data.patient.address.street

string

required

Street address of residence.

Minimum string length: 1

data.patient.address.city

string

required

City of residence.

Minimum string length: 1

data.patient.address.state_province

string

required

State or province of residence.

Minimum string length: 1

data.patient.address.zip_postal_code

string

required

ZIP or postal code part of the address.

Minimum string length: 1

data.patient.address.country

string

required

Country of residence.

Minimum string length: 1

data.patient.address.street_line_2

string

Additional street address information.

data.patient.date_of_birth

string<date>

required

The patient's date of birth

data.patient.first_name

string

required

The patient's first name

Minimum string length: 1

data.patient.last_name

string

required

The patient's last name

Minimum string length: 1

data.patient.gender

enum<string>

required

The patient's gender

Available options:

male,

female,

other,

not_specified

data.patient.internal_id

string

required

Your internal ID for this patient. This is used for linking all of the requests for a given patient.

Minimum string length: 1

data.patient.email

string<email>

The patient's email address

data.patient.phone

string

The patient's phone number

data.insurance

InsuranceDocumentInfo · object[]

required

Array of insurance documents.

Show child attributes

data.insurance.scanned_content

Scanned Content · object

required

An object containing details that were extracted from the insurance card images provided in the creation request.

Show child attributes

data.insurance.scanned_content.client_name

string

The client/employer name.

data.insurance.scanned_content.group_number

string

The group number on the card.

data.insurance.scanned_content.member_name

string

The member name on the card.

data.insurance.scanned_content.member_number

string

The member number on the card.

data.insurance.scanned_content.payer_name

string

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

data.insurance.scanned_content.plan_name

string

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

data.insurance.scanned_content.rx_bin

string

The Rx BIN number on the card.

data.insurance.scanned_content.rx_group

string

The Rx group number on the card.

data.insurance.scanned_content.rx_pcn

string

The Rx PCN number on the card.

data.insurance.scanned_content.error

string

Error message if we were unable to extract information from the card.

data.insurance.discrete_content

Discrete Content · object

required

An object containing manually-provided insurance details from the creation request.

Show child attributes

data.insurance.discrete_content.client_name

string

The client/employer name.

data.insurance.discrete_content.group_number

string

The group number on the card.

data.insurance.discrete_content.member_name

string

The member name on the card.

data.insurance.discrete_content.member_number

string

The member number on the card.

data.insurance.discrete_content.payer_name

string

data.insurance.discrete_content.plan_name

string

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

data.insurance.discrete_content.rx_bin

string

The Rx BIN number on the card.

data.insurance.discrete_content.rx_group

string

The Rx group number on the card.

data.insurance.discrete_content.rx_pcn

string

The Rx PCN number on the card.

data.insurance.url

string

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.

data.provider

Provider · object

required

Details of the healthcare provider who created the prescription.

Show child attributes

data.provider.address

Address · object

required

The provider's postal address.

Show child attributes

data.provider.address.street

string

Street address of residence.

data.provider.address.street_line_2

string

Additional street address information.

data.provider.address.city

string

City of residence.

data.provider.address.state_province

string

State or province of residence.

data.provider.address.zip_postal_code

string

ZIP or postal code part of the address.

data.provider.address.country

string

Country of residence.

data.provider.first_name

string

required

The provider's first name.

Minimum string length: 1

data.provider.last_name

string

required

The provider's last name.

Minimum string length: 1

data.provider.npi

string

required

The provider's NPI.

Minimum string length: 1

data.provider.fax

string

The provider's fax number.

data.provider.internal_id

string

Your internal ID for this provider. This is used for linking all of the requests for a given provider.

data.provider.phone

string

The provider's phone number.

data.outcome

PriorAuthSubmissionApprovalOutcome · object

required

Details of the outcome of the prior authorization request.

PriorAuthSubmissionApprovalOutcome
PriorAuthSubmissionDenialOutcome
PriorAuthSubmissionOtherOutcome
PriorAuthSubmissionPendingOutcome
PriorAuthSubmissionNotSubmittedOutcome

Show child attributes

data.outcome.detail

string

A human-readable note providing additional information about the outcome. This will usually be an automated message corresponding to detail_code. In some cases it will contain more specific details about the outcome. For example, "Patient must enroll in the Omada Health Program."

data.outcome.result

enum<string>

default:Approved

The Prior Authorization has been approved.

Available options:

Approved

Allowed value: "Approved"

data.outcome.detail_code

enum<string>

A code indicating the reason for the prior auth outcome. The possible values are:

prior_auth_not_required: A prior authorization is not required.
approval: The prior authorization request has been approved.
existing_approval: An active prior authorization approval already exists for the patient.

