API Documentation
- Quickstart Guide
- Changelog
- POSTRun Benefit Verification
- GETRetrieve Benefit Verification
- POSTCancel Benefit Verification
- POSTSend Prior Authorization
- GETRetrieve Prior Authorization
- POSTAuthorize Provider
- POSTCheck Clinical Qualification
- GETRetrieve Clinical Qualification
- POSTCheck Prior Authorization Status
- POSTSubmit Patient Enrollment
- Authentication
- Webhooks
Retrieve Prior Authorization
curl --request GET \
--url https://api.develophealth.ai/prior-authorization/{id} \
--header 'Authorization: Bearer <token>'{
"status": "success",
"data": {
"id": "pa_sdkfj3f",
"object": "prior_authorization",
"url": "https://platform.develophealth.ai/prior-authorizations/pa_sdkfj3f",
"status": "processing",
"diagnoses": [
{
"code": "E66.9"
}
],
"evidence": [
{
"content": {
"bmi_value": 32,
"date_measured": "2023-11-10"
},
"date_created": "2023-11-10T10:15:00",
"title": "BMI Chart"
},
{
"content": {
"medication_name": "Metformin",
"response": "No significant weight loss"
},
"date_created": "2023-11-10T10:15:00",
"title": "Previous Medication History"
}
],
"patient": {
"address": {
"street": "123 Health St.",
"city": "Wellness",
"state_province": "CA",
"zip_postal_code": "12345",
"country": "USA"
},
"date_of_birth": "1980-01-01",
"email": "[email protected]",
"first_name": "John",
"last_name": "Doe",
"gender": "male",
"internal_id": "123456",
"phone": "123-456-7890"
},
"insurance": [
{
"scanned_content": {
"client_name": "Company",
"group_number": "12345678",
"member_name": "John Doe",
"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"
}
],
"prescription": {
"days_supply": 30,
"quantity": 2,
"directions": "Inject subcutaneously once a week",
"drug_name": "Wegovy",
"strength": "0.25 mg/0.5 mL (0.25 mg dose)",
"dose_form": "injectable",
"dispense_unit": "milliliter",
"route_of_administration": "subcutaneous",
"extra": {
"prescribing_information": "Prescribed for weight management in patients with obesity"
},
"prescription_date": "2024-02-14T05:46:07.764000"
},
"provider": {
"address": {
"street": "456 Care Blvd.",
"city": "Healtown",
"state_province": "CA",
"zip_postal_code": "67890",
"country": "USA"
},
"fax": "987-654-3211",
"first_name": "Alice",
"last_name": "Smith",
"npi": "1234567890",
"phone": "987-654-3210"
},
"pharmacy": {
"name": "Walgreens",
"address": {
"street": "789 Pharmacy Ave.",
"city": "Medtown",
"state_province": "MD",
"zip_postal_code": "12345",
"country": "USA"
}
},
"questionnaires": [
{
"questions": [
{
"answer": "I usually eat a balanced diet and exercise 3 times a week.",
"question": "Please describe your current diet and exercise routine."
},
{
"answer": "Yes, I have tried metformin without significant results.",
"question": "Have you previously tried other weight loss medications?"
}
],
"date_created": "2023-11-01T08:00:00"
}
],
"visit_notes": [
{
"content": "Patient presents with a BMI of 32, indicating obesity. Recommended to start Wegovy for weight management.",
"date_created": "2023-11-10T10:00:00"
}
],
"activity_log": [
{
"id": "sent_fax__S4382DA",
"created_at": "2024-02-14T02:01:02",
"type": "sent_fax",
"details": {
"url": "https://example.com/sent_fax"
}
},
{
"id": "rec_fax__SJ34WX",
"created_at": "2024-02-14T05:46:07",
"type": "received_fax",
"details": {
"url": "https://example.com/received_fax"
}
},
{
"id": "pa_follow_up_call__BF9AJ56",
"created_at": "2024-02-14T05:50:10",
"type": "follow_up_call",
"details": {
"notes": "Called Example PBM and ...",
"recording_url": "https://example.com/follow_up_call_recording",
"transcript": "Hello, this is Example PBM ..."
