Develop Health public-api API

openapi: 3.1.0
info:
  title: Develop Health Public public-api API
  description: Develop Health Public API
  version: '1.0'
servers:
- url: https://api.develophealth.ai
tags:
- name: public-api
paths:
  /benefit-verification:
    post:
      tags:
      - public-api
      summary: Create Benefit Verification Route
      operationId: create_benefit_verification_route_benefit_verification_post
      requestBody:
        content:
          application/json:
            schema:
              allOf:
              - $ref: '#/components/schemas/CreateBenefitVerificationRequest'
              title: Data
              examples:
              - priority: 3
                drugs:
                - name: Wegovy
                  dosage: 0.25 mg
                  quantity: 1.0
                - name: Ozempic
                  dosage: 2.68 mg
                  quantity: 1.0
                - name: Mounjaro
                  dosage: 2.5 mg
                  quantity: 1.0
                drug_history:
                  currently_taking_drugs:
                  - name: Metformin
                  previously_taken_drugs:
                  - name: Jardiance
                  - name: Rybelsus
                diagnoses:
                - code: E66.9
                - code: I10
                insurance:
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                patient:
                  internal_id: 39dca4a2-8788-4fd6-9e31-15c56e454322
                  first_name: John
                  last_name: Smith
                  gender: male
                  date_of_birth: '1980-01-01'
                  address:
                    street: 123 Main St, Apt 1
                    city: Los Angeles
                    state_province: CA
                    zip_postal_code: '94001'
                    country: USA
                  phone: 555-555-5555
                provider:
                  first_name: Jane
                  last_name: Green
                  address:
                    street: 9071 E. Mississippi Ave
                    city: Denver
                    state_province: CO
                    zip_postal_code: '80247'
                    country: USA
                  phone: '1231231234'
                  fax: None
                  npi: '0000000000'
                  in_network_payers: []
                entity:
                  legal_name: Test Entity
                  tax_id: '111223333'
                mock_result:
                  status: completed
                  case: drugs_covered__prior_auth_required__has_copay
                use_patient_plan_fund_source_check: false
        required: true
      responses:
        '200':
          description: Successful creation of a benefit verification
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CreateBenefitVerificationResponse'
              example:
                status: success
                data:
                  id: bv_sdkfj3f
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
      security:
      - FronteggJWTAuthentication: []
  /benefit-verification/{id}:
    get:
      tags:
      - public-api
      summary: Get Benefit Verification Route
      operationId: get_benefit_verification_route_benefit_verification__id__get
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      responses:
        '200':
          description: Successfully returned a benefit verification
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/GetBenefitVerificationResponse'
              example:
                status: success
                data:
                  id: bv_dj3wiu
                  object: benefit_verification
                  status: completed
                  status_description: The verification was successful
                  review_status: not_reviewed
                  drugs:
                  - name: Wegovy
                    dosage: 0.25 mg
                    quantity: 1.0
                    coverage: covered
                    coverage_detail_code: insurer_reported_value
                    prior_authorization_required: 'yes'
                    copay: $30 for 28 days supply
                    copay_options:
                    - amount_cents: 3000
                      supply_duration_days: 28
                    determination_details:
                      is_on_formulary: true
                  - name: Ozempic
                    dosage: 2.68 mg
                    quantity: 1.0
                    coverage: covered
                    coverage_detail_code: insurer_reported_value
                    prior_authorization_required: 'yes'
                    copay: $30 for 28 days supply
                    copay_options:
                    - amount_cents: 3000
                      supply_duration_days: 28
                    determination_details:
                      is_on_formulary: true
                  - name: Mounjaro
                    dosage: 2.5 mg
                    quantity: 1.0
                    coverage: covered
                    coverage_detail_code: insurer_reported_value
                    prior_authorization_required: 'yes'
                    copay: $30 for 28 days supply
                    copay_options:
                    - amount_cents: 3000
                      supply_duration_days: 28
                    determination_details:
                      is_on_formulary: true
                  drug_history:
                    currently_taking_drugs:
                    - name: Metformin
                    previously_taken_drugs:
                    - name: Jardiance
                    - name: Rybelsus
                  diagnoses:
                  - code: E66.9
                  - code: I10
                  patient:
                    internal_id: 39dca4a2-8788-4fd6-9e31-15c56e454322
                    first_name: John
                    last_name: Smith
                    gender: male
                    date_of_birth: '1980-01-01'
                    address:
                      street: 123 Main St, Apt 1
                      city: Los Angeles
                      state_province: CA
                      zip_postal_code: '94001'
                      country: USA
                    phone: 555-555-5555
                  provider:
                    first_name: Jane
                    last_name: Green
                    address:
                      street: 9071 E. Mississippi Ave
                      city: Denver
                      state_province: CO
                      zip_postal_code: '80247'
                      country: USA
                    phone: '1231231234'
                    fax: None
                    npi: '0000000000'
                    in_network_payers: []
                  entity:
                    legal_name: Test Entity
                    tax_id: '111223333'
                  insurance:
                  - scanned_content:
                      client_name: Company
                      group_number: '12345678'
                      member_name: John Smith
                      member_number: '12345678'
                      payer_name: United
                      plan_name: Plus Plan
                      rx_bin: '123456'
                      rx_group: ADV
                      rx_pcn: FAC
                    discrete_content: {}
                    url: https://example.com/insurance_doc
                  - scanned_content:
                      error: Unable to extract information from card
                    discrete_content: {}
                    url: https://example.com/insurance_doc2
                  patient_coverage_status: covered
                  verification_methods:
                  - id: bva_23j3234
                    type: ai_call
                    transcript: Call transcript
                    recording_url: https://example.com/recording
                  patient_plan_fund_source: question_not_asked
                  patient_coverage_type: question_not_asked
                  priority: 2
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /benefit-verification/{id}/cancel:
    post:
      tags:
      - public-api
      summary: Cancel Benefit Verification Route
      operationId: cancel_benefit_verification_route_benefit_verification__id__cancel_post
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      responses:
        '204':
          description: Successful Response
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /clinical-qualification:
    post:
      tags:
      - public-api
      summary: Create Clinical Qualification Route
      operationId: create_clinical_qualification_route_clinical_qualification_post
      requestBody:
        content:
          application/json:
            schema:
              allOf:
              - $ref: '#/components/schemas/CreateClinicalQualificationRequest'
              title: Data
              examples:
              - diagnoses:
                - code: E66.9
                evidence:
                - content:
                    bmi_value: 32
                    date_measured: '2023-11-10'
                  date_created: '2023-11-10T10:15:00'
                  title: BMI Chart
                - content:
                    medication_name: Metformin
                    response: No significant weight loss
                  date_created: '2023-11-10T10:15:00'
                  title: Previous Medication History
                patient:
                  address:
                    street: 123 Health St.
                    city: Wellness
                    state_province: CA
                    zip_postal_code: '12345'
                    country: USA
                  date_of_birth: '1980-01-01'
                  email: johndoe@email.com
                  first_name: John
                  last_name: Doe
                  gender: male
                  internal_id: '123456'
                  phone: 123-456-7890
                insurance:
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                drugs:
                - days_supply: 30
                  quantity: 2
                  directions: Inject subcutaneously once a week
                  drug_name: Wegovy
                  strength: 0.25 mg/0.5 mL (0.25 mg dose)
                  dose_form: injectable
                  route_of_administration: subcutaneous
                - days_supply: 28
                  quantity: 1
                  directions: Inject subcutaneously once a week
                  drug_name: Ozempic
                  strength: 0.5 mg/dose
                  dose_form: injectable
                  route_of_administration: subcutaneous
                - days_supply: 28
                  quantity: 4
                  directions: Inject subcutaneously once a week
                  drug_name: Zepbound
                  strength: 1 mg/dose
                  dose_form: injectable
                  route_of_administration: subcutaneous
                provider:
                  address:
                    street: 456 Care Blvd.
                    city: Healtown
                    state_province: CA
                    zip_postal_code: '67890'
                    country: USA
                  fax: 987-654-3211
                  first_name: Alice
                  internal_id: provider_12345
                  last_name: Smith
                  npi: '1234567890'
                  phone: 987-654-3210
                questionnaires:
                - questions:
                  - answer: I usually eat a balanced diet and exercise 3 times a week.
                    question: Please describe your current diet and exercise routine.
                  - answer: Yes, I have tried metformin without significant results.
                    question: Have you previously tried other weight loss medications?
                  date_created: '2023-11-01T08:00:00'
                visit_notes:
                - content: Patient presents with a BMI of 32, indicating obesity. Recommended to start Wegovy for weight management.
                  date_created: '2023-11-10T10:00:00'
        required: true
      responses:
        '200':
          description: Successful creation of an clinical qualification.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CreateClinicalQualificationResponse'
              example:
                status: success
                data:
                  id: cq_sdkfj3f
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
      security:
      - FronteggJWTAuthentication: []
  /clinical-qualification/{id}:
    get:
      tags:
      - public-api
      summary: Get Clinical Qualification Submission By Id
      operationId: get_clinical_qualification_submission_by_id_clinical_qualification__id__get
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      responses:
        '200':
          description: Successfully returned an clinical qualification.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/GetClinicalQualificationResponse'
              example:
                status: success
                data:
                  id: cq_sdkfj3f
                  object: clinical_qualification
                  diagnoses:
                  - code: E66.9
                  evidence:
                  - content:
                      bmi_value: 32
                      date_measured: '2023-11-10'
                    date_created: '2023-11-10T10:15:00'
                    title: BMI Chart
                  - content:
                      medication_name: Metformin
                      response: No significant weight loss
                    date_created: '2023-11-10T10:15:00'
                    title: Previous Medication History
                  patient:
                    address:
                      street: 123 Health St.
                      city: Wellness
                      state_province: CA
                      zip_postal_code: '12345'
                      country: USA
                    date_of_birth: '1980-01-01'
                    email: johndoe@email.com
                    first_name: John
                    last_name: Doe
                    gender: male
                    internal_id: '123456'
                    phone: 123-456-7890
                  insurance:
                  - scanned_content:
                      client_name: Company
                      group_number: '12345678'
                      member_name: John Doe
                      member_number: '12345678'
                      payer_name: United
                      plan_name: Plus Plan
                      rx_bin: '123456'
                      rx_group: ADV
                      rx_pcn: FAC
                    discrete_content: {}
                    url: https://example.com/insurance_doc
                  - scanned_content:
                      error: Unable to extract information from card
                    discrete_content: {}
                    url: https://example.com/insurance_doc2
                  drugs:
                  - days_supply: 30
                    quantity: 2
                    directions: Inject subcutaneously once a week
                    drug_name: Wegovy
                    strength: 0.25 mg/0.5 mL (0.25 mg dose)
                    dose_form: injectable
                    route_of_administration: subcutaneous
                  - days_supply: 28
                    quantity: 1
                    directions: Inject subcutaneously once a week
                    drug_name: Ozempic
                    strength: 0.5 mg/dose
                    dose_form: injectable
                    route_of_administration: subcutaneous
                  - days_supply: 28
                    quantity: 4
                    directions: Inject subcutaneously once a week
                    drug_name: Zepbound
                    strength: 1 mg/dose
                    dose_form: injectable
                    route_of_administration: subcutaneous
                  provider:
                    address:
                      street: 456 Care Blvd.
                      city: Healtown
                      state_province: CA
                      zip_postal_code: '67890'
                      country: USA
                    fax: 987-654-3211
                    first_name: Alice
                    internal_id: provider_12345
                    last_name: Smith
                    npi: '1234567890'
                    phone: 987-654-3210
                  questionnaires:
                  - questions:
                    - answer: I usually eat a balanced diet and exercise 3 times a week.
                      question: Please describe your current diet and exercise routine.
                    - answer: Yes, I have tried metformin without significant results.
                      question: Have you previously tried other weight loss medications?
                    date_created: '2023-11-01T08:00:00'
                  visit_notes:
                  - content: Patient presents with a BMI of 32, indicating obesity. Recommended to start Wegovy for weight management.
                    date_created: '2023-11-10T10:00:00'
                  results:
                  - drug:
                      days_supply: 30
                      quantity: 2
                      directions: Inject subcutaneously once a week
                      drug_name: Wegovy
                      strength: 0.25 mg/0.5 mL (0.25 mg dose)
                      dose_form: injectable
                      route_of_administration: subcutaneous
                    status: qualified
                    unqualified_reasons: []
                  - drug:
                      days_supply: 28
                      quantity: 4
                      directions: Inject subcutaneously once a week
                      drug_name: Zepbound
                      strength: 1 mg/dose
                      dose_form: injectable
                      route_of_administration: subcutaneous
                    status: qualified
                    unqualified_reasons: []
                  - drug:
                      days_supply: 28
                      quantity: 1
                      directions: Inject subcutaneously once a week
                      drug_name: Ozempic
                      strength: 0.5 mg/dose
                      dose_form: injectable
                      route_of_administration: subcutaneous
                    status: unqualified
                    unqualified_reasons:
                    - description: The patient does not have a diagnosis of type 2 diabetes.
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /prior-authorization/{id}/cancel:
    post:
      tags:
      - public-api
      summary: Cancel Prior Auth Submission By Id
      description: 'Cancel a prior authorization request.


