{
"status": "error",
"error": {
"title": "API Access Not Enabled",
"description": "Programmatic API access is not enabled for this organization.",
"code": "api_access_not_enabled"
}
}
{
"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"
}
}
Additional evidence triggers re-answering of this PA using all accepted
evidence. An upload alone keeps an external outreach round open until
explicit completion or its configured deadline. Completion returns the PA
to review after any accepted evidence finishes processing. Completion applies
to this PA’s current external outreach and is safe to repeat after it ends.
{
"status": "error",
"error": {
"title": "API Access Not Enabled",
"description": "Programmatic API access is not enabled for this organization.",
"code": "api_access_not_enabled"
}
}
{
"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"
}
}
Append evidence to an existing PA, complete outreach, or do both in one
request. Use the PA ID returned at creation.
New evidence is added to the PA and triggers re-answering using all accepted
evidence. Existing evidence is retained. Send a non-empty evidence array using
the clinical evidence formats.
Or use asset.file_content with Base64-encoded file bytes instead of file_url.An evidence upload alone keeps outreach open until explicit
completion or the organization’s configured deadline.
Send only status inside provider_outreach; no outreach ID is accepted. You
can include this object alongside evidence in the same PATCH. Status-only
completion can be repeated while the PA remains eligible for updates.The PATCH cannot start outreach or change the organization’s method or deadline.
See provider outreach setup
for the creation and platform review flows.
A 200 response contains the updated PA in the same format as
GET /prior-authorization/{id}.
Evidence processing is asynchronous: acceptance does not mean updated answers
are ready. Track data.status through GET or
PA status-change webhooks.Evidence processing can return processing. If outreach is still active, the
PA returns to awaiting_provider_response. Completion or deadline exhaustion
returns it to awaiting_review after accepted evidence finishes processing.
For external outreach, data.provider_outreach reports the current
outreach status and deadline.
Updates are available before submission while awaiting review or processing
provider information. This endpoint cannot replace an active
DH-managed outreach flow or update a submitted or terminal PA.
HTTP status
Meaning
400
An evidence file could not be downloaded or has an unsupported format. No evidence or completion is accepted.
404
The PA does not exist in the authenticated organization.
409
The PA cannot accept the update, the payer’s clinical form is pending, or there is no eligible external outreach to complete.
422
The body has no evidence or completion, an evidence array is empty, or a field or completion status is unsupported.
See Response handling for common authentication
and validation errors.
Complete this PA's current external outreach, alone or with evidence. This endpoint cannot start outreach.
Show child attributes
Response
The prior authorization after the accepted update. Evidence processing is asynchronous; acceptance does not mean updated answers are ready.
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.
Contains the data from your prior authorization request, or None if an error occurred.
Show child attributes
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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.","uniqueKey":"data.insurance.items.[INDEX].url","typeLabel":"string"}},"type":"object","required":["scanned_content","discrete_content"],"title":"InsuranceDocumentInfo","uniqueKey":"data.insurance.items.[INDEX]","typeLabel":"InsuranceDocumentInfo · object"},"type":"array","title":"Insurance","description":"Array of insurance documents.","isRequired":true,"uniqueKey":"data.insurance","typeLabel":"InsuranceDocumentInfo · object[]"},"provider":{"type":"object","title":"Provider","description":"Details of the healthcare provider who created the prescription.","required":["address","first_name","last_name","npi"],"properties":{"address":{"type":"object","title":"Address","description":"The provider's postal address.","properties":{"street":{"type":"string","title":"Street","description":"Street address of residence.","uniqueKey":"data.provider.address.street","typeLabel":"string"},"street_line_2":{"type":"string","title":"Street Line 2","description":"Additional street address information.","uniqueKey":"data.provider.address.street_line_2","typeLabel":"string"},"city":{"type":"string","title":"City","description":"City of residence.","uniqueKey":"data.provider.address.city","typeLabel":"string"},"state_province":{"type":"string","title":"State Province","description":"State or province of residence.","uniqueKey":"data.provider.address.state_province","typeLabel":"string"},"zip_postal_code":{"type":"string","title":"Zip Postal Code","description":"ZIP or postal code part of the address.","uniqueKey":"data.provider.address.zip_postal_code","typeLabel":"string"},"country":{"type":"string","title":"Country","description":"Country of residence.","uniqueKey":"data.provider.address.country","typeLabel":"string"}},"isRequired":true,"uniqueKey":"data.provider.address","typeLabel":"Address · object"},"first_name":{"type":"string","minLength":1,"title":"First Name","description":"The provider's first name.","isRequired":true,"uniqueKey":"data.provider.first_name","typeLabel":"string"},"last_name":{"type":"string","minLength":1,"title":"Last Name","description":"The provider's last name.","isRequired":true,"uniqueKey":"data.provider.last_name","typeLabel":"string"},"npi":{"type":"string","minLength":1,"title":"Npi","description":"The provider's NPI.","isRequired":true,"uniqueKey":"data.provider.npi","typeLabel":"string"},"email":{"type":"string","format":"email","title":"Email","description":"The provider's email address.","uniqueKey":"data.provider.email","typeLabel":"string\u003cemail>"},"fax":{"type":"string","title":"Fax","description":"The provider's fax number.","uniqueKey":"data.provider.fax","typeLabel":"string"},"internal_id":{"type":"string","title":"Internal Id","description":"Your internal ID for this provider. This is used for linking all of the requests for a given provider.","uniqueKey":"data.provider.internal_id","typeLabel":"string"},"phone":{"type":"string","title":"Phone","description":"The provider's phone number.","uniqueKey":"data.provider.phone","typeLabel":"string"}},"isRequired":true,"uniqueKey":"data.provider","typeLabel":"Provider · object"},"outcome":{"oneOf":[{"type":"object","title":"PriorAuthSubmissionApprovalOutcome","description":"Details of the outcome of the prior authorization request.","properties":{"detail":{"type":"string","maxLength":2048,"title":"Detail","description":"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.\"","uniqueKey":"data.outcome.oneOf.0.detail","typeLabel":"string"},"result":{"type":"string","enum":["Approved"],"const":"Approved","title":"Result","description":"The Prior Authorization has been approved.","default":"Approved","uniqueKey":"data.outcome.oneOf.0.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeApprovalDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **prior_auth_not_required**: A prior authorization is not required.\n- **approval**: The prior authorization request has been approved.\n- **existing_approval**: An active prior authorization approval already exists for the patient.","enum":["prior_auth_not_required","approval","existing_approval"],"uniqueKey":"data.outcome.oneOf.0.detail_code","typeLabel":"enum\u003cstring>"},"authorization_start_date":{"type":"string","format":"date","title":"Authorization Start Date","description":"The date when the authorization became effective. This will typically only be populated for approved outcomes.","uniqueKey":"data.outcome.oneOf.0.authorization_start_date","typeLabel":"string\u003cdate>"},"authorization_expiration":{"type":"string","format":"date","title":"Authorization Expiration","description":"The date when the authorization expires. This information is not always available, but it will be included where possible.","uniqueKey":"data.outcome.oneOf.0.authorization_expiration","typeLabel":"string\u003cdate>"}},"isRequired":true,"uniqueKey":"data.outcome.oneOf.0","typeLabel":"PriorAuthSubmissionApprovalOutcome · object"},{"type":"object","title":"PriorAuthSubmissionDenialOutcome","description":"Details of the outcome of the prior authorization request.","properties":{"detail":{"type":"string","maxLength":2048,"title":"Detail","description":"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.