Available options:

prior_auth_not_required,

approval,

existing_approval

data.outcome.authorization_start_date

string<date>

The date when the authorization became effective. This will typically only be populated for approved outcomes.

data.outcome.authorization_expiration

string<date>

The date when the authorization expires. This information is not always available, but it will be included where possible.

data.object

enum<string>

default:prior_authorization

The type of object. This will always be 'prior_authorization', from this endpoint, but this can be helpful for differentiating between different types of objects when parsing webhook responses.

Available options:

prior_authorization

data.evidence

ResponseEvidenceItem · object[]

A collection of evidence items supporting the authorization request. Any other supporting evidence that doesn't fit into one of the explicitly declared fields above can be added here.

Show child attributes

data.evidence.date_created

string<date-time>

required

The date and time (if available) when the evidence was created. This is important for ensuring we have an accurate timeline of the patient's history.

data.evidence.title

string

required

Title of the evidence. This will be shown to users in the platform UI so it's recommended to give it a name that would be meaningful to them, such as 'Intake Form'

data.evidence.asset

Asset · object

File asset containing the evidence.

Show child attributes

data.evidence.asset.url

string

required

The URL where the asset can be accessed.

Minimum string length: 1

data.evidence.asset.file_type

enum<string>

required

MIME type of the file. e.g. application/pdf

Available options:

application/pdf,

application/msword,

text/plain,

application/vnd.ms-excel

data.evidence.content

Content · object

Detailed content of the evidence, which varies based on the type of evidence.

data.prescription

Prescription · object

Information regarding the prescription this prior authorization is being created for.

Show child attributes

data.prescription.days_supply

integer

required

The number of days the prescription will be expected to last.

data.prescription.quantity

integer

required

The quantity of the medication.

data.prescription.directions

string

required

Instructions on how the medication should be taken.

Minimum string length: 1

data.prescription.drug_name

string

required

The name of the medication.

Minimum string length: 1

data.prescription.strength

string

required

The strength of the medication.

Minimum string length: 1

data.prescription.dose_form

enum<string>

required

The form of the medication.

Available options:

aerosol,

bar,

bead,

breadstick,

bulk,

capsule,

catheter,

cement,

cigarette,

cloth,

concentrate,

cone,

cream,

crystal,

culture,

dentifrice,

deposit,

device,

diaphragm,

disc,

douche,

dressing,

drops,

elixir,

emulsion,

enema,

extract,

film,

food,

foam,

gel,

generator,

globule,

graft,

gum,

implant,

infusion,

inhalant,

inhalation,

inhaler,

injectable,

injection,

insert,

irrigant,

irrigation,

jelly,

kit,

lens,

liner,

liniment,

lipstick,

liquid,

lollipop,

lotion,

lozenge,

miscellaneous,

mouthwash,

mucilage,

oil,

ointment,

packing,

paste,

pastille,

patch,

pellet,

pill,

plaster,

poultice,

powder,

resin,

ring,

rinse,

rod,

salve,

shampoo,

soap,

sol,

solution,

sponge,

spray,

stick,

strip,

suppository,

suspension,

suture,

swab,

syrup,

tablet,

tampon,

tape,

tea,

test,

tincture,

troche,

vaginal_suppository,

vaginal_tablet,

wafer,

wash,

wax

data.prescription.route_of_administration

enum<string>

required

The route of administration for the medication.

Available options:

