Get Verification

Authorizations

Authorization

string

header

required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Response

A verification

verificationId

string<uuid>

The Sohar ID for the verification

Example:

"fb701ac1-1246-4860-b1ec-bd916b97a990"

created

string<date-time>

An ISO 8601 date and time string describing when the verification was created

Example:

"2024-01-01T12:00:00.000Z"

status

string

The status of the verification

Example:

"complete.eligible"

statusReason

enum<string> | null

Reason for the verification status when status is "complete.ineligible" or "error.payer". INACTIVE indicates coverage is inactive, NON_COVERED indicates coverage is active but the requested service type is not covered, CONTACT_PAYER_REQUIRED indicates the verification is pending but requires manual payer contact when manual resolution is not enabled.

Available options:

INACTIVE,

NON_COVERED,

CONTACT_PAYER_REQUIRED

string | null

An optional identifier for the verification. This is a user-defined value that can be used when creating the verification

Example:

"123456"

placeOfServiceCode

string | null

Provided place of service code for the verification

Example:

"11"

specialtyCode

string | null

Provided specialty code for the verification

Example:

"PSY"

benefits

object[]

Show child attributes

benefits.networkStatus

enum<string>

Describes the network status of the benefits

inn In Network oon Out of Network

Available options:

inn,

oon

benefits.tier

number | null

The benefits tier, if multiple benefits are available. This attribute will be null if only one tier is available.

Example:

1

benefits.accuracy

number | null

Confidence score (0–1) indicating historical accuracy of copay, coinsurance, deductible, and out-of-pocket values for a customer–payer. Calculated at runtime from past verifications and returned with each benefit tier when available.

Required range: 0 <= x <= 1

Example:

0.84

benefits.copay

number | null

The co-payment value, in USD

Example:

30

benefits.coinsurance

number | null

The co-insurance value. Has the value 1 if co-insurance is 100%, indicating that the payer will not reimburse for this network status

Example:

0.1

benefits.deductible

object

Show child attributes

benefits.deductible.total

number | null

The patient's total deductible value, in USD

Example:

1000

benefits.deductible.remaining

number | null

The patient's remaining deductible value, in USD

Example:

847.56

benefits.deductible.coverageLevelCode

string | null

Indicates the coverage level of the provided deductible information. Possible values include: IND, FAM, CHD, DEP, ECH, EMP, ESP, SPC, SPO

Example:

"IND"

benefits.outOfPocket

object

Show child attributes

benefits.outOfPocket.total

number | null

The patient's out of pocket maximum value, in USD. Also known as the stop loss value

Example:

10000

benefits.outOfPocket.remaining

number | null

The patient's remaining out of pocket value, in USD. Also known as the stop loss value

Example:

5103.21

An array of related entities

Show child attributes

The ID of the related entity

Example:

"01260"

The name of the related entity

Example:

"Magellan"

The insurance member ID, if the related entity knows the patient by a different member ID

Example:

"00000000"

Specifies the role of the related entity

VN Vendor PRP Primary Payer SEP Secondary Payer TTP Tertiary Payer X3 Utilization Management Organization TV Third Party Administrator Y2 Managed Care Organization I3 Independent Physicians Association (IPA) PR Payer P5 Plan Sponsor 13 Contracted Service Provider 1P Provider 1I Preferred Provider Organization (PPO) 2B Third-Party Administrator

Available options:

VN,

PRP,

SEP,

TTP,

X3,

TV,

Y2,

I3,

PR,

P5,

13,

1P,

1I,

2B

Example:

"PRP"

Qualifier to indicate Medicare Part. Defaults to null and currently only populated for Medicare entities.

