--- title: "Get Benefits Check V2" method: GET path: "/public/v2/benefits-checks/{benefits_check_id}" tags: ["V2BenefitsCheckResource"] --- # Get Benefits Check V2 `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_id` string, required ## Response `200` - V2BenefitsCheckResponse - `id` string, uuid, required: Benefits Check ID - `status` 'REQUESTED' | 'AWAITING_SILNA' | 'AWAITING_PROVIDER' | 'COMPLETE' | 'WITHDRAWN', required - `eligibility_status` 'ELIGIBLE' | 'INELIGIBLE' - `ineligibility_reason` 'PLAN_INACTIVE' | 'PATIENT_HAS_OUT_OF_NETWORK_IPA' | 'PLAN_HAS_TERMINATED'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' - `reference` string, nullable: Reference number - `note` string, nullable: Note - `insurance_type` 'COMMERCIAL' | 'MEDICARE' | 'MEDICAID' | 'REGIONAL_CENTER' | 'WORKERS_COMPENSATION' | 'AUTO_INSURANCE' - `date_verified` string, date-time, nullable: Date verified - `patient_plan_id` string, uuid, required: Patient Plan ID - `patient_id` string, uuid, required: Patient ID - `provider_id` string, uuid, required: Provider ID - `network_status` 'IN_NETWORK' | 'OUT_OF_NETWORK' - `plan_type` string, nullable: Plan type - `payor_plan_id` string, 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_date` string, date, nullable: Plan start date - `plan_end_date` string, date, nullable: Plan end date - `group_number` string, nullable: Plan group ID - `patient_information` BenefitsCheckPatientInformation: Patient Information Schema - shared between V1 and V2 - `subscriber_first_name` string, nullable: Subscriber first name - `subscriber_last_name` string, nullable: Subscriber last name - `subscriber_date_of_birth` string, date, nullable: Subscriber date of birth - `subscriber_address` string, nullable: Subscriber address - `subscriber_state` string, nullable: Subscriber state - `subscriber_city` string, nullable: Subscriber city - `subscriber_zip_code` string, nullable: Subscriber zip code - `subscriber_patient_relationship` string, nullable: Subscriber Patient relationship - `other_payor_information` BenefitsCheckOtherPayorInformation[], nullable: Other payor information - `payor_name` string, nullable: Payor name - `plan_order_number` integer, nullable: Plan order number - `other_payor_entity_name` string, nullable: Name of the other insurance payor entity when ineligibility reason is patient has other insurance - `independent_physician_association_name` string, nullable: Name of the Independent Physician Association (IPA) managing the provider network for the patient's plan - `is_qualified_medicare_beneficiary` boolean, nullable: Whether the patient is a Qualified Medicare Beneficiary (QMB) - `incomplete_reasons` BenefitsCheckIncompleteReasonSchema[], nullable: Details on why an automation-only benefits check could not be auto-completed - `type` 'AAA' | 'CAQH_CORE_ERROR' | 'VALIDATION', required - `code` string, nullable: Code from the payor or clearinghouse - `message` string, required: Human-readable description - `created_at` string, date-time, required: Created at timestamp - `silna_url` string, nullable: Silna benefits check URL - `template_id` string, uuid, nullable: Benefits Check Template ID - `template_name` string, nullable: Benefits Check Template Name - `specialty_fields` V2SpecialtyFieldsProvider[], required: Specialty specific benefits data - `specialty` 'PHYSICAL_THERAPY' | 'ABA_THERAPY' | 'SPEECH_THERAPY' | 'OCCUPATIONAL_THERAPY' | 'PSYCHOLOGICAL_TESTING' | 'HOME_HEALTH_CARE' | 'HOSPICE' | 'CARDIAC_REHABILITATION' | 'INTENSIVE_CARDIAC_REHABILITATION' | 'MENTAL_HEALTH' | 'PRINCIPAL_ILLNESS_NAVIGATION' | 'PRINCIPAL_CARE_MANAGEMENT' | 'ADVANCED_PRIMARY_CARE_MODELS' | 'PREVENTATIVE_HEALTH' | 'PARTIAL_HOSPITALIZATION_PROGRAM' | 'INTENSIVE_OUTPATIENT_PROGRAM' | 'INTERVENTIONAL_RADIOLOGY' | 'VASCULAR_SURGERY' | 'INTERVENTIONAL_CARDIOLOGY' | 'ORTHOPEDICS' | 'CHIROPRACTIC' | 'GYNECOLOGY' | 'LONG_TERM_CARE' | 'NUTRITIONAL_COUNSELING' | 'PHYSICAL_MEDICINE' | 'PULMONARY_REHABILITATION' | 'INJECTABLE_SPECIALTY_MEDICATIONS' | 'ALLERGY_TESTING' | 'SKILLED_NURSING' | 'RADIOLOGY' | 'OTOLARYNGOLOGY' | 'DURABLE_MEDICAL_EQUIPMENT' | 'DERMATOLOGY' | 'PROFESSIONAL_OFFICE_VISIT' | 'PSYCHIATRY' | 'PRIVATE_DUTY_NURSING' | 'NEUROLOGY', required - `copay_fields` V2CopayField[]: List of copay fields - `value` union: Copay Amount - number - string - `modifier` V2CopayModifier - `timing` V2BenefitsCheckTiming - `before_after` 'BEFORE' | 'AFTER' - `quantity` integer, nullable: Numeric quantity associated with