\"","uniqueKey":"data.outcome.oneOf.1.detail","typeLabel":"string"},"result":{"type":"string","enum":["Denied"],"const":"Denied","title":"Result","description":"The Prior Authorization has been denied.","default":"Denied","uniqueKey":"data.outcome.oneOf.1.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeDenialDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **formulary_alternative_preferred**: The formulary alternative is preferred.\n- **medical_necessity_criteria_not_met**: The medical necessity criteria are not met.\n- **plan_exclusion**: The drug is excluded by the plan.\n- **step_therapy_criteria_not_met**: The step therapy criteria are not met.\n- **existing_denial**: An existing denial is on file for this medication and patient. Please follow the appeals process if you wish to adjust this outcome\n- **coverage_limits_exceeded**: The coverage limits have been exceeded for this patient's plan.\n- **prior_weight_loss_program_required**: The patient has not completed the required weight loss program prior to therapy.\n- **unknown**: The prior authorization request has been denied.","enum":["formulary_alternative_preferred","medical_necessity_criteria_not_met","plan_exclusion","step_therapy_criteria_not_met","existing_denial","coverage_limits_exceeded","prior_weight_loss_program_required","unknown"],"uniqueKey":"data.outcome.oneOf.1.detail_code","typeLabel":"enum\u003cstring>"},"client_code":{"type":"string","title":"Client Code","description":"A client-specific outcome code for the prior authorization request. This field is only populated for clients with custom client codes configured. To configure your outcome codes, please contact support.","uniqueKey":"data.outcome.oneOf.1.client_code","typeLabel":"string"}},"isRequired":true,"uniqueKey":"data.outcome.oneOf.1","typeLabel":"PriorAuthSubmissionDenialOutcome · object"},{"type":"object","title":"PriorAuthSubmissionOtherOutcome","description":"Details of the outcome of the prior authorization request.","properties":{"detail":{"type":"string","maxLength":2048,"title":"Detail","description":"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.\"","uniqueKey":"data.outcome.oneOf.2.detail","typeLabel":"string"},"result":{"type":"string","enum":["Other"],"const":"Other","title":"Result","description":"The Prior Authorization has completed without an approval/denial determination.","default":"Other","uniqueKey":"data.outcome.oneOf.2.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeOtherDetailPublic","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **coverage_inactive**: The patient's coverage has expired.\n- **coverage_not_yet_started**: The patient's coverage has not yet started.\n- **no_pharmacy_benefits**: The patient's insurance does not include pharmacy benefits.\n- **payer_unable_to_locate_member**: The payer could not locate the member in their system.\n- **npi_taxonomy_ineligible**: The payer rejected the request because the prescriber's NPI taxonomy, provider type, specialty, or credentials are not eligible to submit this prior authorization.\n- **payer_reported_invalid_patient_info**: The payer located the patient in their system but some submitted patient information does not match.\n- **duplicate_request**: The request is a duplicate. Please cancel the existing request and resubmit if needed.\n- **prior_auth_not_required**: A prior authorization is not required for this medication.\n- **patient_consent_required**: The payer requires verbal consent from the patient before discussing or processing the prior authorization.\n- **more_information_required**: Insufficient information provided to complete the prior authorization.\n- **other**: A problem not listed here was encountered. Check the `outcome.detail` field for more information.","enum":["coverage_inactive","coverage_not_yet_started","no_pharmacy_benefits","payer_unable_to_locate_member","npi_taxonomy_ineligible","payer_reported_invalid_patient_info","duplicate_request","prior_auth_not_required","patient_consent_required","more_information_required","other"],"uniqueKey":"data.outcome.oneOf.2.detail_code","typeLabel":"enum\u003cstring>"}},"isRequired":true,"uniqueKey":"data.outcome.oneOf.2","typeLabel":"PriorAuthSubmissionOtherOutcome · object"},{"type":"object","title":"PriorAuthSubmissionPendingOutcome","description":"Details of the outcome of the prior authorization request.","required":["detail","detail_code"],"properties":{"detail":{"type":"null","title":"Detail","isRequired":true,"uniqueKey":"data.outcome.oneOf.3.detail","typeLabel":"null"},"detail_code":{"type":"null","title":"Detail Code","isRequired":true,"uniqueKey":"data.outcome.oneOf.3.detail_code","typeLabel":"null"},"result":{"type":"string","enum":["Pending"],"const":"Pending","title":"Result","description":"The Prior Authorization has been submitted but does not yet have a determination.","default":"Pending","uniqueKey":"data.outcome.oneOf.3.result","typeLabel":"enum\u003cstring>"}},"isRequired":true,"uniqueKey":"data.outcome.oneOf.3","typeLabel":"PriorAuthSubmissionPendingOutcome · object"},{"type":"object","title":"PriorAuthSubmissionNotSubmittedOutcome","description":"Details of the outcome of the prior authorization request.","properties":{"detail":{"type":"string","maxLength":2048,"title":"Detail","description":"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.\"","uniqueKey":"data.outcome.oneOf.4.detail","typeLabel":"string"},"result":{"type":"string","enum":["Not Submitted"],"const":"Not Submitted","title":"Result","description":"The prior authorization request will not be submitted. For example, when the eligibility check is enabled and the check returns as error.","default":"Not Submitted","uniqueKey":"data.outcome.oneOf.4.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeNotSubmittedDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **eligibility_check_error**: Indicates eligibility check encountered an error. Error details will be surfaced in the `eligibility_check_response` field. This status will not happen if `ndp_submission.ignore_eligibility_check_error` was set to True for the PA request.\n- **eligibility_check_government_plan**: Indicates that the eligibility check revealed the patient has only government insurance plan(s). The `eligibility_check_response` field will contain the successful eligibility check response. This status will not happen if `ndp_submission.submit_pa_with_eligibility_check_government_plan` was set to True for the PA request.\n- **prescription_message_not_found**: Indicates the provided prescription message ID does not correspond to a prescription. This can happen if the eScript received to the NDP could not be converted into a valid prescription.\n- **more_information_required**: Indicates that additional information is required before this request can be submitted. The request was not submitted and should be resubmitted with the additional details.\n- **formulary_alternative_required**: Indicates that the patient needs to try a formulary alternative before the PA can be approved. The request was not submitted and should instead be submitted for the formulary alternative outlined in the outcome message.\n- **benefit_verification_no_medication_coverage**: Indicates that a triggered benefit verification determined the prescribed medication is not covered by the patient's plan.\n- **benefit_verification_only_alternative_medication_covered**: Indicates that a triggered benefit verification determined the prescribed medication is not covered, but an alternative medication specified in the request is covered.\n- **benefit_verification_pa_not_required**: Indicates that a triggered benefit verification determined the prescribed medication is covered and does not require prior authorization.\n- **pbm_excluded**: Indicates that the eligibility check revealed only an excluded PBM payer and the PA was not submitted. The `eligibility_check_response` field will contain the successful eligibility check response.