As a prerequisite, you must have credentials to access our API. If you do not have credentials, please reach out to our team to get set up.

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Authentication

Our API is authenticated using HTTP Basic Authentication. You’ll need to pass in your credentials with every API request.

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Additional Prerequisites

For mental health inquiries, we have customized benefits_querys for each customer. Please reach out to our team to get set up to use our Mental Health API.

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Create an Inquiry

Let’s walk through an example use case of the Mental Health API. Say you want to request benefits for certain procedure codes for a patient for a mental health provider.

You will need to provide information on the patient, patient’s insurance, provider, and the benefits you are interested in checking.

For specific benefits codes, please use CODE_LOOKUP_BENEFITS as the benefits_query and pass in the specific codes as benefits_codes.

Successful creations will return an inquiry_id. You will need this inquiry_id to check on its status and see results.

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Retrieve an Inquiry

Now that you’ve made a mental health inquiry, you want to check on the results. You can use our API to do so. The inquiry_id is required.

Here is a sample response.

JSON
{
  "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"
    },
    "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",
      "individual_out_of_pocket_maximum": "1000",
      "individual_out_of_pocket_maximum_used": "800",
      "family_deductible": "200",
      "family_deductible_used": "100",
      "family_out_of_pocket_maximum": "2000",
      "family_out_of_pocket_maximum_used": "1000"
    },
    "procedure_classes": {},
    "procedure_codes": [
      [
        {
          "procedure_code": "90832",
          "procedure_name": "Psychotherapy"
        },
        {
          "is_covered": true,
          "is_prior_auth_required": true,
          "prior_auth_info": "Call Cigna at 1-800-997-1654",
          "is_deductible_waived": false,
          "copay_amount": "20.00",
          "coinsurance_percentage": "20",
          "frequency_limitations": "Two visits per week",
          "more_info": "Diagnosis of medium to severe COPD is required for coverage."
        }
      ]
    ]
  },
  "request": {
    "type": "BENEFITS",
    "desired_completion_date": "08-19-2024",
    "patient_name": "Alex Martin",
    "dob": "01-31-2020",
    "member_id": "123456789",
    "group_id": "123456",
    "insurance_in_network": true,
    "npi": "1245319599",
    "tax_id": "123456789",
    "external_id": "health_harbor_sf",
    "diagnosis_codes": ["F41.1", "F42.23"],
    "claims_date_of_service": "01-31-2020",
    "claim_number": "1234567890",
    "insurance": "CIGNA",
    "is_specialist": true,
    "place_of_service": "office"
  }
}
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