Get Dental Inquiry
{
"id": "<string>",
"status": "SUCCESS",
"creation_ts": "2020-01-01T00:00:00.000000Z",
"summary": "Benefits retrieved successfully.",
"results": {
"call_details": [
{
"call_end_time": "2024-03-01T06:00:00.0000Z",
"representative_name": "Deborah M",
"reference_number": "2812129",
"call_recording_url": "https://www.google.com/voice_recording.wav"
}
],
"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": {
"10-01-2020": [
{
"procedure_code": "D1110",
"tooth_numbers": [
"17"
],
"surfaces": [
"occlusal"
],
"quadrant_numbers": [
10
]
},
{
"procedure_code": "D1120",
"tooth_numbers": [
"A"
],
"surfaces": [
"distal"
],
"quadrant_numbers": [
20
]
}
]
},
"procedure_classes": {
"DIAGNOSTIC": {
"is_covered": true,
"coverage_percentage": 100
},
"IMPLANTS": {
"is_covered": false
}
},
"procedure_codes": [
[
{
"procedure_code": "D1110",
"procedure_name": "Prophylaxis"
},
{
"is_covered": true,
"is_prior_auth_required": true,
"prior_auth_info": "Call United Healthcare at 555-123-1234",
"coverage_percentage": 100,
"frequency_limitations": "1 every 6 floating months",
"more_info": ""
}
],
[
{
"procedure_code": "D1206",
"procedure_name": "Fluoride"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"age_limit": 16,
"coverage_percentage": 100,
"frequency_limitations": "1 every calendar year",
"more_info": ""
}
],
[
{
"procedure_code": "D6058",
"procedure_name": "Crowns"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"is_downgraded": true,
"coverage_percentage": 50,
"downgraded_info": "Downgraded to D6063 on molars.",
"frequency_limitations": "1 every 5 years",
"more_info": "Prior authorization is not required, however, predetermination is highly recommended."
}
],
[
{
"procedure_code": "D0364",
"procedure_name": "CT Scan"
},
{
"is_covered": false,
"more_info": ""
}
]
],
"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
}
},
"request": {
"type": "BENEFITS",
"desired_completion_date": "03-19-2024",
"patient_name": "Alex Martin",
"dob": "01-31-2020",
"member_id": "123456789",
"group_id": "123456",
"insurance_in_network": true,
"npi": "1234567890",
"tax_id": "123456789",
"external_id": "<string>",
"practice_billing_address": "123 Main St, New York, NY 10001",
"diagnosis_codes": [
"F41.1",
"F42.23"
],
"claims_date_of_service": "01-31-2020",
"claim_number": "1234567890",
"additional_info": "The patient is on a Medicare plan and we need to know their secondary insurance benefits.",
"insurance": "CIGNA",
"benefits_query": [
"CODE_LOOKUP_BENEFITS"
],
"benefits_codes": [
"D1110",
"D1120",
"1130"
],
"is_specialist": true
}
}Authorizations
The access token received from the authorization server in the OAuth 2.0 flow.
Path Parameters
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
"2020-01-01T00:00:00.000000Z"
The request that was used to create the inquiry.
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.
"03-19-2024"
name of the patient
"Alex Martin"
date of birth of the patient in MM-DD-YYYY format
"01-31-2020"
member id of the patient
"123456789"
Ten digit NPI of the provider
"1234567890"
Nine digit tax id of the provider
"123456789"
The insurance provider for the patient.
AETNA, HEALTHPLEX, HUMANA, METLIFE, UNITED_HEALTHCARE, UNKNOWN "CIGNA"
group id of the patient
"123456"
whether or not the provider is in-network. If it is not known, leave this field blank and it will be determined.
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.
"123 Main St, New York, NY 10001"
Any diagnosis codes for the patient. If omitted, a general diagnosis code will be used.
["F41.1", "F42.23"]
The date of service for the claim in MM-DD-YYYY format. Only used for claims inquiries.
"01-31-2020"
The claim number for the inquiry if provided by the user. Only used for claims inquiries.
"1234567890"
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 patient is on a Medicare plan and we need to know their secondary insurance benefits."
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 ["CODE_LOOKUP_BENEFITS"]
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.
["D1110", "D1120", "1130"]
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.
true
summary of the call results
"Benefits retrieved successfully."
The output from the call containing the benefits results.
The details of the placed calls including the call time in iso format, representative name and reference number.
[
{
"call_end_time": "2024-03-01T06:00:00.0000Z",
"representative_name": "Deborah M",
"reference_number": "2812129",
"call_recording_url": "https://www.google.com/voice_recording.wav"
}
]
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.
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.
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.
5 digit CDT code that refers to a procedure performed on a patient.
"D2140"
Integers from 1-32 that refers to particular teeth as designated by the ADA. For child teeth, the letters A-T will be used.
["15", "17"]
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.