\n- **payer_not_supported**: Indicates that the eligibility check revealed the patient's health plan is not supported. Currently, Kaiser health plans are not supported. The `eligibility_check_response` field will contain the successful eligibility check response.","enum":["eligibility_check_error","eligibility_check_government_plan","prescription_message_not_found","more_information_required","formulary_alternative_required","benefit_verification_no_medication_coverage","benefit_verification_only_alternative_medication_covered","benefit_verification_pa_not_required","pbm_excluded","payer_not_supported"],"uniqueKey":"data.outcome.oneOf.4.detail_code","typeLabel":"enum\u003cstring>"}},"isRequired":true,"uniqueKey":"data.outcome.oneOf.4","typeLabel":"PriorAuthSubmissionNotSubmittedOutcome · object"}],"isRequired":true,"uniqueKey":"data.outcome","typeLabel":"PriorAuthSubmissionApprovalOutcome · object | PriorAuthSubmissionDenialOutcome · object | PriorAuthSubmissionOtherOutcome · object | PriorAuthSubmissionPendingOutcome · object | PriorAuthSubmissionNotSubmittedOutcome · object"},"coverage_assessment":{"type":"string","title":"CoverageAssessment","description":"Beta feature. Only populated for prior authorizations created while the organization has opted in to coverage assessments. Returns null by default and while pending. Contact support to learn more.","enum":["pa_required","pa_not_required","not_covered","pa_completed","unknown"],"uniqueKey":"data.coverage_assessment","typeLabel":"enum\u003cstring>"},"object":{"type":"string","enum":["prior_authorization"],"title":"Object","description":"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.","default":"prior_authorization","uniqueKey":"data.object","typeLabel":"enum\u003cstring>"},"provider_outreach":{"type":"object","title":"Provider Outreach","description":"The PA's current external outreach status and deadline. Null when the latest outreach uses a DH communication channel.","required":["id","status","started_at","deadline_at"],"properties":{"id":{"type":"string","title":"Id","isRequired":true,"uniqueKey":"data.provider_outreach.id","typeLabel":"string"},"status":{"type":"string","enum":["active","completed","exhausted","cancelled"],"title":"Status","isRequired":true,"uniqueKey":"data.provider_outreach.status","typeLabel":"enum\u003cstring>"},"started_at":{"type":"string","format":"date-time","title":"Started At","isRequired":true,"uniqueKey":"data.provider_outreach.started_at","typeLabel":"string\u003cdate-time>"},"deadline_at":{"type":"string","format":"date-time","title":"Deadline At","description":"The original deadline from the configured wait when outreach started.","isRequired":true,"uniqueKey":"data.provider_outreach.deadline_at","typeLabel":"string\u003cdate-time>"},"method":{"type":"string","enum":["external"],"title":"Method","default":"external","uniqueKey":"data.provider_outreach.method","typeLabel":"enum\u003cstring>"},"ended_at":{"type":"string","format":"date-time","title":"Ended At","uniqueKey":"data.provider_outreach.ended_at","typeLabel":"string\u003cdate-time>"}},"uniqueKey":"data.provider_outreach","typeLabel":"Provider Outreach · object"},"evidence":{"items":{"properties":{"date_created":{"type":"string","format":"date-time","title":"Date Created","description":"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.","isRequired":true,"uniqueKey":"data.evidence.items.[INDEX].date_created","typeLabel":"string\u003cdate-time>"},"title":{"type":"string","title":"Title","description":"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'","isRequired":true,"uniqueKey":"data.evidence.items.[INDEX].title","typeLabel":"string"},"asset":{"type":"object","title":"Asset","description":"File asset containing the evidence.","required":["url","file_type"],"properties":{"url":{"type":"string","minLength":1,"title":"Url","description":"The URL where the asset can be accessed.","isRequired":true,"uniqueKey":"data.evidence.items.[INDEX].asset.url","typeLabel":"string"},"file_type":{"type":"string","title":"DocType","description":"MIME type of the file. e.g. `application/pdf`","enum":["application/pdf","application/msword","text/plain","application/vnd.ms-excel"],"isRequired":true,"uniqueKey":"data.evidence.items.[INDEX].asset.file_type","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.evidence.items.[INDEX].asset","typeLabel":"Asset · object"},"content":{"type":"object","title":"Content","description":"Detailed content of the evidence, which varies based on the type of evidence.","uniqueKey":"data.evidence.items.[INDEX].content","typeLabel":"Content · object"},"document_date":{"type":"string","format":"date","title":"Document Date","description":"The clinical/source document date to display to reviewers, when known. This excludes ingestion/upload/export timestamps.","uniqueKey":"data.evidence.items.[INDEX].document_date","typeLabel":"string\u003cdate>"}},"type":"object","required":["date_created","title"],"title":"ResponseEvidenceItem","description":"Represents an item of evidence, which can include an associated digital asset.","uniqueKey":"data.evidence.items.[INDEX]","typeLabel":"ResponseEvidenceItem · object"},"type":"array","title":"Evidence","description":"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.","uniqueKey":"data.evidence","typeLabel":"ResponseEvidenceItem · object[]"},"prescription":{"type":"object","title":"Prescription","description":"Information regarding the prescription this prior authorization is being created for.","required":["days_supply","quantity","directions","drug_name","strength","dose_form","route_of_administration","prescription_date"],"properties":{"days_supply":{"type":"integer","title":"Days Supply","description":"The number of days the prescription will be expected to last.","isRequired":true,"uniqueKey":"data.prescription.days_supply","typeLabel":"integer"},"quantity":{"type":"integer","title":"Quantity","description":"The quantity of the medication.","isRequired":true,"uniqueKey":"data.prescription.quantity","typeLabel":"integer"},"directions":{"type":"string","minLength":1,"title":"Directions","description":"Instructions on how the medication should be taken.","isRequired":true,"uniqueKey":"data.prescription.directions","typeLabel":"string"},"drug_name":{"type":"string","minLength":1,"title":"Drug Name","description":"The name of the medication.","isRequired":true,"uniqueKey":"data.prescription.drug_name","typeLabel":"string"},"strength":{"type":"string","minLength":1,"title":"Strength","description":"The strength of the medication.","isRequired":true,"uniqueKey":"data.prescription.strength","typeLabel":"string"},"dose_form":{"type":"string","title":"DoseForm","description":"The form of the medication.","enum":["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"],"isRequired":true,"uniqueKey":"data.prescription.dose_form","typeLabel":"enum\u003cstring>"},"route_of_administration":{"type":"string","title":"RouteOfAdministration","description":"The route of administration for the medication.","enum":["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"],"isRequired":true,"uniqueKey":"data.prescription.route_of_administration","typeLabel":"enum\u003cstring>"},"prescription_date":{"type":"string","format":"date-time","title":"Prescription Date","description":"The date the prescription was issued","isRequired":true,"uniqueKey":"data.prescription.prescription_date","typeLabel":"string\u003cdate-time>"},"extra":{"type":"object","title":"Extra","description":"An optional dictionary containing additional information related to the drug or future prescription.","uniqueKey":"data.prescription.extra","typeLabel":"Extra · object"},"expected_length_of_therapy":{"type":"string","title":"Expected Length Of Therapy","description":"The expected length of therapy for the prescribed drug. Defaults to 'Until No Longer Needed' if not provided.","examples":["Until No Longer Needed","12 months","6 weeks"],"uniqueKey":"data.prescription.expected_length_of_therapy","typeLabel":"string"}},"uniqueKey":"data.prescription","typeLabel":"Prescription · object"},"pharmacy":{"type":"object","title":"Pharmacy","description":"Information about the pharmacy where the prescription will be filled.","required":["name"],"properties":{"name":{"type":"string","minLength":1,"title":"Name","description":"The name of the pharmacy.","isRequired":true,"uniqueKey":"data.pharmacy.name","typeLabel":"string"},"address":{"properties":{"street":{"type":"string","minLength":1,"title":"Street","description":"Street address of residence.","isRequired":true,"uniqueKey":"data.pharmacy.address.street","typeLabel":"string"},"city":{"type":"string","minLength":1,"title":"City","description":"City of residence.","isRequired":true,"uniqueKey":"data.pharmacy.address.city","typeLabel":"string"},"state_province":{"type":"string","minLength":1,"title":"State Province","description":"State or province of residence.","isRequired":true,"uniqueKey":"data.pharmacy.address.state_province","typeLabel":"string"},"zip_postal_code":{"type":"string","minLength":1,"title":"Zip Postal Code","description":"ZIP or postal code part of the address.","isRequired":true,"uniqueKey":"data.pharmacy.address.zip_postal_code","typeLabel":"string"},"street_line_2":{"type":"string","title":"Street Line 2","description":"Additional street address information.","uniqueKey":"data.pharmacy.address.street_line_2","typeLabel":"string"},"country":{"type":"string","title":"Country","description":"Country of residence.","default":"USA","uniqueKey":"data.pharmacy.address.country","typeLabel":"string"}},"type":"object","required":["street","city","state_province","zip_postal_code"],"title":"Address","description":"Represents a postal address.","uniqueKey":"data.pharmacy.address","typeLabel":"Address · object"}},"uniqueKey":"data.pharmacy","typeLabel":"Pharmacy · object"},"questionnaires":{"items":{"properties":{"questions":{"items":{"properties":{"answer":{"type":"string","minLength":1,"title":"Answer","description":"The answer to the question.","isRequired":true,"uniqueKey":"data.questionnaires.items.