auricular (otic),

otic,

buccal,

conjunctival,

cutaneous,

dental,

electro-osmosis,

endocervical,

endosinusial,

endotracheal,

enteral,

epidural,

extra-amniotic,

extracorporeal,

hemodialysis,

infiltration,

interstitial,

intra-abdominal,

intra-amniotic,

intra-arterial,

intra-articular,

intrabiliary,

intrabronchial,

intrabursal,

intracameral,

intracanalicular,

intracardiac,

intracartilaginous,

intracaudal,

intracavernous,

intracavitary,

intracerebral,

intracisternal,

intracorneal,

intracoronal, dental,

intracoronary,

intracorporus cavernosum,

intracranial,

intradermal,

intradiscal,

intraductal,

intraduodenal,

intradural,

intraepicardial,

intraepidermal,

intraesophageal,

intragastric,

intragingival,

intrahepatic,

intraileal,

intralesional,

intralingual,

intraluminal,

intralymphatic,

intramammary,

intramedullary,

intrameningeal,

intramuscular,

intranodal,

intraocular,

intraomentum,

intraovarian,

intrapericardial,

intraperitoneal,

intrapleural,

intraprostatic,

intrapulmonary,

intraruminal,

intrasinal,

intraspinal,

intrasynovial,

intratendinous,

intratesticular,

intrathecal,

intrathoracic,

intratubular,

intratumor,

intratympanic,

intrauterine,

intravascular,

intravenous,

intraventricular,

intravesical,

intravitreal,

iontophoresis,

irrigation,

laryngeal,

nasal,

nasogastric,

not applicable,

occlusive dressing technique,

ophthalmic,

oral,

oropharyngeal,

parenteral,

percutaneous,

periarticular,

peridural,

perineural,

periodontal,

rectal,

respiratory (inhalation),

inhalation,

retrobulbar,

soft tissue,

subarachnoid,

subconjunctival,

subcutaneous,

subgingival,

sublingual,

submucosal,

subretinal,

suprachoroidal,

topical,

transdermal,

transendocardial,

transmucosal,

transplacental,

transtracheal,

transtympanic,

ureteral,

urethral,

vaginal

data.prescription.prescription_date

string<date-time>

required

The date the prescription was issued

data.prescription.extra

Extra · object

An optional dictionary containing additional information related to the drug or future prescription.

data.prescription.expected_length_of_therapy

string

The expected length of therapy for the prescribed drug. Defaults to 'Until No Longer Needed' if not provided.

data.pharmacy

Pharmacy · object

Information about the pharmacy where the prescription will be filled.

Show child attributes

data.pharmacy.name

string

required

The name of the pharmacy.

Minimum string length: 1

data.pharmacy.address

Address · object

required

Represents a postal address.

Show child attributes

data.pharmacy.address.street

string

required

Street address of residence.

Minimum string length: 1

data.pharmacy.address.city

string

required

City of residence.

Minimum string length: 1

data.pharmacy.address.state_province

string

required

State or province of residence.

Minimum string length: 1

data.pharmacy.address.zip_postal_code

string

required

ZIP or postal code part of the address.

Minimum string length: 1

data.pharmacy.address.country

string

required

Country of residence.

Minimum string length: 1

data.pharmacy.address.street_line_2

string

Additional street address information.

data.questionnaires

Questionnaire · object[]

List of questionnaires. This is the best place to send structured Q&A format data, such as intake forms, etc.

Show child attributes

data.questionnaires.questions

Question · object[]

required

A list of questions included in the questionnaire.

Show child attributes

data.questionnaires.questions.answer

string

required

The answer to the question.

Minimum string length: 1

data.questionnaires.questions.question

string

required

The question to be answered.

Minimum string length: 1

data.questionnaires.questions.choices

string[]

Optional list of choices for the question. If provided, the answer must be one of the choices. It's important to include this list of choices for any multiple choice question. This allows our AI to know what a user has effectively said 'no' to by picking another option. I.e. for a question 'Do you have any of the following conditions: Diabetes, Heart Disease, Cancer, None of the above' if the user answers 'None of the above' we can infer that they don't have any of those conditions. Without the choices list we would have no way of knowing that.

data.questionnaires.date_created

string<date-time>

required

The date and time when the questionnaire was answered. This is important for ensuring we have an accurate timeline of the patient's history.

data.visit_notes

VisitNote · object[]

List of visit notes.

Show child attributes

data.visit_notes.content

string

required

The content of the visit note.

Minimum string length: 1

data.visit_notes.date_created

string<date-time>

required

The date and time (if available) when the visit note was created. This is important for ensuring we have an accurate timeline of the patient's history.

data.visit_notes.title

string

The title of the visit note. This is optional and can be used to give the note a meaningful name, such as 'Initial Consultation'.

Minimum string length: 1

data.ndp_submission

Ndp Submission · object

Configuration for processing the prescription associated with this PA request.

Show child attributes

data.ndp_submission.prescription_message_id

string

required

The Surescripts message ID for the prescription transfer.

Minimum string length: 1

data.ndp_submission.ignore_eligibility_check_error

boolean

required

If set to True, error responses from the eligibility check will not terminate the PA request.

data.ndp_submission.preferred_pharmacy_ncpdp_id

string

required

The NCPDP ID of the preferred pharmacy where the prescription will be transferred after the PA request has been approved.

data.ndp_submission.submit_pa_with_eligibility_check_government_plan

boolean

default:false

If set to True, the PA request will be submitted even if the eligibility check reveals the patient has only government insurance plan(s).

data.resubmission_info

Resubmission Info · object

Information provided when resubmitting a prior authorization request.

