SIsilnahealth
V2BenefitsCheckResource

Get Benefits Check V2

Changed on
get/public/v2/benefits-checks/{benefits_check_id}

Request

  • Base URL
    https://app.silnahealth.com/api
  • URL
    https://app.silnahealth.com/api/public/v2/benefits-checks/{benefits_check_id}
  • Auth
    HTTP bearer

Path parameters

benefits_check_idstring required

Response

idstring uuid required

Benefits Check ID

status'REQUESTED' | 'AWAITING_SILNA' | 'AWAITING_PROVIDER' | 'COMPLETE' | 'WITHDRAWN' required
eligibility_status'ELIGIBLE' | 'INELIGIBLE'
ineligibility_reason'PLAN_INACTIVE' | 'PATIENT_HAS_OUT_OF_NETWORK_IPA' | 'PLAN_HAS_TERMINATED' | 'MBI_TERMINATED' | 'NO_MEDICARE_PART_B_COVERAGE' | 'MEMBER_NUMBER_MISMATCH' | 'SPECIALTY_NOT_COVERED' | 'PATIENT_HAS_OTHER_INSURANCE' | 'NO_OUT_OF_NETWORK_BENEFITS' | 'HAS_ACTIVE_HOME_PLAN' | 'ENROLLED_IN_HOSPICE' | 'PROVIDER_PLACE_OF_SERVICE_NOT_COVERED' | 'PATIENT_DECEASED'
referencestring nullable

Reference number

notestring nullable

Note

insurance_type'COMMERCIAL' | 'MEDICARE' | 'MEDICAID' | 'REGIONAL_CENTER' | 'WORKERS_COMPENSATION' | 'AUTO_INSURANCE'
date_verifiedstring date-time nullable

Date verified

patient_plan_idstring uuid required

Patient Plan ID

patient_idstring uuid required

Patient ID

provider_idstring uuid required

Provider ID

network_status'IN_NETWORK' | 'OUT_OF_NETWORK'
plan_typestring nullable

Plan type

payor_plan_idstring uuid nullable

Silna identifier of the payor plan. Benefits checks with the same payor_plan_id share the same plan. Matches the id returned by GET /public/v1/payors/plans.

plan_start_datestring date nullable

Plan start date

plan_end_datestring date nullable

Plan end date

group_numberstring nullable

Plan group ID

other_payor_entity_namestring nullable

Name of the other insurance payor entity when ineligibility reason is patient has other insurance

independent_physician_association_namestring nullable

Name of the Independent Physician Association (IPA) managing the provider network for the patient's plan

is_qualified_medicare_beneficiaryboolean nullable

Whether the patient is a Qualified Medicare Beneficiary (QMB)

created_atstring date-time required

Created at timestamp

silna_urlstring nullable

Silna benefits check URL

template_idstring uuid nullable

Benefits Check Template ID

template_namestring nullable

Benefits Check Template Name

member_numberstring nullable

Member number found during the benefits check, falling back to the member number on the patient plan

Example response

{
  "specialty_fields": [
    {
      "copay_fields": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "coinsurance_fields": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "visit_limits": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "dollar_limits": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "authorization_requirements": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "referral_requirements": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ],
      "exclusions": [
        {
          "modifier": {
            "places_of_service": [
              {
                "code": "11",
                "name": "Office"
              }
            ]
          }
        }
      ]
    }
  ]
}

Changes