the timing - `unit` 'VISITS' | 'CPT_UNITS' | 'DOLLARS' | 'HOURS' | 'DAYS' | 'WEEKS' | 'MONTHS' | 'YEARS' - `treatment_codes` string[]: List of treatment codes for which the treatment code applies - `places_of_service` V2PlaceOfServiceCode[]: List of place of services for which the copay applies. - `code` string, required: Service code - `name` string, required: Service name - `applies_to_deductible` boolean: Whether the copay applies to the deductible - `before_deductible` boolean: Whether the copay applies before or after the deductible - `benefit_unit` 'VISIT' | 'DAY' | 'WEEK' | 'MONTH' | 'YEAR' | 'LIFETIME' | 'CPT_UNIT' | 'EPISODE' | 'ADMISSION' - `diagnosis_codes` string[]: List of diagnosis codes for which the copay applies. - `coinsurance_fields` V2CoinsuranceField[]: List of coinsurance fields - `value` union: Coinsurance Percentage - number - string - `modifier` V2CoinsuranceModifier - `timing` V2BenefitsCheckTiming - `before_after` 'BEFORE' | 'AFTER' - `quantity` integer, nullable: Numeric quantity associated with the timing - `unit` 'VISITS' | 'CPT_UNITS' | 'DOLLARS' | 'HOURS' | 'DAYS' | 'WEEKS' | 'MONTHS' | 'YEARS' - `treatment_codes` string[]: List of treatment codes for which the co-insurance applies. - `places_of_service` V2PlaceOfServiceCode[]: List of place of service codes - `code` string, required: Service code - `name` string, required: Service name - `applies_to_deductible` boolean: Whether the coinsurance applies to the deductible - `before_deductible` boolean: Whether the coinsurance applies before the deductible - `diagnosis_codes` string[]: List of diagnosis codes for which the coinsurance applies. - `deductible` V2AccumulationFields - `individual` V2AccumulationField, required - `amount` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `amount_met` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `family` V2AccumulationField, required - `amount` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `amount_met` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `out_of_pocket` V2AccumulationFields - `individual` V2AccumulationField, required - `amount` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `amount_met` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `family` V2AccumulationField, required - `amount` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `amount_met` V2DecimalFieldNoModifier, required - `value` union: Decimal value - number - string - `visit_limits` V2VisitLimitField[]: List of visit limit fields - `value` union: Visit Limit - number - string - `visits_met` union: Visits already used against this limit - number - string - `modifier` V2VisitLimitModifier - `treatment_codes` string[]: List of treatment codes for which the treatment codes applie - `places_of_service` V2PlaceOfServiceCode[]: List of place of service codes for which the visit limit applies - `code` string, required: Service code - `name` string, required: Service name - `specialties` PublicSpecialty[]: List of specialties for which the visit limit applies - `timing` V2BenefitsCheckTiming - `before_after` 'BEFORE' | 'AFTER' - `quantity` integer, nullable: Numeric quantity associated with the timing - `unit` 'VISITS' | 'CPT_UNITS' | 'DOLLARS' | 'HOURS' | 'DAYS' | 'WEEKS' | 'MONTHS' | 'YEARS' - `diagnosis_codes` string[]: List of diagnosis codes for which the visit limit applies. - `dollar_limits` V2DollarLimitField[]: List of dollar limit fields - `value` union: Dollar Limit - number - string - `dollars_used` union: Dollars already used against this limit - number - string - `modifier` V2DollarLimitModifier - `treatment_codes` string[]: List of treatment codes for which the dollar limit applies. - `places_of_service` V2PlaceOfServiceCode[]: List of place of service codes for which the dollar limit applies. - `code` string, required: Service code - `name` string, required: Service name - `specialties` PublicSpecialty[]: List of specialties for which the dollar limit applies. - `timing` V2BenefitsCheckTiming - `before_after` 'BEFORE' | 'AFTER' - `quantity` integer, nullable: Numeric quantity associated with the timing - `unit` 'VISITS' | 'CPT_UNITS' | 'DOLLARS' | 'HOURS' | 'DAYS' | 'WEEKS' | 'MONTHS' | 'YEARS' - `diagnosis_codes` string[]: List of diagnosis codes for which the dollar limit applies. - `authorization_requirements` V2AuthorizationField[]: List of authorization requirement fields - `value` boolean: Whether an authorization is required. - `modifier` V2AuthorizationModifier - `payor_name` string, nullable: Name of the payor - `timing` V2BenefitsCheckTiming - `before_after` 'BEFORE' | 'AFTER' - `quantity` integer, nullable: Numeric quantity associated with the timing - `unit` 'VISITS' | 'CPT_UNITS' | 'DOLLARS' | 'HOURS' | 'DAYS' | 'WEEKS' | 'MONTHS' | 'YEARS' - `treatment_codes` string[]: List of treatment codes for which the authorization requirement applies. - `places_of_service` V2PlaceOfServiceCode[]: List of place of service codes for which the authorization requirement applies. - `code` string, required: Service code - `name` string, required: Service name - `diagnosis_codes` string[]: List of diagnosis codes for which the authorization requirement applies. - `referral_requirements` V2ReferralField[]: List of referral requirement fields - `value` boolean: Whether a referral is required. - `modifier` V2ReferralModifier - `treatment_codes` string[]: List of treatment codes for which the referral requirement applies. - `places_of_service` V2PlaceOfServiceCode[]: List of place of services for which the referral requirement applies. - `code` string, required: Service code - `name` string, required: Service name - `diagnosis_codes` string[]: List of diagnosis codes for which the referral requirement applies. - `exclusions` V2ExclusionField[]: List of exclusion fields - `value` boolean: True if the associated services are excluded from coverage; False if covered or unknown - `modifier` V2ExclusionModifier - `treatment_codes` string[]: List of treatment codes for which the exclusion applies. - `places_of_service` V2PlaceOfServiceCode[]: List of place of services for which the exclusion applies. - `code` string, required: Service code - `name` string, required: Service name - `diagnosis_codes` string[]: List of diagnosis codes for which the exclusion applies. - `reimbursement_rate` V2ReimbursementRateField - `value` string, nullable: Reimbursement Rate - `modifier` V2ReimbursementRateModifier - `reimbursement_rate_type` 'USUAL_CUSTOMARY_AND_REASONABLE' | 'REASONABLE_AND_CUSTOMARY' | 'FAIR_HEALTH_RATE' | 'MEDICARE_COMPARABLE_RATE' | 'RELATIVE_CUSTOMARY_RATE' | 'REFERENCE_BASED_PRICING' | 'ALLOWED_AMOUNT' | 'MEDICALLY_NECESSARY_REASONABLE_AND_PROPER' | 'NOT_SPECIFIED' - `medicare_dollars_used` V2MedicareDollarsUsedField - `value` union: Medicare Dollars Used - number - string - `exclusions_and_limitations` string, nullable: Exclusions and limitations text - `buy_and_bill_allowed` V2BuyAndBillAllowedField - `value` boolean, nullable: Whether buy and bill is allowed - `patient_cost_estimates` V2PatientCostOfServiceEstimate[]: List of patient cost estimates - `cost_estimate_name` string, required: Name of the cost estimate - `cost_of_service` string, required: Cost of service - `cost_of_service_duration` 'PER_VISIT' | 'PER_HOUR' | 'PER_DAY' | 'PER_SESSION' | 'PER_MONTH' | 'PER_WEEK' | 'PER_PHASE' | 'NONE_HIDDEN' - `member_number` string, nullable: Member number found during the benefits check, falling back to the member number on the patient plan ## Other responses - `401` - `404` - `429` ## Changes - **2026-10-26** `80f43c0cedef`: 1 info - added the optional property `member_number` to the response with the `200` status - **2026-10-15** `d5adf321aa4b`: 1 info - added the optional property `payor_plan_id` to the response with the `200` status - **2026-10-10** `69e990953a0c`: 5 info - added the optional property `specialty_fields/items/coinsurance_fields/items/modifier/diagnosis_codes` to the response with the `200` status - added the optional property `specialty_fields/items/copay_fields/items/modifier/diagnosis_codes` to the response with the `200` status - added the optional property `specialty_fields/items/dollar_limits/items/modifier/diagnosis_codes` to the response with the `200` status - added the optional property `specialty_fields/items/referral_requirements/items/modifier/diagnosis_codes` to the response with the `200` status - …1 more - **2026-10-09** `21a1da5cc32a`: 1 info - added the optional property `specialty_fields/items/buy_and_bill_allowed` to the response with the `200` status - …earlier changes not shown [Operation history](https://skmtc.dev/silnahealth/apis/silna-public-api/changes/public/v2/benefits-checks/:benefits_check_id/get.md) --- [API](https://skmtc.dev/silnahealth/apis/silna-public-api.md) - [All operations](https://skmtc.dev/silnahealth/apis/silna-public-api/llms.txt) - [OpenAPI document](https://skmtc.dev/silnahealth/apis/silna-public-api/revisions/06b4547aa602?raw)