Show child attributes

data.resubmission_info.note

string

required

Reason for resubmission or additional instructions for this attempt.

data.resubmission_info.previous_prior_auth_request_id

string

Identifier of the previous prior authorization request.

data.resubmission_info.quantity_limit_exception_reason

string

Explanation for requesting an exception to the plan's quantity limit. Required when resubmitting due to a quantity limit denial.

data.activity_log

(PriorAuthActivityLogSentFax · object | PriorAuthActivityLogReceivedFax · object | PriorAuthActivityLogFollowUpCall · object)[]

A list of activity log items for the prior authorization request. Note: additional item types will be added here in future, so please ensure that unknown types are ignored when parsing this array to avoid validation errors when new types are added.

PriorAuthActivityLogSentFax
PriorAuthActivityLogReceivedFax
PriorAuthActivityLogFollowUpCall

Show child attributes

data.activity_log.id

string

required

data.activity_log.created_at

string<date-time>

required

data.activity_log.details

PriorAuthActivityLogFaxDetails · object

required

Show child attributes

data.activity_log.details.url

string

required

A signed URL to download the fax file. Note that this URL has a short lifespan and should be used immediately to download the file.

data.activity_log.type

enum<string>

default:sent_fax

Available options:

sent_fax

data.submitted_by

Submitted By · object

The user who submitted the prior authorization request.

Show child attributes

data.submitted_by.email

string

required

The email of the user.

data.submitted_by.first_name

string

The first name of the user.

data.submitted_by.last_name

string

The last name of the user.

data.reviewed_by

Reviewed By · object

The user who reviewed the prior authorization request.

Show child attributes

data.reviewed_by.email

string

required

The email of the user.

data.reviewed_by.first_name

string

The first name of the user.

data.reviewed_by.last_name

string

The last name of the user.

data.eligibility_check_response

(EligibilityCheckResponseSuccessItem · object | EligibilityCheckResponseErrorItem · object)[]

Populated after the eligibility check has been made for the PA, if enabled

Minimum array length: 1

EligibilityCheckResponseSuccessItem
EligibilityCheckResponseErrorItem

Show child attributes

data.eligibility_check_response.effective_start_date

string<date>

required

Effective start date of coverage

data.eligibility_check_response.status

enum<string>

default:success

Available options:

success

data.eligibility_check_response.health_plan_name

string | null

Health plan name

data.eligibility_check_response.plan_type

enum<string>

Type of the health plan if determined.

Available options:

medicare,

medicare_advantage,

medicaid,

tricare

data.eligibility_check_response.rx_bin

string | null

Rx BIN

data.eligibility_check_response.rx_pcn

string | null

Rx PCN

data.eligibility_check_response.rx_grp

string | null

Rx GRP

data.eligibility_check_response.effective_end_date

string<date>

Effective end date of coverage

data.real_time_benefits_check_response

Real Time Benefits Check Response · object

Populated after the real-time benefits check has been made for the PA, if enabled

Show child attributes

data.real_time_benefits_check_response.patient_cost

string

required

Patient cost for the requested prescription

data.real_time_benefits_check_response.prior_auth_required

boolean

Whether a prior authorization is required for the requested prescription

data.real_time_benefits_check_response.alternatives

RealTimeBenefitsCheckAlternative · object[]

List of alternative drugs

Show child attributes

data.real_time_benefits_check_response.alternatives.product_id

string

required

The product ID (NDC or RxNorm) of the alternative drug

data.real_time_benefits_check_response.alternatives.description

string

required

Drug name and strength of the alternative drug

data.real_time_benefits_check_response.alternatives.patient_cost

string

required

Patient cost for the alternative drug

data.real_time_benefits_check_response.alternatives.prior_auth_required

boolean

Whether prior authorization is required for the alternative drug

data.prescription_transfer

Prescription Transfer · object

Information about the prescription transfer status and attempts

Show child attributes

data.prescription_transfer.status

enum<string>

required

Status of the pharmacy transfer

Available options:

in_progress,

cancelled,

completed,

error

data.prescription_transfer.confirmed

boolean

default:false

True if completed and confirmation succeeded

data.prescription_transfer.error_code

enum<string>

Error code if transfer failed.

