The Auth Verification API is designed to flag whether a particular medical procedure requires Prior Authorization (PA) from the insurance provider. This API helps healthcare providers determine if the insurance plan requires additional approval before a procedure or treatment can be carried out.

Endpoint

POST /api/v1/auth/verify

Input Parameters

• Insurance & plan name: The name of the patient's insurance provider and their specific plan.
• HCPCS/CPT code: The code for the medical procedure or service being requested.

API Response

The response indicates whether or not Prior Authorization is required for the specified procedure under the given insurance plan.

Example Request

1
2{
3  "insurance": "Blue Cross",
4  "plan": "PPO",
5  "hcpcs_code": "J1745"
6}
7

Example Response

1
2{
3  "prior_auth_required": true
4}
5

‍Response Codes

‍