API Documentation
Dental
Mental Health
[
{
"id": "<string>",
"status": "SUCCESS",
"creation_ts": "2023-11-07T05:31:56Z",
"request": {
"type": "BENEFITS",
"desired_completion_date": "<string>",
"patient_name": "<string>",
"dob": "<string>",
"member_id": "<string>",
"npi": "<string>",
"tax_id": "<string>",
"group_id": "<string>",
"insurance_in_network": true,
"billing_npi": "<string>",
"rendering_npi": "<string>",
"external_id": "<string>",
"practice_billing_address": "<string>",
"diagnosis_codes": [
"<string>"
],
"claims_date_of_service": "<string>",
"claim_number": "<string>",
"additional_info": "<string>",
"insurance": "CIGNA",
"benefits_query": [
"STANDARD"
],
"benefits_codes": [
"<string>"
],
"is_specialist": true,
"insurance_payor_id": "<string>"
},
"summary": "<string>",
"results": {
"call_details": [
{
"representative_name": "<string>",
"reference_number": "<string>",
"call_end_time": "2023-11-07T05:31:56Z",
"call_recording_url": "<string>",
"call_transcript": "<string>"
}
],
"plan_information": {
"is_active": true,
"plan_type": "PPO",
"effective_date": "10-01-2020",
"termination_date": "10-31-2021",
"is_calendar_year_plan": true,
"is_provider_in_network": true,
"is_primary_insurance": true
},
"maximums": {
"individual_deductible": "100",
"individual_deductible_used": "80",
"family_deductible": "200",
"family_deductible_used": "100",
"coverage_limit": "1000",
"coverage_limit_remaining": "800",
"orthodontics_coverage_limit": "1500"
},
"treatment_history": {},
"procedure_classes": {},
"procedure_codes": [
[
"<unknown>"
]
],
"extra_info": {
"waiting_periods": "None",
"deductible_applies_to_preventive": false,
"preventative_applies_to_maximum": true,
"missing_tooth_clause": "coverage reduction of 50% for first 12 months",
"has_pending_claims": true
}
}
}
]Get Dental Inquiries
[
{
"id": "<string>",
"status": "SUCCESS",
"creation_ts": "2023-11-07T05:31:56Z",
"request": {
"type": "BENEFITS",
"desired_completion_date": "<string>",
"patient_name": "<string>",
"dob": "<string>",
"member_id": "<string>",
"npi": "<string>",
"tax_id": "<string>",
"group_id": "<string>",
"insurance_in_network": true,
"billing_npi": "<string>",
"rendering_npi": "<string>",
"external_id": "<string>",
"practice_billing_address": "<string>",
"diagnosis_codes": [
"<string>"
],
"claims_date_of_service": "<string>",
"claim_number": "<string>",
"additional_info": "<string>",
"insurance": "CIGNA",
"benefits_query": [
"STANDARD"
],
"benefits_codes": [
"<string>"
],
"is_specialist": true,
"insurance_payor_id": "<string>"
},
"summary": "<string>",
"results": {
"call_details": [
{
"representative_name": "<string>",
"reference_number": "<string>",
"call_end_time": "2023-11-07T05:31:56Z",
"call_recording_url": "<string>",
"call_transcript": "<string>"
}
],
"plan_information": {
"is_active": true,
"plan_type": "PPO",
"effective_date": "10-01-2020",
"termination_date": "10-31-2021",
"is_calendar_year_plan": true,
"is_provider_in_network": true,
"is_primary_insurance": true
},
"maximums": {
"individual_deductible": "100",
"individual_deductible_used": "80",
"family_deductible": "200",
"family_deductible_used": "100",
"coverage_limit": "1000",
"coverage_limit_remaining": "800",
"orthodontics_coverage_limit": "1500"
},
"treatment_history": {},
"procedure_classes": {},
"procedure_codes": [
[
"<unknown>"
]
],
"extra_info": {
"waiting_periods": "None",
"deductible_applies_to_preventive": false,
"preventative_applies_to_maximum": true,
"missing_tooth_clause": "coverage reduction of 50% for first 12 months",
"has_pending_claims": true
}
}
}
]Authorizations
The access token received from the authorization server in the OAuth 2.0 flow.
Response
Successful Response
unique generated (uuid4) id for the inquiry
status of the inquiry
SCHEDULED, IN_PROGRESS, SUCCESS, UNSUCCESSFUL, CANCELLED, UNKNOWN "SUCCESS"
timestamp of when the inquiry was created
The request that was used to create the inquiry.