Note: this list of codes may grow over time, so your implementation should handle unrecognized values (probably in the same way as 'other').

pharmacy_does_not_exist: The specified pharmacy does not exist in our records.
pharmacy_permanently_closed: The pharmacy has been permanently closed and cannot accept any transfers.
pharmacy_unable_to_accept_transfer: The pharmacy is unable to accept the prescription transfer.
pharmacy_unable_to_fill_prescription: The pharmacy cannot fill the prescription due to restrictions or lack of stock.
prescription_transfer_not_received: The pharmacy did not receive the prescription transfer, possibly after several attempts.
other: An unexpected error occurred during the prescription transfer process.

Available options:

pharmacy_does_not_exist,

pharmacy_permanently_closed,

pharmacy_unable_to_accept_transfer,

pharmacy_unable_to_fill_prescription,

prescription_transfer_not_received,

other

data.prescription_transfer.transfer_attempts

PrescriptionTransferAttempt · object[]

List of transfer attempts

Show child attributes

data.prescription_transfer.transfer_attempts.timestamp

string<date-time>

required

Timestamp of transfer attempt

data.prescription_transfer.transfer_attempts.pharmacy_ncpdp_id

string

NCPDP ID for the pharmacy receiving the transfer

data.prescription_transfer.confirmation_attempts

PrescriptionTransferConfirmationAttempt · object[]

List of confirmation attempts

Show child attributes

data.prescription_transfer.confirmation_attempts.timestamp

string<date-time>

required

Timestamp of confirmation attempt

data.prescription_transfer.confirmation_attempts.outcome

enum<string>

required

Outcome of the transfer confirmation attempt

Available options:

success,

failed

data.mock_result

PriorAuthMockResultApproved · object

The mock result of the prior authorization request, if one was provided in the initial request

PriorAuthMockResultApproved
PriorAuthMockResultDenied
PriorAuthMockResultOther
PriorAuthMockResultNotSubmitted

Show child attributes

data.mock_result.result

enum<string>

default:Approved

The Prior Authorization has been approved.

Available options:

Approved

Allowed value: "Approved"

data.mock_result.detail_code

enum<string>

A code indicating the reason for the prior auth outcome. The possible values are:

prior_auth_not_required: A prior authorization is not required.
approval: The prior authorization request has been approved.
existing_approval: An active prior authorization approval already exists for the patient.

Available options:

prior_auth_not_required,

approval,

existing_approval

data.mock_result.prescription_transfer_error_code

enum<string>

This field is only used if the ndp_submission.preferred_pharmacy_ncpdp_id was provided in the request. If provided, a prescription transfer error will be mocked. Otherwise / by default, a successful transfer will be mocked.

Available options:

pharmacy_does_not_exist,

pharmacy_permanently_closed,

pharmacy_unable_to_accept_transfer,

pharmacy_unable_to_fill_prescription,

prescription_transfer_not_received,

other

data.out_of_pocket_costs

CopayOption · object[]

List of copay options with amounts in cents and supply duration in days

Show child attributes

data.out_of_pocket_costs.amount_cents

integer

The amount of the copay in cents.

data.out_of_pocket_costs.supply_duration_days

integer

The duration of the supply in days. Use null if unknown.

data.denial_reason_analysis

Denial Reason Analysis · object

Analysis of the denial reason(s). Populated when the prior authorization request has been denied.

Show child attributes

data.denial_reason_analysis.categories

string[]

required

Categories describing the denial reason

data.denial_reason_analysis.explanation

string

required

Explanation of the denial

data.denial_reason_analysis.next_steps

string

required

Suggested next steps to address the denial

data.denial_reason_analysis.next_steps_explanation

string

required

Further details about the suggested next steps

data.message_thread

Message Thread · object

Message thread for this prior authorization, including whether it is resolved and its messages.

Show child attributes

data.message_thread.is_resolved

boolean

required

Whether this message thread is currently resolved. A thread may be unresolved/reopened if further discussion is needed.

data.message_thread.messages

PlatformMessage · object[]

required

Messages in this thread.

Show child attributes

data.message_thread.messages.id

string

required

The ID of this message.

data.message_thread.messages.timestamp

string<date-time>

required

Timestamp of when the message was sent

data.message_thread.messages.content

string

required

Message content

data.message_thread.messages.sent_by_name

string

required

Display name of the sender of this message.

data.message_thread.messages.direction

enum<string>

required

Direction of the message relative to you.

Available options:

sent,

received

data.message_thread.messages.is_resolution

boolean

required

Whether this message resolves the thread.

API Documentation

​Prior Authorization Statuses

​Status Descriptions

Authorizations

Path Parameters

Response

Prior Authorization Statuses

Status Descriptions