[New] Insurance API
- Anton Tolkachiov
- 1 Check Eligibility and Claims Submission Workflow
- 2 POST /users/:id/edit
- 3 POST /me
- 4 POST /users/:id/:carrier_code/eligibility
- 4.1 Result
- 4.2 Response
- 4.3 Raw Data in user_datas
- 4.4 Webhook
- 4.5 Eligibility Responses List
- 4.6 Rejection reason and codes
- 5 GET /insurances/
- 5.1 Output
- 6 POST /insurance/claims
- 6.1 Claims collection
- 6.2 Input
- 6.3 Output
- 6.4 Webhook
Check Eligibility and Claims Submission Workflow
You have patient’s demographics information and patient’s insurance information.
You want to check if the patient is eligible for the procedure / visit.
Steps | Example Request | Example Response | |
|---|---|---|---|
| 1 | Contact the VSee team to configure which insurers you want to support. Once configured, use [New] Insurance API | GET /insurance/archived to pull the list which will also contain insurer_id. | curl --location --request GET 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/insurances/' \
--header 'X-ApiToken: xxxx' | {
"data": {
"insurers": [
{
"id": "car7551",
"name": "AETNA"
},
{
"id": "car7414",
"name": "AETNA BETTER HEALTH OF ILLINOIS"
},
{
"id": "car11406",
"name": "ANTHEM BLUE SHIELD"
},
{
"id": "car7147",
"name": "CIGNA HEALTH CARE"
},
{
"id": "car7580",
"name": "MONTGOMERY HEALTH INSURANCE"
},
{
"id": "car7556",
"name": "HEALTH CHOICE ARIZONA"
}
]
}
} |
| 2 | Create a VSee Clinic user via [New] User API | POST /users/ssoarchived
| curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/sso' \
--header 'X-AccountCode: vclinic' \
--header 'X-ApiKey: xxx' \
--header 'X-ApiSecret: xxx' \
--header 'X-ApiToken: xxx' \
--form 'first_name="Edward"' \
--form 'last_name="VSee"' \
--form 'type="200"' \
--form 'code="edward+001.vclinic@vseelab.com"' \
--form 'email="edward+001.vclinic@vseelab.com"' \
--form 'dob="1986-01-01"' \
--form 'gender="1"' \
--form 'street_addr="2868 Tully Street"' \
--form 'state="Detroit"' \
--form 'city="MI"' \
--form 'zip="48226"' \
--form 'insurance__primary__carrier_code="car11400"' \
--form 'insurance__primary__subscriber_num="10000022"' \
--form 'insurance__primary__group_number="test"' \
--form 'insurance__primary__card_front="card_front_url"' \
--form 'insurance__primary__card_back="card_back_url"' \
--form 'insurance__secondary__carrier_code="car11406"' \
--form 'insurance__secondary__group_number="XX1243"' \
--form 'insurance__secondary__subscriber_num="5678"' \
--form 'insurance__secondary__card_front="card_front_url"' \
--form 'insurance__secondary__card_back="card_back_url"' \
--form 'insurance__patient__respparty="self"' \
--form 'insurance__patient__guarantor_name="Edward VSee"' \
--form 'insurance__patient__guarantor_dob="1986-01-01"' \
--form 'insurance__patient__guarantor_city="NY"' \
--form 'insurance__patient__guarantor_zip="10001"' \
--form 'insurance__patient__guarantor_address="test"' \
--form 'extra__th_id="123456"' | |
| 3 | Run Insurance API (Draft) | POST-/users/:id/:carrier_code/eligibility to trigger the eligibility check for the given user_id. The eligibility check may take some time. A cron job will be created. The cron job will run after 10 seconds and the response will be saved in the
Use the | ||
| 4 | Receive a webhook request with eligibility_response message which will contain the result of the eligibility check. Skip this step if the clinic doesn’t have webhook. |
| |
| 5 | If the user is eligible, trigger a claim submission process for the member_id [New] Insurance API | POST /insurance/claimsarchived | ||
| 6 | Receive a webhook request which will contain the result of the claim. | TBD | TBD |
POST /users/:id/edit
https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/:id/edit
Update patient insurance information.
Request | Response |
|---|---|
POST /me
https://api-vclinic.vseepreview.com/vc/dev/api_v3/me.json
Setup the required patient insurance information for eligibility check.
Request | Response |
|---|---|
Required Insurance Information
POST /users/:id/:carrier_code/eligibility
https://api-vclinic.vseepreview.com/vc/next/api_v3/users/:id/:carrier_code/eligibility
Check insurance eligibility for the given patient. This assumes all required insurance data is saved for this user.
Set insurance data with [New] User API | POST /mearchived
VSee will create a patient record in AdvancedMD as needed if it’s not existing yet.
Result
Since the check may take up to 5 seconds to 1 minute, a webhook eligibility.checked is triggered when it is ready.
Response
In case of error / missing data we should display a proper error message.
Raw Data in user_datas
It will populate the user’s primary insurance or secondary insurance eligibility response fields when response received from the 3rd party.
Webhook
Eligibility Responses List
eligibility_response may be one of the following:
Rejection reason and codes
GET /insurances/
https://api-vclinic.vseepreview.com/vc/next/api_v3/insurance/
Get the available list of insurers for patient to pick from.
Is it stored in clinic Raw settings.
Output
A list of supported insurers.
“id” here is AMD’s payer ID. “name” is readable name.
POST /insurance/claims
https://api-vclinic.vseepreview.com/vc/next/api_v3/insurance/claims
Request | Response |
|---|---|
| |
|
|
Claims collection
Input
Parameter Name | Type | Description |
visit_id |
| … |
date_of_service |
| 12/1/2021 |
location |
| 41 |
procedure_code |
| U0003;U0005 |
units |
| 1 |
diagnosis_code |
| Z20.822;R05.9 |
Output
Webhook