These endpoints require authentication. Please see authentication for more information.

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Overview

In this quickstart, we will retrieve benefits for a patient for a dental provider. We will walk through the requests needed to create an inquiry and retrieve the results.

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Create an Inquiry

First, we will send a POST request to create a dental inquiry. This provides the information necessary to check the patient’s benefits on behalf of the dental provider.

The first character in the CDT codes (D) can be optionally omitted when passed into benefits_codes.

If the request has been successfully created, we will receive a response like this:

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Retrieve an Inquiry

Now that we’ve made a dental inquiry, we can check on the results using the inquiry_id received during inquiry creation.

Here is a sample response.

JSON
[
  {
    "id": "722b06d8-1855-402b-9916-bfa450cc1572",
    "status": "SUCCESS",
    "creation_ts": "2023-08-01T00:00:00.000000Z",
    "summary": "Benefits retrieved successfully.",
    "results": {
      "call_details": [
        {
          "call_end_time": "2023-08-01T06:00:00.0000Z",
          "representative_name": "Deborah M",
          "reference_number": "2812129",
          "call_recording_url": "https://www.google.com/voice_recording.wav"
        }
      ],
      "procedure_codes": [
        [
          {
            "procedure_code": "D0120",
            "procedure_name": "Exam"
          },
          {
            "is_covered": true,
            "is_prior_auth_required": false,
            "coverage_percentage": 100.0,
            "more_info": ""
          }
        ],
        [
          {
            "procedure_code": "D4240",
            "procedure_name": "Gingival Flap Procedure"
          },
          {
            "is_covered": true,
            "is_prior_auth_required": true,
            "prior_auth_info": "Call United Healthcare at 555-123-1234",
            "coverage_percentage": 50.0,
            "more_info": ""
          }
        ]
      ]
    },
    "request": {
      "type": "BENEFITS",
      "desired_completion_date": "08-25-2024",
      "patient_name": "Alex Martin",
      "dob": "01-31-2020",
      "member_id": "123456789",
      "group_id": "123456",
      "insurance_in_network": true,
      "insurance": "UNITED_HEALTHCARE",
      "npi": "1245319599",
      "tax_id": "123456789",
      "external_id": "provider_123",
      "benefits_codes": ["D0120", "D4240"],
      "benefits_query": ["CODE_LOOKUP_BENEFITS"],
      "is_specialist": true
    }
  }
]

Alternatively, you can instead retrieve information on all the inquiries you’ve submitted. This can be filtered by the external_id you provided when you created the inquiry. Each inquiry will be returned in the array.

Here is an example of a more complex benefits request that also retrieves frequencies and treatment history. Note the addition of CODE_LOOKUP_FREQUENCIES and TREATMENT_HISTORY to benefits_query.

And the associated response:

JSON
[
  {
    "id": "722b06d8-1855-402b-9916-bfa450cc1572",
    "status": "SUCCESS",
    "creation_ts": "2023-08-01T00:00:00.000000Z",
    "summary": "Benefits retrieved successfully.",
    "results": {
      "call_details": [{
        "call_end_time": "2023-08-01T06:00:00.0000Z",
        "representative_name": "Deborah M",
        "reference_number": "2812129",
        "call_recording_url": "https://www.google.com/voice_recording.wav"
      }],
      "treatment_history": {
        "10-01-2020": [{
          "procedure_code": "D1110",
          "tooth_numbers": [1, 21],
          "surfaces": ["occlusal"],
          "quadrant_numbers": [10]
          },
          {
          "procedure_code": "D1120",
          "tooth_numbers": [5],
          "surfaces": ["distal"],
          "quadrant_numbers": [20,30]
          }
        ]
      },
      "procedure_codes": [
        [
          {
            "procedure_code": "D0120",
            "procedure_name": "Exam"
          },
          {
            "is_covered": true,
            "is_prior_auth_required": false,
            "coverage_percentage": 100.0,
            "frequency_limitations": "once per 36 floating months",
            "more_info": ""
          }
        ],
        [
          {
            "procedure_code": "D4240",
            "procedure_name": "Gingival Flap Procedure"
          },
          {
            "is_covered": true,
            "is_prior_auth_required": true,
            "prior_auth_info": "Call United Healthcare at 555-123-1234",
            "coverage_percentage": 50.0,
            "frequency_limitations": "once per 5 years"
            "more_info": ""
          }
        ]
      ]
    },
    "request": {
      "type": "BENEFITS",
      "desired_completion_date": "08-25-2024",
      "patient_name": "Alex Martin",
      "dob": "01-31-2020",
      "member_id": "123456789",
      "group_id": "123456",
      "insurance_in_network": true,
      "insurance": "UNITED_HEALTHCARE",
      "npi": "1245319599",
      "tax_id": "123456789",
      "external_id": "provider_123",
      "benefits_codes": ["D0120", "D4240"],
      "benefits_query": ["CODE_LOOKUP_BENEFITS",  "CODE_LOOKUP_FREQUENCIES", "TREATMENT_HISTORY"],
      "is_specialist": true
    }
  }
]

Great! Now you have successfully created a dental inquiry and retrieved the results. For further details on the parameters and fields in the requests and the responses, please refer to our Detailed API Reference.

Additional OptionsCreate Dental Inquiry