[INDEX].questions.items.[INDEX].answer","typeLabel":"string"},"question":{"type":"string","minLength":1,"title":"Question","description":"The question to be answered.","isRequired":true,"uniqueKey":"data.questionnaires.items.[INDEX].questions.items.[INDEX].question","typeLabel":"string"},"choices":{"items":{"type":"string","uniqueKey":"data.questionnaires.items.[INDEX].questions.items.[INDEX].choices.items.[INDEX]","typeLabel":"string"},"type":"array","title":"Choices","description":"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.","uniqueKey":"data.questionnaires.items.[INDEX].questions.items.[INDEX].choices","typeLabel":"string[]"}},"type":"object","required":["answer","question"],"title":"Question","description":"Represents a single question, as part of a questionnaire.","uniqueKey":"data.questionnaires.items.[INDEX].questions.items.[INDEX]","typeLabel":"Question · object"},"type":"array","title":"Questions","description":"A list of questions included in the questionnaire.","isRequired":true,"uniqueKey":"data.questionnaires.items.[INDEX].questions","typeLabel":"Question · object[]"},"date_created":{"type":"string","format":"date-time","title":"Date Created","description":"The date and time when the questionnaire was answered. This is important for ensuring we have an accurate timeline of the patient's history.","isRequired":true,"uniqueKey":"data.questionnaires.items.[INDEX].date_created","typeLabel":"string\u003cdate-time>"}},"type":"object","required":["questions","date_created"],"title":"Questionnaire","uniqueKey":"data.questionnaires.items.[INDEX]","typeLabel":"Questionnaire · object"},"type":"array","title":"Questionnaires","description":"List of questionnaires. This is the best place to send structured Q\u0026A format data, such as intake forms, etc.","uniqueKey":"data.questionnaires","typeLabel":"Questionnaire · object[]"},"visit_notes":{"items":{"properties":{"content":{"type":"string","minLength":1,"title":"Content","description":"The content of the visit note.","isRequired":true,"uniqueKey":"data.visit_notes.items.[INDEX].content","typeLabel":"string"},"date_created":{"type":"string","format":"date-time","title":"Date Created","description":"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.","isRequired":true,"uniqueKey":"data.visit_notes.items.[INDEX].date_created","typeLabel":"string\u003cdate-time>"},"title":{"type":"string","minLength":1,"title":"Title","description":"The title of the visit note. This is optional and can be used to give the note a meaningful name, such as 'Initial Consultation'.","uniqueKey":"data.visit_notes.items.[INDEX].title","typeLabel":"string"}},"type":"object","required":["content","date_created"],"title":"VisitNote","description":"Represents a note made during a patient visit.","uniqueKey":"data.visit_notes.items.[INDEX]","typeLabel":"VisitNote · object"},"type":"array","title":"Visit Notes","description":"List of visit notes.","uniqueKey":"data.visit_notes","typeLabel":"VisitNote · object[]"},"ndp_submission":{"type":"object","title":"Ndp Submission","description":"Configuration for processing the prescription associated with this PA request.","required":["prescription_message_id","ignore_eligibility_check_error"],"properties":{"prescription_message_id":{"type":"string","minLength":1,"title":"Prescription Message Id","description":"The Surescripts message ID for the prescription transfer.","isRequired":true,"uniqueKey":"data.ndp_submission.prescription_message_id","typeLabel":"string"},"ignore_eligibility_check_error":{"type":"boolean","title":"Ignore Eligibility Check Error","description":"If set to True, error responses from the eligibility check will not terminate the PA request.","isRequired":true,"uniqueKey":"data.ndp_submission.ignore_eligibility_check_error","typeLabel":"boolean"},"submit_pa_with_eligibility_check_government_plan":{"type":"boolean","title":"Submit Pa With Eligibility Check Government Plan","description":"If set to True, the PA request will be submitted even if the eligibility check reveals the patient has only government insurance plan(s).","default":false,"uniqueKey":"data.ndp_submission.submit_pa_with_eligibility_check_government_plan","typeLabel":"boolean"},"preferred_pharmacy_ncpdp_id":{"type":"string","pattern":"^\\d{7}$","title":"Preferred Pharmacy Ncpdp Id","description":"The NCPDP ID of the preferred pharmacy where the prescription will be transferred after the PA request has been approved.","uniqueKey":"data.ndp_submission.preferred_pharmacy_ncpdp_id","typeLabel":"string"},"preferred_pharmacy_details":{"type":"string","title":"Preferred Pharmacy Details","description":"Free-text pharmacy preference information (e.g. 'CVS Pharmacy, 123 Main St, Portland OR 97201').","uniqueKey":"data.ndp_submission.preferred_pharmacy_details","typeLabel":"string"}},"uniqueKey":"data.ndp_submission","typeLabel":"Ndp Submission · object"},"resubmission_info":{"type":"object","title":"Resubmission Info","description":"Information provided when resubmitting a prior authorization request.","properties":{"previous_prior_auth_request_id":{"type":"string","title":"Previous Prior Auth Request Id","description":"Identifier of the previous prior authorization request.","uniqueKey":"data.resubmission_info.previous_prior_auth_request_id","typeLabel":"string"},"note":{"type":"string","title":"Note","description":"Reason for resubmission or additional instructions for this attempt. Required unless `appeal_details` or a quantity limit exception reason is provided.","uniqueKey":"data.resubmission_info.note","typeLabel":"string"}},"uniqueKey":"data.resubmission_info","typeLabel":"Resubmission Info · object"},"quantity_limit_exception_reason":{"type":"string","title":"Quantity Limit Exception Reason","description":"Explanation for requesting an exception to the plan's quantity limit.","uniqueKey":"data.quantity_limit_exception_reason","typeLabel":"string"},"activity_log":{"items":{"oneOf":[{"type":"object","title":"PriorAuthActivityLogSentFax","required":["id","created_at","details"],"properties":{"id":{"type":"string","title":"Id","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.0.id","typeLabel":"string"},"created_at":{"type":"string","format":"date-time","title":"Created At","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.0.created_at","typeLabel":"string\u003cdate-time>"},"details":{"properties":{"url":{"type":"string","title":"Url","description":"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.","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.0.details.url","typeLabel":"string"}},"type":"object","required":["url"],"title":"PriorAuthActivityLogFaxDetails","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.0.details","typeLabel":"PriorAuthActivityLogFaxDetails · object"},"type":{"type":"string","enum":["sent_fax"],"title":"Type","default":"sent_fax","uniqueKey":"data.activity_log.items.[INDEX].oneOf.0.type","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.activity_log.items.[INDEX].oneOf.0","typeLabel":"PriorAuthActivityLogSentFax · object"},{"type":"object","title":"PriorAuthActivityLogReceivedFax","required":["id","created_at","details"],"properties":{"id":{"type":"string","title":"Id","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.1.id","typeLabel":"string"},"created_at":{"type":"string","format":"date-time","title":"Created At","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.1.created_at","typeLabel":"string\u003cdate-time>"},"details":{"properties":{"url":{"type":"string","title":"Url","description":"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.","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.1.details.url","typeLabel":"string"}},"type":"object","required":["url"],"title":"PriorAuthActivityLogFaxDetails","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.1.details","typeLabel":"PriorAuthActivityLogFaxDetails · object"},"type":{"type":"string","enum":["received_fax"],"title":"Type","default":"received_fax","uniqueKey":"data.activity_log.items.[INDEX].oneOf.1.type","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.activity_log.items.