}
}
],
"submitted_by": {
"first_name": "John",
"last_name": "Doe",
"email": "[email protected]"
},
"reviewed_by": {
"first_name": "Jane",
"last_name": "Doe",
"email": "[email protected]"
},
"outcome": {
"detail": "Approval",
"result": "Approved",
"detail_code": "approval",
"authorization_expiration": "2025-02-14"
}
}
}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. -
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 theawaiting_outcomestatus 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 successfully, with an approval or denial outcome. -
failed: The prior authorization has failed due to an error or unexpected outcome. This status may require attention to resolve any issues. -
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
Bearer authentication header of the form Bearer <token>, where <token> is your auth token.
Path Parameters
Response
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.
success Contains the data from your prior authorization request, or None if an error occurred.
The ID of this prior authorization
The URL where the Prior Authorization can be viewed.
The current status of the prior auth request.
processing, awaiting_review, awaiting_outcome, validating_outcome, completed, failed, cancelled Clinical diagnoses for the patient in ICD-10 format. i.e. 'E66.9'
Represents a medical diagnosis with a code and description.
ICD-10 code for the diagnosis. i.e. 'E66.9'
Demographic information for the patient
The patient's postal address
Street address of residence.
1City of residence.
1State or province of residence.
1ZIP or postal code part of the address.
1Country of residence.
1Additional street address information.
The patient's date of birth
The patient's first name
1The patient's last name
1The patient's gender
male, female, other, not_specified Your internal ID for this patient. This is used for linking all of the requests for a given patient.
1The patient's email address
The patient's phone number
Array of insurance documents.
An object containing details that were extracted from the insurance card images provided in the creation request.
The client/employer name.
The group number on the card.
The member name on the card.
The member number on the card.
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
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
The Rx BIN number on the card.
The Rx group number on the card.
The Rx PCN number on the card.
Error message if we were unable to extract information from the card.
An object containing manually-provided insurance details from the creation request.
The client/employer name.
The group number on the card.
The member name on the card.
The member number on the card.
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
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
The Rx BIN number on the card.
The Rx group number on the card.
The Rx PCN number on the card.
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.
Information regarding the prescription this prior authorization is being created for.
The number of days the prescription will be expected to last.
The quantity of the medication.
Instructions on how the medication should be taken.
1The name of the medication.
1The strength of the medication.
1The form of the medication.
tablet, capsule, suspension, cream, solution, ointment, suppository, inhaler, liquid, powder, injectable, patch, gel, lozenge, concentrate, film The unit of measurement for the medication.
milliliter, liter, gram, milligram, microgram, unit, tablet, capsule, patch, inhaler, applicator, pack, vial, film The route of administration for the medication.
oral, subcutaneous, intravenous, intramuscular, topical, inhalation, nasal, ophthalmic, otic, rectal, vaginal, transdermal, buccal, sublingual The date the prescription was issued
An optional dictionary containing additional information related to the drug or future prescription.
Details of the healthcare provider who created the prescription.
The provider's postal address.
Street address of residence.
1City of residence.
1State or province of residence.
1ZIP or postal code part of the address.
1Country of residence.
1Additional street address information.
The provider's first name.
1The provider's last name.
1The provider's NPI.
1The provider's fax number.
The provider's phone number.
The Prior Authorization has been approved.
Approved More details regarding the prior auth request status, if the prior auth has completed and more information is available
A code indicating the reason for the prior auth approval. 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.
prior_auth_not_required, approval, existing_approval The date when the authorization expires. This information is not always available, but it will be included where possible.
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.
prior_authorization 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.
Represents an item of evidence, which can include an associated digital asset.
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.
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'
File asset containing the evidence.
Detailed content of the evidence, which varies based on the type of evidence.
Information about the pharmacy where the prescription will be filled.
The name of the pharmacy.
1Represents a postal address.
Street address of residence.
1City of residence.
1State or province of residence.
1ZIP or postal code part of the address.
1Country of residence.
1Additional street address information.
List of questionnaires. This is the best place to send structured Q&A format data, such as intake forms, etc.
A list of questions included in the questionnaire.
Represents a single question, as part of a questionnaire.
The answer to the question.
1The question to be answered.
1Optional 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.
The date and time when the questionnaire was answered. This is important for ensuring we have an accurate timeline of the patient's history.
List of visit notes.
Represents a note made during a patient visit.
The content of the visit note.
1The 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.
The title of the visit note. This is optional and can be used to give the note a meaningful name, such as 'Initial Consultation'.