Show child attributes
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type of the inquiry
CLAIMS_STATUS, BENEFITS, UNKNOWN "BENEFITS"
The requested completion date of the inquiry in MM-DD-YYYY format. Calls will typically be completed by the morning of the requested completion date, but in some cases may be completed earlier.
name of the patient
date of birth of the patient in MM-DD-YYYY format
member id of the patient
(deprecated, use billing_npi and rendering_npi instead) Ten digit NPI of the provider
Nine digit tax id of the provider
group id of the patient
whether or not the provider is in-network. If it is not known, leave this field blank and it will be determined.
Ten digit NPI of the billing provider
Ten digit NPI of the rendering provider
An identifier which you can define and pass in with your creation request. This is useful for tracking a specific subgroup of inquiries. For instance, you can assign a unique external id to all inquiries for a specific provider on your platform.
The billing address of the practice. If omitted, the address will be determined from the NPI.
Any diagnosis codes for the patient. If omitted, a general diagnosis code will be used.
The date of service for the claim in MM-DD-YYYY format. Only used for claims inquiries.
The claim number for the inquiry if provided by the user. Only used for claims inquiries.
Any additional information about the inquiry that is not covered by the other fields. This can be used to pass in any additional information for the request. Please check with the Health Harbor team before using this field as it may not be incorporated into the inquiry unless we are already aware of it.
The insurance provider for the patient.
AETNA, HEALTHPLEX, HUMANA, METLIFE, UNITED_HEALTHCARE, UNKNOWN "CIGNA"
The benefits queries for the inquiry if provided by the user. Can be either a pre-defined set of questions (e.g. STANDARD for returning patients) or an ad-hoc defined set of codes.
An enumeration.
STANDARD, CODE_LOOKUP_BENEFITS, CODE_LOOKUP_FREQUENCIES, TREATMENT_HISTORY, DEDUCTIBLES_AND_MAXIMUMS, UNKNOWN Codes processed for a CODE_LOOKUP_BENEFITS or a CODE_LOOKUP_PRIOR_AUTH benefits inquiry. The first character in the CDT codes (D) can be optionally omitted.
The type of provider making the inquiry. If the provider is a specialist (e.g. periodontist, oral surgeon), set this to True. If the provider is a dentist, set this to False. Defaults to False if not provided.
The payor id for the insurance. Usually five characters. For example, one payor id for Aetna is 60054.
summary of the call results
The output from the call containing the benefits results.
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The details of the placed calls including the call time in iso format, representative name, reference number, and transcript.
The plan information for the patient including the plan type and effective date. Dates will be provided in MM-DD-YYYY format. Fields will only be included if applicable, for example, when the plan is not active, no other information will be provided.
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Show child attributes
An enumeration.
HMO, PPO, POS, EPO, OAP, MEDICAID, HMO_POS, OTHER {
"is_active": true,
"plan_type": "PPO",
"effective_date": "10-01-2020",
"termination_date": "10-31-2021",
"is_calendar_year_plan": true,
"is_provider_in_network": true,
"is_primary_insurance": true
}The maximums for the patient including the individual and family deductible and any annual coverage limits. Fields will only be included if applicable, for example, on individual plans, family information will not be available.
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The amount of deductible remaining for the patient. Calculated as the minimum of the individual and family deductible remaining.
x >= 0The amount of out of pocket maximum remaining for the patient. Calculated as the minimum of the individual and family out of pocket maximum remaining.
x >= 0{
"individual_deductible": "100",
"individual_deductible_used": "80",
"family_deductible": "200",
"family_deductible_used": "100",
"coverage_limit": "1000",
"coverage_limit_remaining": "800",
"orthodontics_coverage_limit": "1500"
}The treatment history for the patient. The keys are dates in MM-DD-YYYY format and the values are a list of procedure codes performed on that date. See examples for more information.
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Show child attributes
Show child attributes
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5 digit CDT code that refers to a procedure performed on a patient.
Integers from 1-32 that refers to particular teeth as designated by the ADA. For child teeth, the letters A-T will be used.
The surfaces for the tooth. Each surface applies to all the teeth in tooth_numbers. Surfaces are in {buccal, occlusal, distal, mesial, lingual, facial, incisal}. If the surface is not applicable, the field will be null.
Integers in {10,20,30,40} that refer to a particular quadrant.
A list that contains information from the different procedure codes and the requested benefits information for that code. See examples for more information.
2 elementsExtra information about the patient's dental plan. Fields are omitted if not applicable.
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Show child attributes
{
"waiting_periods": "None",
"deductible_applies_to_preventive": false,
"preventative_applies_to_maximum": true,
"missing_tooth_clause": "coverage reduction of 50% for first 12 months",
"has_pending_claims": true
}