[INDEX].oneOf.1","typeLabel":"PriorAuthActivityLogReceivedFax · object"},{"type":"object","title":"PriorAuthActivityLogFollowUpCall","required":["id","created_at","details"],"properties":{"id":{"type":"string","title":"Id","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.id","typeLabel":"string"},"created_at":{"type":"string","format":"date-time","title":"Created At","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.created_at","typeLabel":"string\u003cdate-time>"},"details":{"properties":{"notes":{"type":"string","title":"Notes","description":"Notes from the follow-up call.","uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.details.notes","typeLabel":"string"},"recording_url":{"type":"string","title":"Recording Url","description":"URL to download the call recording.","uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.details.recording_url","typeLabel":"string"},"transcript":{"type":"string","title":"Transcript","description":"Transcript of the follow-up call if available.","uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.details.transcript","typeLabel":"string"}},"type":"object","title":"PriorAuthActivityLogFollowUpCallDetails","isRequired":true,"uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.details","typeLabel":"PriorAuthActivityLogFollowUpCallDetails · object"},"type":{"type":"string","enum":["follow_up_call"],"title":"Type","default":"follow_up_call","uniqueKey":"data.activity_log.items.[INDEX].oneOf.2.type","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.activity_log.items.[INDEX].oneOf.2","typeLabel":"PriorAuthActivityLogFollowUpCall · object"}],"uniqueKey":"data.activity_log.items.[INDEX]","typeLabel":"PriorAuthActivityLogSentFax · object | PriorAuthActivityLogReceivedFax · object | PriorAuthActivityLogFollowUpCall · object"},"type":"array","title":"Activity Log","description":"A list of activity log items for the prior authorization request.\nNote: 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.","uniqueKey":"data.activity_log","typeLabel":"(PriorAuthActivityLogSentFax · object | PriorAuthActivityLogReceivedFax · object | PriorAuthActivityLogFollowUpCall · object)[]"},"submitted_by":{"type":"object","title":"Submitted By","description":"The user who submitted the prior authorization request.","required":["email"],"properties":{"email":{"type":"string","title":"Email","description":"The email of the user.","isRequired":true,"uniqueKey":"data.submitted_by.email","typeLabel":"string"},"first_name":{"type":"string","title":"First Name","description":"The first name of the user.","uniqueKey":"data.submitted_by.first_name","typeLabel":"string"},"last_name":{"type":"string","title":"Last Name","description":"The last name of the user.","uniqueKey":"data.submitted_by.last_name","typeLabel":"string"}},"uniqueKey":"data.submitted_by","typeLabel":"Submitted By · object"},"reviewed_by":{"type":"object","title":"Reviewed By","description":"The user who reviewed the prior authorization request.","required":["email"],"properties":{"email":{"type":"string","title":"Email","description":"The email of the user.","isRequired":true,"uniqueKey":"data.reviewed_by.email","typeLabel":"string"},"first_name":{"type":"string","title":"First Name","description":"The first name of the user.","uniqueKey":"data.reviewed_by.first_name","typeLabel":"string"},"last_name":{"type":"string","title":"Last Name","description":"The last name of the user.","uniqueKey":"data.reviewed_by.last_name","typeLabel":"string"}},"uniqueKey":"data.reviewed_by","typeLabel":"Reviewed By · object"},"eligibility_check_response":{"items":{"oneOf":[{"type":"object","title":"EligibilityCheckResponseSuccessItem","required":["effective_start_date"],"properties":{"effective_start_date":{"type":"string","format":"date","title":"Effective Start Date","description":"Effective start date of 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determined.","enum":["medicare","medicare_advantage","medicaid","tricare","commercial","unclassified"],"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.plan_type","typeLabel":"enum\u003cstring>"},"rx_bin":{"oneOf":[{"type":"string","pattern":"^\\d{6}$","title":"Rx Bin","description":"Rx BIN","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_bin.oneOf.0","typeLabel":"string"},{"type":"null","pattern":"^\\d{6}$","title":"Rx Bin","description":"Rx BIN","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_bin.oneOf.1","typeLabel":"null"}],"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_bin","typeLabel":"string | null"},"rx_pcn":{"oneOf":[{"type":"string","title":"Rx Pcn","description":"Rx PCN","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_pcn.oneOf.0","typeLabel":"string"},{"type":"null","title":"Rx Pcn","description":"Rx PCN","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_pcn.oneOf.1","typeLabel":"null"}],"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_pcn","typeLabel":"string | null"},"rx_grp":{"oneOf":[{"type":"string","title":"Rx Grp","description":"Rx GRP","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_grp.oneOf.0","typeLabel":"string"},{"type":"null","title":"Rx Grp","description":"Rx GRP","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_grp.oneOf.1","typeLabel":"null"}],"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.rx_grp","typeLabel":"string | null"},"effective_end_date":{"type":"string","format":"date","title":"Effective End Date","description":"Effective end date of coverage","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0.effective_end_date","typeLabel":"string\u003cdate>"}},"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.0","typeLabel":"EligibilityCheckResponseSuccessItem · object"},{"type":"object","title":"EligibilityCheckResponseErrorItem","required":["error_code","error_message","action_code"],"properties":{"error_code":{"type":"string","title":"EligibilityCheckErrorCode","description":"The error code indicating the specific error encountered. Possible values are:\n- **provider_not_on_file**: The payer has no record of the provider ID supplied. Provider is not registered with the payer, provider must call payer directly to register their NPI.\n- **patient_birth_date_does_not_match_database**: The DOB supplied doesn’t match the payer’s record for the member ID.\n- **invalid_missing_subscriber_insured_id**: Member ID is empty, wrong length, or fails checksum/cross-file lookup. Or does not meet the payer requirements for subscriber ID. This error is rarely encountered.\n- **subscriber_insured_not_found**: Member could not be located with the ID / name / DOB combination submitted. This error is the most common by far.\n- **duplicate_subscriber_insured_id_number**: The ID supplied matches more than one person in the payer’s system; inquiry is ambiguous. This error is very rarely encountered, usually only around New Year.","enum":["provider_not_on_file","patient_birth_date_does_not_match_database","invalid_missing_subscriber_insured_id","subscriber_insured_not_found","duplicate_subscriber_insured_id_number"],"isRequired":true,"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.1.error_code","typeLabel":"enum\u003cstring>"},"error_message":{"type":"string","maxLength":256,"title":"Error Message","description":"Human-readable description of the error. This always corresponds to the error code.","isRequired":true,"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.1.error_message","typeLabel":"string"},"action_code":{"type":"string","title":"EligibilityCheckActionCode","description":"The action suggested by the payer in response to the error. Possible values are:\n- **please_correct_and_resubmit**: The transaction failed basic edits (e.g., missing or invalid data). Fix the errors and resubmit. This indicates the data submitted is incorrect.\n- **resubmission_not_allowed**: The payer will not accept this inquiry again in its current form; requires taking action outside of PMS / contacting the payer directly. For example, (49) PCP assignment requires updating, (76) duplicate patient records must be merged.","enum":["please_correct_and_resubmit","resubmission_not_allowed"],"isRequired":true,"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.1.action_code","typeLabel":"enum\u003cstring>"},"status":{"type":"string","enum":["error"],"title":"Status","default":"error","uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.1.status","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.eligibility_check_response.items.[INDEX].oneOf.1","typeLabel":"EligibilityCheckResponseErrorItem · object"}],"uniqueKey":"data.eligibility_check_response.items.