1A list of activity log items for the prior authorization request.
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.
sent_fax The mock result of the prior authorization request, if one was provided in the initial request
The Prior Authorization has been approved.
Approved A code indicating the reason for the prior auth approval. 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.
prior_auth_not_required, approval, existing_approval curl --request GET \
--url https://api.develophealth.ai/prior-authorization/{id} \
--header 'Authorization: Bearer <token>'{
"status": "success",
"data": {
"id": "pa_sdkfj3f",
"object": "prior_authorization",
"url": "https://platform.develophealth.ai/prior-authorizations/pa_sdkfj3f",
"status": "processing",
"diagnoses": [
{
"code": "E66.9"
}
],
"evidence": [
{
"content": {
"bmi_value": 32,
"date_measured": "2023-11-10"
},
"date_created": "2023-11-10T10:15:00",
"title": "BMI Chart"
},
{
"content": {
"medication_name": "Metformin",
"response": "No significant weight loss"
},
"date_created": "2023-11-10T10:15:00",
"title": "Previous Medication History"
}
],
"patient": {
"address": {
"street": "123 Health St.",
"city": "Wellness",
"state_province": "CA",
"zip_postal_code": "12345",
"country": "USA"
},
"date_of_birth": "1980-01-01",
"email": "[email protected]",
"first_name": "John",
"last_name": "Doe",
"gender": "male",
"internal_id": "123456",
"phone": "123-456-7890"
},
"insurance": [
{
"scanned_content": {
"client_name": "Company",
"group_number": "12345678",
"member_name": "John Doe",
"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"
}
],
"prescription": {
"days_supply": 30,
"quantity": 2,
"directions": "Inject subcutaneously once a week",
"drug_name": "Wegovy",
"strength": "0.25 mg/0.5 mL (0.25 mg dose)",
"dose_form": "injectable",
"dispense_unit": "milliliter",
"route_of_administration": "subcutaneous",
"extra": {
"prescribing_information": "Prescribed for weight management in patients with obesity"
},
"prescription_date": "2024-02-14T05:46:07.764000"
},
"provider": {
"address": {
"street": "456 Care Blvd.",
"city": "Healtown",
"state_province": "CA",
"zip_postal_code": "67890",
"country": "USA"
},
"fax": "987-654-3211",
"first_name": "Alice",
"last_name": "Smith",
"npi": "1234567890",
"phone": "987-654-3210"
},
"pharmacy": {
"name": "Walgreens",
"address": {
"street": "789 Pharmacy Ave.",
"city": "Medtown",
"state_province": "MD",
"zip_postal_code": "12345",
"country": "USA"
}
},
"questionnaires": [
{
"questions": [
{
"answer": "I usually eat a balanced diet and exercise 3 times a week.",
"question": "Please describe your current diet and exercise routine."
},
{
"answer": "Yes, I have tried metformin without significant results.",
"question": "Have you previously tried other weight loss medications?"
}
],
"date_created": "2023-11-01T08:00:00"
}
],
"visit_notes": [
{
"content": "Patient presents with a BMI of 32, indicating obesity. Recommended to start Wegovy for weight management.",
"date_created": "2023-11-10T10:00:00"
}
],
"activity_log": [
{
"id": "sent_fax__S4382DA",
"created_at": "2024-02-14T02:01:02",
"type": "sent_fax",
"details": {
"url": "https://example.com/sent_fax"
}
},
{
"id": "rec_fax__SJ34WX",
"created_at": "2024-02-14T05:46:07",
"type": "received_fax",
"details": {
"url": "https://example.com/received_fax"
}
},
{
"id": "pa_follow_up_call__BF9AJ56",
"created_at": "2024-02-14T05:50:10",
"type": "follow_up_call",
"details": {
"notes": "Called Example PBM and ...",
"recording_url": "https://example.com/follow_up_call_recording",
"transcript": "Hello, this is Example PBM ..."
}
}
],
"submitted_by": {
"first_name": "John",
"last_name": "Doe",
"email": "[email protected]"
},
"reviewed_by": {
"first_name": "Jane",
"last_name": "Doe",
"email": "[email protected]"
},
"outcome": {
"detail": "Approval",
"result": "Approved",
"detail_code": "approval",
"authorization_expiration": "2025-02-14"
}
}
}