["occlusal"]
Integers in {10,20,30,40} that refer to a particular quadrant.
[10]
{
"10-01-2020": [
{
"procedure_code": "D1110",
"tooth_numbers": ["17"],
"surfaces": ["occlusal"],
"quadrant_numbers": [10]
},
{
"procedure_code": "D1120",
"tooth_numbers": ["A"],
"surfaces": ["distal"],
"quadrant_numbers": [20]
}
]
}
A dict that maps from the different classes of procedures to their benefits. If a class is not covered, it may not have any other fields. See examples for more information.
{
"DIAGNOSTIC": {
"is_covered": true,
"coverage_percentage": 100
},
"IMPLANTS": { "is_covered": false }
}
A list that contains information from the different procedure codes and the requested benefits information for that code. See examples for more information.
[
[
{
"procedure_code": "D1110",
"procedure_name": "Prophylaxis"
},
{
"is_covered": true,
"is_prior_auth_required": true,
"prior_auth_info": "Call United Healthcare at 555-123-1234",
"coverage_percentage": 100,
"frequency_limitations": "1 every 6 floating months",
"more_info": ""
}
],
[
{
"procedure_code": "D1206",
"procedure_name": "Fluoride"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"age_limit": 16,
"coverage_percentage": 100,
"frequency_limitations": "1 every calendar year",
"more_info": ""
}
],
[
{
"procedure_code": "D6058",
"procedure_name": "Crowns"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"is_downgraded": true,
"coverage_percentage": 50,
"downgraded_info": "Downgraded to D6063 on molars.",
"frequency_limitations": "1 every 5 years",
"more_info": "Prior authorization is not required, however, predetermination is highly recommended."
}
],
[
{
"procedure_code": "D0364",
"procedure_name": "CT Scan"
},
{ "is_covered": false, "more_info": "" }
]
]
Extra information about the patient's dental plan. Fields are omitted if not applicable.
{
"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
}
{
"id": "<string>",
"status": "SUCCESS",
"creation_ts": "2020-01-01T00:00:00.000000Z",
"summary": "Benefits retrieved successfully.",
"results": {
"call_details": [
{
"call_end_time": "2024-03-01T06:00:00.0000Z",
"representative_name": "Deborah M",
"reference_number": "2812129",
"call_recording_url": "https://www.google.com/voice_recording.wav"
}
],
"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": {
"10-01-2020": [
{
"procedure_code": "D1110",
"tooth_numbers": [
"17"
],
"surfaces": [
"occlusal"
],
"quadrant_numbers": [
10
]
},
{
"procedure_code": "D1120",
"tooth_numbers": [
"A"
],
"surfaces": [
"distal"
],
"quadrant_numbers": [
20
]
}
]
},
"procedure_classes": {
"DIAGNOSTIC": {
"is_covered": true,
"coverage_percentage": 100
},
"IMPLANTS": {
"is_covered": false
}
},
"procedure_codes": [
[
{
"procedure_code": "D1110",
"procedure_name": "Prophylaxis"
},
{
"is_covered": true,
"is_prior_auth_required": true,
"prior_auth_info": "Call United Healthcare at 555-123-1234",
"coverage_percentage": 100,
"frequency_limitations": "1 every 6 floating months",
"more_info": ""
}
],
[
{
"procedure_code": "D1206",
"procedure_name": "Fluoride"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"age_limit": 16,
"coverage_percentage": 100,
"frequency_limitations": "1 every calendar year",
"more_info": ""
}
],
[
{
"procedure_code": "D6058",
"procedure_name": "Crowns"
},
{
"is_covered": true,
"is_prior_auth_required": false,
"is_downgraded": true,
"coverage_percentage": 50,
"downgraded_info": "Downgraded to D6063 on molars.",
"frequency_limitations": "1 every 5 years",
"more_info": "Prior authorization is not required, however, predetermination is highly recommended."
}
],
[
{
"procedure_code": "D0364",
"procedure_name": "CT Scan"
},
{
"is_covered": false,
"more_info": ""
}
]
],
"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
}
},
"request": {
"type": "BENEFITS",
"desired_completion_date": "03-19-2024",
"patient_name": "Alex Martin",
"dob": "01-31-2020",
"member_id": "123456789",
"group_id": "123456",
"insurance_in_network": true,
"npi": "1234567890",
"tax_id": "123456789",
"external_id": "<string>",
"practice_billing_address": "123 Main St, New York, NY 10001",
"diagnosis_codes": [
"F41.1",
"F42.23"
],
"claims_date_of_service": "01-31-2020",
"claim_number": "1234567890",
"additional_info": "The patient is on a Medicare plan and we need to know their secondary insurance benefits.",
"insurance": "CIGNA",
"benefits_query": [
"CODE_LOOKUP_BENEFITS"
],
"benefits_codes": [
"D1110",
"D1120",
"1130"
],
"is_specialist": true
}
}