[INDEX]","typeLabel":"EligibilityCheckResponseSuccessItem · object | EligibilityCheckResponseErrorItem · object"},"type":"array","minItems":1,"title":"Eligibility Check Response","description":"Populated after the eligibility check has been made for the PA, if enabled","uniqueKey":"data.eligibility_check_response","typeLabel":"(EligibilityCheckResponseSuccessItem · object | EligibilityCheckResponseErrorItem · object)[]"},"prescription_transfer":{"type":"object","title":"Prescription Transfer","description":"Information about the prescription transfer status and attempts","required":["status"],"properties":{"status":{"type":"string","title":"PrescriptionTransferStatus","description":"Status of the pharmacy transfer","enum":["in_progress","cancelled","awaiting_provider_response","completed","error"],"isRequired":true,"uniqueKey":"data.prescription_transfer.status","typeLabel":"enum\u003cstring>"},"confirmed":{"type":"boolean","title":"Confirmed","description":"True if completed and confirmation succeeded","default":false,"uniqueKey":"data.prescription_transfer.confirmed","typeLabel":"boolean"},"error_code":{"type":"string","title":"PrescriptionTransferErrorCode","description":"Error code if transfer failed.\n\nNote: this list of codes may grow over time, so your implementation should handle unrecognized values (probably in the same way as 'other').\n- **pharmacy_does_not_exist**: The specified pharmacy does not exist in our records.\n- **pharmacy_permanently_closed**: The pharmacy has been permanently closed and cannot accept any transfers.\n- **pharmacy_unable_to_accept_transfer**: The pharmacy is unable to accept the prescription transfer.\n- **pharmacy_unable_to_fill_prescription**: The pharmacy cannot fill the prescription due to restrictions or lack of stock.\n- **prescription_transfer_not_received**: The pharmacy did not receive the prescription transfer, possibly after several attempts.\n- **transfer_timed_out**: The prescription transfer timed out before it could be completed.\n- **other**: An unexpected error occurred during the prescription transfer process.","enum":["pharmacy_does_not_exist","pharmacy_permanently_closed","pharmacy_unable_to_accept_transfer","pharmacy_unable_to_fill_prescription","prescription_transfer_not_received","transfer_timed_out","other"],"uniqueKey":"data.prescription_transfer.error_code","typeLabel":"enum\u003cstring>"},"transfer_attempts":{"items":{"properties":{"timestamp":{"type":"string","format":"date-time","title":"Timestamp","description":"Timestamp of transfer attempt","isRequired":true,"uniqueKey":"data.prescription_transfer.transfer_attempts.items.[INDEX].timestamp","typeLabel":"string\u003cdate-time>"},"pharmacy_ncpdp_id":{"type":"string","title":"Pharmacy Ncpdp Id","description":"NCPDP ID for the pharmacy receiving the transfer","uniqueKey":"data.prescription_transfer.transfer_attempts.items.[INDEX].pharmacy_ncpdp_id","typeLabel":"string"}},"type":"object","required":["timestamp"],"title":"PrescriptionTransferAttempt","uniqueKey":"data.prescription_transfer.transfer_attempts.items.[INDEX]","typeLabel":"PrescriptionTransferAttempt · object"},"type":"array","title":"Transfer Attempts","description":"List of transfer attempts","uniqueKey":"data.prescription_transfer.transfer_attempts","typeLabel":"PrescriptionTransferAttempt · object[]"},"confirmation_attempts":{"items":{"properties":{"timestamp":{"type":"string","format":"date-time","title":"Timestamp","description":"Timestamp of confirmation attempt","isRequired":true,"uniqueKey":"data.prescription_transfer.confirmation_attempts.items.[INDEX].timestamp","typeLabel":"string\u003cdate-time>"},"outcome":{"type":"string","title":"PrescriptionTransferConfirmationAttemptOutcome","description":"Outcome of the transfer confirmation attempt","enum":["success","failed"],"isRequired":true,"uniqueKey":"data.prescription_transfer.confirmation_attempts.items.[INDEX].outcome","typeLabel":"enum\u003cstring>"}},"type":"object","required":["timestamp","outcome"],"title":"PrescriptionTransferConfirmationAttempt","uniqueKey":"data.prescription_transfer.confirmation_attempts.items.[INDEX]","typeLabel":"PrescriptionTransferConfirmationAttempt · object"},"type":"array","title":"Confirmation Attempts","description":"List of confirmation attempts","uniqueKey":"data.prescription_transfer.confirmation_attempts","typeLabel":"PrescriptionTransferConfirmationAttempt · object[]"}},"uniqueKey":"data.prescription_transfer","typeLabel":"Prescription Transfer · object"},"mock_result":{"oneOf":[{"type":"object","title":"PriorAuthMockResultApproved","description":"Represents a mock result for a prior authorization request.","properties":{"coverage_assessment":{"type":"string","title":"CoverageAssessment","description":"Simulates a coverage assessment independently of the mocked PA outcome. Requires a sandbox organization opted in to coverage assessments. Published asynchronously through the coverage assessment response field and webhook. Omit or set to null to use the usual assessment behavior.","enum":["pa_required","pa_not_required","not_covered","pa_completed","unknown"],"uniqueKey":"data.mock_result.oneOf.0.coverage_assessment","typeLabel":"enum\u003cstring>"},"prescription_transfer_error_code":{"type":"string","title":"PrescriptionTransferErrorCode","description":"This field is only used if the ndp_submission.preferred_pharmacy_ncpdp_id was provided in the request. The mock outcome must be approved or prior_auth_not_required. If provided, a prescription transfer error will be mocked. Otherwise / by default, a successful transfer will be mocked.","enum":["pharmacy_does_not_exist","pharmacy_permanently_closed","pharmacy_unable_to_accept_transfer","pharmacy_unable_to_fill_prescription","prescription_transfer_not_received","transfer_timed_out","other"],"uniqueKey":"data.mock_result.oneOf.0.prescription_transfer_error_code","typeLabel":"enum\u003cstring>"},"result":{"type":"string","enum":["Approved"],"const":"Approved","title":"Result","description":"The Prior Authorization has been approved.","default":"Approved","uniqueKey":"data.mock_result.oneOf.0.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeApprovalDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **prior_auth_not_required**: A prior authorization is not required.\n- **approval**: The prior authorization request has been approved.\n- **existing_approval**: An active prior authorization approval already exists for the patient.","enum":["prior_auth_not_required","approval","existing_approval"],"uniqueKey":"data.mock_result.oneOf.0.detail_code","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.mock_result.oneOf.0","typeLabel":"PriorAuthMockResultApproved · object"},{"type":"object","title":"PriorAuthMockResultDenied","description":"Represents a mock result for a prior authorization request.","properties":{"coverage_assessment":{"type":"string","title":"CoverageAssessment","description":"Simulates a coverage assessment independently of the mocked PA outcome. Requires a sandbox organization opted in to coverage assessments. Published asynchronously through the coverage assessment response field and webhook. Omit or set to null to use the usual assessment behavior.","enum":["pa_required","pa_not_required","not_covered","pa_completed","unknown"],"uniqueKey":"data.mock_result.oneOf.1.coverage_assessment","typeLabel":"enum\u003cstring>"},"result":{"type":"string","enum":["Denied"],"const":"Denied","title":"Result","description":"The Prior Authorization has been denied.","default":"Denied","uniqueKey":"data.mock_result.oneOf.1.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeDenialDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **formulary_alternative_preferred**: The formulary alternative is preferred.\n- **medical_necessity_criteria_not_met**: The medical necessity criteria are not met.\n- **plan_exclusion**: The drug is excluded by the plan.\n- **step_therapy_criteria_not_met**: The step therapy criteria are not met.\n- **existing_denial**: An existing denial is on file for this medication and patient. Please follow the appeals process if you wish to adjust this outcome\n- **coverage_limits_exceeded**: The coverage limits have been exceeded for this patient's plan.\n- **prior_weight_loss_program_required**: The patient has not completed the required weight loss program prior to therapy.