API Reference

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Call End Time

Call Recording Url

Reference Number

Representative Name

CallDetails

ExternalInquiryStatus

ExternalInquiryType

The details of the placed calls including the call time in iso format, representative name and reference number.

Call Details

The maximums for the patient including the individual and family deductible and out of pocket maximums. Fields will only be included if applicable, for example, on individual plans, family information will not be available.

Maximums

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.

Plan Information

A dict that maps from the different categories of procedures to their benefits. Categories will contain prior auth, deductibles, copay amounts, coinsurance percentages and any frequency limitations. See examples for more information

Procedure Classes

A list that contains a tuple of procedure code information and their benefits. For medical, procedure codes, if covered, will contain deductible information, copays, coinsurance, frequency limitations and whether or not prior authorization is needed. Coinsurance refers to the patient's portion of the payment.

Procedure Codes

ExternalMedicalEligibilityQueryResults

ExternalMedicalEligibilitySearchQuery

The specific set of benefits to query. These are customized for each customer. Contact alan@healthharbor.co for details.

The billed amount for the claim. Value should be a float with 2 decimal places. Only used for claims inquiries.

Billed Amount

The claim number for the inquiry if provided by the user. Only used for claims inquiries.

Claim Number

The date of service for the claim in MM-DD-YYYY format. Only used for claims inquiries.

Claims Date Of Service

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.

Desired Completion Date

Any diagnosis codes for the patient. If omitted, a general diagnosis code will be used.

Diagnosis Codes

date of birth of the patient in MM-DD-YYYY format

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.

External Id

Group Id

Insurance

whether or not the provider is in-network. If it is not known, leave this field blank and it will be determined.

Insurance In Network

The type of provider making the inquiry. If the provider is a specialist, set this to True. If the provider is a general PCP, set this to False. 

Is Specialist

Member Id

Patient Name

Where the service will be performed. This is typically one of a few places: the doctors office, telehealth or an ambulatory surgical center. See this page for the full list: https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets 

Place Of Service

The billing address of the practice. If omitted, the address will be determined from the NPI.

Practice Billing Address

Tax Id

ExternalMedicalInquiryRequest

ExternalMedicalInsuranceProvider

Coverage Limit

Coverage Limit Remaining

The amount of deductible remaining for the patient. Calculated as the minimum of the individual and family deductible remaining.

Deductible Remaining

Family Deductible

Family Deductible Used

Family Out Of Pocket Maximum

Family Out Of Pocket Maximum Used

Implant Maximum

Implant Maximum Used

Individual Deductible

Individual Deductible Used

Individual Out Of Pocket Maximum

Individual Out Of Pocket Maximum Used

Orthodontic Deductible

Orthodontics Coverage Limit

Orthodontics Coverage Limit Remaining

Orthodontics Deductible Used

Orthodontics Lifetime Maximum

Orthodontics Lifetime Maximum Used

Orthodontics Maximum Benefits Per Case

The amount of out of pocket maximum remaining for the patient. Calculated as the minimum of the individual and family out of pocket maximum remaining.

Out Of Pocket Maximum Remaining

Periodontic Maximum

Periodontic Maximum Used

Effective Date

Has Out Of State Coverage

Is Active

Is Calendar Year Plan

Is Primary Insurance

Is Provider In Network

Is Provider Pcp

Is Self Funded

Plan Name

Referral Info

Referral Required

Termination Date

PlanInformation

PlanType

Procedure Code

Procedure Name

ProcedureCodeInfo

Location

Message

Error Type

ValidationError

OAuth2PasswordBearer

HTTPBasic

ExternalMedicalInquiry

HTTPValidationError

Introduction

Authentication

Webhooks

API Reference Introduction

Additional Options

Dental Quickstart

Create Dental Inquiry

Create Dental Inquiries

Get Dental Inquiry

Get Dental Inquiries

Mental Health Quickstart

Create Mental Health Inquiry

Create Mental Health Inquiries

Get Mental Health Inquiries

Medical Benefits Quickstart

Medical Claim Status Quickstart

Create Medical Inquiry

Create Medical Inquiries

Get Medical Inquiry

Get Medical Inquiries

API Documentation

Dental

Mental Health

Medical

Get Mental Health Inquiry

Authorizations

Path Parameters

Response