Available options:

PART_A,

PART_B,

PART_C,

PART_D

Example:

"PART_A"

patient

object

Show child attributes

patient.firstName

string

The patient's first name

Example:

"JOHN"

patient.lastName

string

The patient's last name

Example:

"DOE"

patient.dateOfBirth

string

The patient's birth date in MM/DD/YYYY format

Example:

"09/20/2023"

patient.memberId

string

The insurance member ID

Example:

"00000000"

patient.gender

enum<string>

The patient's gender code

M Male F Female U Unknown

Available options:

M,

F,

U

Example:

"F"

patient.subscriberRelationshipCode

enum<string> | null

Describes the relationship between the patient and the subscriber

01 Spouse 04 Grandfather or Grandmother 05 Grandson or Granddaughter 07 Nephew or Niece 10 Foster Child 15 Ward of the Court 17 Stepson or Stepdaughter 18 Self 19 Child 20 Employee 21 Unknown 22 Handicapped/Dependent 23 Sponsored Dependent 24 Dependent of Minor Dependent 26 Guardian 29 Significant Other 30 Both Parents - The legal custody of the student is with both parents 31 Court Appointed Guardian 32 Mother 33 Father 36 Emancipated Minor 39 Organ Donor 40 Cadaver Donor 41 Injured Plaintiff 43 Child Where Insured Has No Financial Responsibility 53 Life Partner G8 Other Relationship

Available options:

01,

04,

05,

07,

10,

15,

17,

18,

19,

20,

21,

22,

23,

24,

26,

29,

30,

31,

32,

33,

36,

39,

40,

41,

43,

53,

G8

Example:

"18"

patient.address

object

Show child attributes

patient.address.address1

string | null

The first line of the patient's address

Example:

"1 BROADWAY"

patient.address.address2

string | null

The second line of the patient's address

Example:

"P.O. BOX 123"

patient.address.city

string | null

The patient's city

Example:

"LOS ANGELES"

patient.address.state

enum<string>

The patient's state

Available options:

AK,

AL,

AR,

AZ,

CA,

CO,

CT,

DC,

DE,

FL,

GA,

HI,

IA,

ID,

IL,

IN,

KS,

KY,

LA,

MA,

MD,

ME,

MI,

MN,

MO,

MS,

MT,

NC,

ND,

NE,

NH,

NJ,

NM,

NV,

NY,

OH,

OK,

OR,

PA,

RI,

SC,

SD,

TN,

TX,

UT,

VA,

VT,

WA,

WI,

WV,

WY

Example:

"CA"

patient.address.zipCode

string | null

The patient's zip code

Example:

"90210"

subscriber

object

Show child attributes

subscriber.firstName

string | null

The subscriber's first name

Example:

"JOHN"

subscriber.lastName

string | null

The subscriber's last name

Example:

"DOE"

subscriber.dateOfBirth

string | null

The subscriber's birth date in MM/DD/YYYY format

Example:

"09/20/2023"

plan

object

Show child attributes

plan.name

string | null

Describes the patient's plan

Example:

"OPEN CHOICE"

plan.number

string | null

The plan's identification number

Example:

"12345678"

plan.insuranceTypeCode

string | null

Describes the patient's insurance type

Example:

"HM"

plan.startDate

string | null

Date on which coverage began in MM/DD/YYYY format

Example:

"09/20/2023"

plan.endDate

string | null

Date on which coverage ends in MM/DD/YYYY format

Example:

"09/20/2023"

plan.networkId

string | null

The plan's network identifier

Example:

"A2"

payer

object

Show child attributes

payer.id

string<uuid>

The payer ID. Note that this value may be different to the value provided in the original request if the original payer was incorrect and the correct payer has been found

Example:

"60054"

payer.name

string

The payer's name. Note that this value may be different to the value provided in the original request if the original payer was incorrect and the correct payer has been found

Example:

"Aetna"

group

object

Show child attributes

group.number

string | null

Describes the patient's group number

Example:

"123456"

group.name

string | null

Describes the patient's group name

Example:

"ACME CORPORATION"

API Reference

Auth

Verification

Discovery

Network Status

Cost Estimation

Payers

Providers

Webhooks

Legacy Endpoints

Authorizations

Response