\n- **unknown**: The prior authorization request has been denied.","enum":["formulary_alternative_preferred","medical_necessity_criteria_not_met","plan_exclusion","step_therapy_criteria_not_met","existing_denial","coverage_limits_exceeded","prior_weight_loss_program_required","unknown"],"uniqueKey":"data.mock_result.oneOf.1.detail_code","typeLabel":"enum\u003cstring>"},"client_code":{"type":"string","title":"Client Code","description":"A client-specific outcome code for the denial. This will be returned in the outcome response.","uniqueKey":"data.mock_result.oneOf.1.client_code","typeLabel":"string"}},"uniqueKey":"data.mock_result.oneOf.1","typeLabel":"PriorAuthMockResultDenied · object"},{"type":"object","title":"PriorAuthMockResultOther","description":"Represents a mock result for a prior authorization request.","properties":{"coverage_assessment":{"type":"string","title":"CoverageAssessment","description":"Simulates a coverage assessment independently of the mocked PA outcome. Requires a sandbox organization opted in to coverage assessments. Published asynchronously through the coverage assessment response field and webhook. Omit or set to null to use the usual assessment behavior.","enum":["pa_required","pa_not_required","not_covered","pa_completed","unknown"],"uniqueKey":"data.mock_result.oneOf.2.coverage_assessment","typeLabel":"enum\u003cstring>"},"prescription_transfer_error_code":{"type":"string","title":"PrescriptionTransferErrorCode","description":"This field is only used if the ndp_submission.preferred_pharmacy_ncpdp_id was provided in the request. The mock outcome must be approved or prior_auth_not_required. If provided, a prescription transfer error will be mocked. Otherwise / by default, a successful transfer will be mocked.","enum":["pharmacy_does_not_exist","pharmacy_permanently_closed","pharmacy_unable_to_accept_transfer","pharmacy_unable_to_fill_prescription","prescription_transfer_not_received","transfer_timed_out","other"],"uniqueKey":"data.mock_result.oneOf.2.prescription_transfer_error_code","typeLabel":"enum\u003cstring>"},"result":{"type":"string","enum":["Other"],"const":"Other","title":"Result","description":"The Prior Authorization has completed without an approval/denial determination.","default":"Other","uniqueKey":"data.mock_result.oneOf.2.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeOtherDetailPublic","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **coverage_inactive**: The patient's coverage has expired.\n- **coverage_not_yet_started**: The patient's coverage has not yet started.\n- **no_pharmacy_benefits**: The patient's insurance does not include pharmacy benefits.\n- **payer_unable_to_locate_member**: The payer could not locate the member in their system.\n- **npi_taxonomy_ineligible**: The payer rejected the request because the prescriber's NPI taxonomy, provider type, specialty, or credentials are not eligible to submit this prior authorization.\n- **payer_reported_invalid_patient_info**: The payer located the patient in their system but some submitted patient information does not match.\n- **duplicate_request**: The request is a duplicate. Please cancel the existing request and resubmit if needed.\n- **prior_auth_not_required**: A prior authorization is not required for this medication.\n- **patient_consent_required**: The payer requires verbal consent from the patient before discussing or processing the prior authorization.\n- **more_information_required**: Insufficient information provided to complete the prior authorization.\n- **other**: A problem not listed here was encountered. Check the `outcome.detail` field for more information.","enum":["coverage_inactive","coverage_not_yet_started","no_pharmacy_benefits","payer_unable_to_locate_member","npi_taxonomy_ineligible","payer_reported_invalid_patient_info","duplicate_request","prior_auth_not_required","patient_consent_required","more_information_required","other"],"uniqueKey":"data.mock_result.oneOf.2.detail_code","typeLabel":"enum\u003cstring>"},"trigger_message":{"type":"boolean","title":"Trigger Message","description":"If True, a message will be added to the prior authorization after creation. This simulates a follow-up message and will trigger the prior authorization message webhook.","default":false,"uniqueKey":"data.mock_result.oneOf.2.trigger_message","typeLabel":"boolean"}},"uniqueKey":"data.mock_result.oneOf.2","typeLabel":"PriorAuthMockResultOther · object"},{"type":"object","title":"PriorAuthMockResultNotSubmitted","description":"Represents a mock result where the prior authorization was NOT submitted\nbecause the eligibility check either encountered an error or revealed the\npatient has a government plan.","properties":{"coverage_assessment":{"type":"string","title":"CoverageAssessment","description":"Simulates a coverage assessment independently of the mocked PA outcome. Requires a sandbox organization opted in to coverage assessments. Published asynchronously through the coverage assessment response field and webhook. Omit or set to null to use the usual assessment behavior.","enum":["pa_required","pa_not_required","not_covered","pa_completed","unknown"],"uniqueKey":"data.mock_result.oneOf.3.coverage_assessment","typeLabel":"enum\u003cstring>"},"result":{"type":"string","enum":["Not Submitted"],"const":"Not Submitted","title":"Result","description":"The prior authorization request will not be submitted. For example, when the eligibility check is enabled and the check returns as error.","default":"Not Submitted","uniqueKey":"data.mock_result.oneOf.3.result","typeLabel":"enum\u003cstring>"},"detail_code":{"type":"string","title":"PriorAuthOutcomeNotSubmittedDetail","description":"A code indicating the reason for the prior auth outcome. The possible values are:\n- **eligibility_check_error**: Indicates eligibility check encountered an error. Error details will be surfaced in the `eligibility_check_response` field. This status will not happen if `ndp_submission.ignore_eligibility_check_error` was set to True for the PA request.\n- **eligibility_check_government_plan**: Indicates that the eligibility check revealed the patient has only government insurance plan(s). The `eligibility_check_response` field will contain the successful eligibility check response. This status will not happen if `ndp_submission.submit_pa_with_eligibility_check_government_plan` was set to True for the PA request.\n- **prescription_message_not_found**: Indicates the provided prescription message ID does not correspond to a prescription. This can happen if the eScript received to the NDP could not be converted into a valid prescription.\n- **more_information_required**: Indicates that additional information is required before this request can be submitted. The request was not submitted and should be resubmitted with the additional details.\n- **formulary_alternative_required**: Indicates that the patient needs to try a formulary alternative before the PA can be approved. The request was not submitted and should instead be submitted for the formulary alternative outlined in the outcome message.\n- **benefit_verification_no_medication_coverage**: Indicates that a triggered benefit verification determined the prescribed medication is not covered by the patient's plan.\n- **benefit_verification_only_alternative_medication_covered**: Indicates that a triggered benefit verification determined the prescribed medication is not covered, but an alternative medication specified in the request is covered.\n- **benefit_verification_pa_not_required**: Indicates that a triggered benefit verification determined the prescribed medication is covered and does not require prior authorization.\n- **pbm_excluded**: Indicates that the eligibility check revealed only an excluded PBM payer and the PA was not submitted. The `eligibility_check_response` field will contain the successful eligibility check response.\n- **payer_not_supported**: Indicates that the eligibility check revealed the patient's health plan is not supported. Currently, Kaiser health plans are not supported. The `eligibility_check_response` field will contain the successful eligibility check response.","enum":["eligibility_check_error","eligibility_check_government_plan","prescription_message_not_found","more_information_required","formulary_alternative_required","benefit_verification_no_medication_coverage","benefit_verification_only_alternative_medication_covered","benefit_verification_pa_not_required","pbm_excluded","payer_not_supported"],"uniqueKey":"data.mock_result.oneOf.3.detail_code","typeLabel":"enum\u003cstring>"}},"uniqueKey":"data.mock_result.oneOf.3","typeLabel":"PriorAuthMockResultNotSubmitted · object"}],"uniqueKey":"data.mock_result","typeLabel":"PriorAuthMockResultApproved · object | PriorAuthMockResultDenied · object | PriorAuthMockResultOther · object | PriorAuthMockResultNotSubmitted · object"},"out_of_pocket_costs":{"items":{"properties":{"amount_cents":{"type":"integer","title":"Amount Cents","description":"The amount of the copay in cents.","uniqueKey":"data.out_of_pocket_costs.items.[INDEX].amount_cents","typeLabel":"integer"},"supply_duration_days":{"type":"integer","title":"Supply Duration Days","description":"The duration of the supply in days. Use null if unknown.","uniqueKey":"data.out_of_pocket_costs.items.[INDEX].supply_duration_days","typeLabel":"integer"}},"type":"object","title":"CopayOption","uniqueKey":"data.out_of_pocket_costs.items.