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

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Overview

In this 5 minute quickstart, we will walk through how to submit claim status requests. Each of these requests will trigger a call to the specified insurance payor, and when completed, you’ll receive the results at any webhooks you’ve set up.

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Create an Inquiry

Let’s walk through an example of how to create an inquiry using a POST request.

You will need to provide the necessary information to check the claims status. This generally includes information about your provider, patient and the claim.

Successful creations will return this response.

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Retrieve an Inquiry

Now that you’ve made your first inquiry, you can check the results with a GET request and the inquiry_id returned when you created an inquiry. This is an alternative to receiving the results at your webhook which will be sent automatically once the results are complete.

Here is a sample response.

JSON
{
  "id": "67daad83-01e3-4e35-9dee-e494a68fad2c",
  "status": "SUCCESS",
  "creation_ts": "2020-01-01T00:00:00.000000Z",
  "summary": "Claims retrieved successfully.",
  "results": {
    "status": "APPROVED",
    "number": "123456789",
    "timeline": {
      "date_received": "08-01-2024",
      "date_processed": "08-05-2024",
      "date_paid": "08-10-2024"
    },
    "unprocessed_claim_info": {
      "date_processed_up_to": "08-05-2024",
      "turnaround_time": null,
    },
    "code_details": [
      {
        "procedure_code": "94625",
        "amound_paid": 80.99,
        "patient_responsibility": 20.00,
        "patient_applied_to_deductible": 20.00,
        "adjustment_details": null,
        "claim_denial_reason": null,
        "appeal_or_correction_info": null,
      }
    ]
  },
  "request":{
    "type": "CLAIMS_STATUS",
    "desired_completion_date": "08-25-2024",
    "patient_name": "Alex Martin",
    "dob": "01-31-2023",
    "member_id": "567891234",
    "insurance": "UNITED_HEALTHCARE",
    "beneficiary":"PRIMARY",
    "npi": "1245319599",
    "practice_billing_address": "123 Main St, New York, NY 10001",
    "tax_id": "123456789",
    "billed_amount": 100.99,
    "claims_date_of_service": "08-01-2024",
    "claim_number": "123456789",
  }
}

You have successfully created a medical 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.

Medical Benefits QuickstartCreate Medical Inquiry