[INDEX]","typeLabel":"CopayOption · object"},"type":"array","title":"Out Of Pocket Costs","description":"List of copay options with amounts in cents and supply duration in days","uniqueKey":"data.out_of_pocket_costs","typeLabel":"CopayOption · object[]"},"denial_reason_analysis":{"type":"object","title":"Denial Reason Analysis","description":"Analysis of the denial reason(s). Populated when the prior authorization request has been denied.","required":["categories","explanation","next_steps_code","next_steps","next_steps_explanation"],"properties":{"categories":{"items":{"type":"string","uniqueKey":"data.denial_reason_analysis.categories.items.[INDEX]","typeLabel":"string"},"type":"array","title":"Categories","description":"Categories describing the denial reason. Values may use the standard category IDs: step_therapy, formulary_alternative, benefit_exclusion, diagnosis_or_indication, clinical_criteria, documentation, quantity_or_duration_limit, administrative_requirement, or other_specific. Legacy-compatible records may contain free-form labels.","isRequired":true,"uniqueKey":"data.denial_reason_analysis.categories","typeLabel":"string[]"},"explanation":{"type":"string","title":"Explanation","description":"Explanation of the denial","isRequired":true,"uniqueKey":"data.denial_reason_analysis.explanation","typeLabel":"string"},"next_steps_code":{"type":"string","title":"DenialReasonNextStepsCode","description":"A machine-readable code for the recommended next step. Possible values are:\n- **resubmit_current**: Resubmit the current prior authorization request as-is.\n- **resubmit_additional_information**: Resubmit the prior authorization request with additional information.\n- **appeal**: Appeal the denial.\n- **consider_alternative_therapy**: Consider an alternative therapy, such as a formulary alternative or step therapy.\n- **other**: Take another action not represented by the other codes.","enum":["resubmit_current","resubmit_additional_information","appeal","consider_alternative_therapy","other"],"isRequired":true,"uniqueKey":"data.denial_reason_analysis.next_steps_code","typeLabel":"enum\u003cstring>"},"next_steps":{"type":"string","title":"Next Steps","description":"Human-readable description of the recommended next steps","isRequired":true,"uniqueKey":"data.denial_reason_analysis.next_steps","typeLabel":"string"},"next_steps_explanation":{"type":"string","title":"Next Steps Explanation","description":"Human-readable explanation of why the next steps are recommended","isRequired":true,"uniqueKey":"data.denial_reason_analysis.next_steps_explanation","typeLabel":"string"}},"uniqueKey":"data.denial_reason_analysis","typeLabel":"Denial Reason Analysis · object"},"message_thread":{"type":"object","title":"Message Thread","description":"Message thread for this prior authorization, including whether it is resolved and its messages.","required":["is_resolved","messages"],"properties":{"is_resolved":{"type":"boolean","title":"Is Resolved","description":"Whether this message thread is currently resolved. A thread may be unresolved/reopened if further discussion is needed.","isRequired":true,"uniqueKey":"data.message_thread.is_resolved","typeLabel":"boolean"},"messages":{"items":{"properties":{"id":{"type":"string","title":"Id","description":"The ID of this message.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].id","typeLabel":"string"},"timestamp":{"type":"string","format":"date-time","title":"Timestamp","description":"Timestamp of when the message was sent","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].timestamp","typeLabel":"string\u003cdate-time>"},"content":{"type":"string","title":"Content","description":"Message content","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].content","typeLabel":"string"},"sent_by_name":{"type":"string","title":"Sent By Name","description":"Display name of the sender of this message.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].sent_by_name","typeLabel":"string"},"direction":{"type":"string","enum":["sent","received"],"title":"Direction","description":"Direction of the message relative to you.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].direction","typeLabel":"enum\u003cstring>"},"is_resolution":{"type":"boolean","title":"Is Resolution","description":"Whether this message resolves the thread.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].is_resolution","typeLabel":"boolean"},"attachments":{"items":{"properties":{"id":{"type":"string","title":"Id","description":"The ID of this attachment.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].attachments.items.[INDEX].id","typeLabel":"string"},"file_name":{"type":"string","title":"File Name","description":"Original filename.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].attachments.items.[INDEX].file_name","typeLabel":"string"},"url":{"type":"string","title":"Url","description":"Download URL for the attachment.","isRequired":true,"uniqueKey":"data.message_thread.messages.items.[INDEX].attachments.items.[INDEX].url","typeLabel":"string"}},"type":"object","required":["id","file_name","url"],"title":"PlatformMessageAttachment","uniqueKey":"data.message_thread.messages.items.[INDEX].attachments.items.[INDEX]","typeLabel":"PlatformMessageAttachment · object"},"type":"array","title":"Attachments","description":"Files attached to this message.","uniqueKey":"data.message_thread.messages.items.[INDEX].attachments","typeLabel":"PlatformMessageAttachment · object[]"}},"type":"object","required":["id","timestamp","content","sent_by_name","direction","is_resolution"],"title":"PlatformMessage","description":"A message within a message thread.","uniqueKey":"data.message_thread.messages.items.[INDEX]","typeLabel":"PlatformMessage · object"},"type":"array","title":"Messages","description":"Messages in this thread.","isRequired":true,"uniqueKey":"data.message_thread.messages","typeLabel":"PlatformMessage · object[]"}},"uniqueKey":"data.message_thread","typeLabel":"Message Thread · object"},"triggered_benefit_verification_id":{"type":"string","title":"Triggered Benefit Verification Id","description":"The ID of the benefit verification triggered by this PA request, if one was configured.","uniqueKey":"data.triggered_benefit_verification_id","typeLabel":"string"},"is_appeal":{"type":"boolean","title":"Is Appeal","description":"Whether this prior authorization request is an appeal of a previously denied PA.","default":false,"uniqueKey":"data.is_appeal","typeLabel":"boolean"},"patient_consent_required":{"type":"boolean","title":"Patient Consent Required","description":"Whether the payer currently requires verbal patient consent for this prior authorization.","default":false,"uniqueKey":"data.patient_consent_required","typeLabel":"boolean"}},"uniqueKey":"data","typeLabel":"Data · object"}},"type":"object","title":"GetPriorAuthResponse","description":"Represents the response structure for a GET /prior-authorization/:id request.\n\nThis class extends the generic ApiResponse, specifically tailored to handle responses related to\nprior authorizations. It primarily includes the data attribute, which holds detailed information\nabout the benefit verification process and its results.","uniqueKey":"","typeLabel":"GetPriorAuthResponse · object"},"examples":{"Example":{"title":"Example","value":{"status":"success","error":{"title":"\u003cstring>","description":"\u003cstring>","code":"\u003cstring>"},"data":{"id":"\u003cstring>","url":"\u003cstring>","status":"failed","diagnoses":[{"code":"\u003cstring>"}],"patient":{"address":{"street":"\u003cstring>","city":"\u003cstring>","state_province":"\u003cstring>","zip_postal_code":"\u003cstring>","street_line_2":"\u003cstring>","country":"USA"},"date_of_birth":"2023-12-25","first_name":"\u003cstring>","last_name":"\u003cstring>","gender":"male","internal_id":"\u003cstring>","email":"[email protected]","mrn":"\u003cstring>","phone":"\u003cstring>"},"insurance":[{"scanned_content":{"client_name":"\u003cstring>","group_number":"\u003cstring>","member_name":"\u003cstring>","member_number":"\u003cstring>","payer_name":"\u003cstring>","plan_name":"\u003cstring>","rx_bin":"\u003cstring>","rx_group":"\u003cstring>","rx_pcn":"\u003cstring>","error":"\u003cstring>"},"discrete_content":{"client_name":"\u003cstring>","group_number":"\u003cstring>","member_name":"\u003cstring>","member_number":"\u003cstring>","payer_name":"\u003cstring>","plan_name":"\u003cstring>","rx_bin":"\u003cstring>","rx_group":"\u003cstring>","rx_pcn":"\u003cstring>"},"url":"\u003cstring>"}],"provider":{"address":{"street":"\u003cstring>","street_line_2":"\u003cstring>","city":"\u003cstring>","state_province":"\u003cstring>","zip_postal_code":"\u003cstring>","country":"\u003cstring>"},"first_name":"\u003cstring>","last_name":"\u003cstring>","npi":"\u003cstring>","email":"[email 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