        The request must not already be in a terminal state (`completed`, `failed`,

        or `cancelled`). Requires a `cancellation_reason` payload which is stored

        for analytics.'
      operationId: cancel_prior_auth_submission_by_id_prior_authorization__id__cancel_post
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      requestBody:
        required: true
        content:
          application/json:
            schema:
              title: Request Data
              allOf:
              - $ref: '#/components/schemas/CancelPriorAuthRequest'
      responses:
        '200':
          description: Successfully cancelled a prior authorization
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CancelPriorAuthResponse'
              example:
                status: success
        '400':
          content:
            application/json:
              example:
                detail: 'Cannot cancel a prior authorization request with status: COMPLETED'
          description: Cannot cancel a prior authorization in completed, failed, or cancelled state
        '404':
          content:
            application/json:
              example:
                detail: Prior Authorization Request does not exist.
          description: Prior Authorization Request does not exist
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /prior-authorization/{id}/feedback:
    post:
      tags:
      - public-api
      summary: Submit Prior Auth Feedback
      description: 'Submit feedback related to a prior authorization request.


        The feedback is used to improve the product and is surfaced in analytics dashboards.'
      operationId: submit_prior_auth_feedback_prior_authorization__id__feedback_post
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      requestBody:
        required: true
        content:
          application/json:
            schema:
              title: Request Data
              allOf:
              - $ref: '#/components/schemas/PriorAuthFeedbackRequest'
      responses:
        '201':
          description: Successfully submitted feedback
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PriorAuthFeedbackResponse'
              example:
                status: success
        '404':
          content:
            application/json:
              example:
                detail: Prior Authorization Request does not exist.
          description: Prior Authorization Request does not exist
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /prior-authorization/{id}/ndp-submission:
    patch:
      tags:
      - public-api
      summary: Update Ndp Submission By Id
      description: 'Update the preferred pharmacy NCPDP ID for a prior authorization''s NDP

        submission. Only allowed while the PA request is active and no transfer

        attempts have been made.'
      operationId: update_ndp_submission_by_id_prior_authorization__id__ndp_submission_patch
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      requestBody:
        required: true
        content:
          application/json:
            schema:
              title: Request Data
              allOf:
              - $ref: '#/components/schemas/UpdateNDPSubmissionRequest'
      responses:
        '200':
          description: Successfully updated preferred pharmacy.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/UpdateNDPSubmissionResponse'
              example:
                status: success
                data:
                  preferred_pharmacy_ncpdp_id: '1234567'
        '400':
          content:
            application/json:
              example:
                detail: 'Cannot update preferred pharmacy for a prior authorization request with status: COMPLETED'
          description: Cannot update preferred pharmacy for terminal PA requests.
        '404':
          content:
            application/json:
              example:
                detail: Prior Authorization Request does not exist.
          description: Prior Authorization Request does not exist.
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /prior-authorization/{id}/prescription-transfer/cancel:
    post:
      tags:
      - public-api
      summary: Cancel Prescription Transfer By Id
      description: Cancel the prescription transfer for a prior authorization with NDP submission.
      operationId: cancel_prescription_transfer_by_id_prior_authorization__id__prescription_transfer_cancel_post
      security:
      - FronteggJWTAuthentication: []
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
          title: Id
      responses:
        '200':
          description: Successfully cancelled prescription transfer
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CancelPriorAuthPrescriptionTransferResponse'
              example:
                status: success
        '400':
          content:
            application/json:
              example:
                detail: Cannot cancel prescription transfer due to completed status
          description: Cannot cancel prescription transfer in completed state
        '404':
          content:
            application/json:
              example:
                detail: Prior Authorization Request does not exist.
          description: Prior Authorization Request does not exist
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /prior-authorization:
    post:
      tags:
      - public-api
      summary: Create Prior Auth Route
      operationId: create_prior_auth_route_prior_authorization_post
      requestBody:
        content:
          application/json:
            schema:
              allOf:
              - $ref: '#/components/schemas/CreatePriorAuthRequest'
              title: Data
              examples:
              - diagnoses:
                - code: E66.9
                evidence:
                - content:
                    bmi_value: 32
                    date_measured: '2023-11-10'
                  date_created: '2023-11-10T10:15:00'
                  title: BMI Chart
                - content:
                    medication_name: Metformin
                    response: No significant weight loss
                  date_created: '2023-11-10T10:15:00'
                  title: Previous Medication History
                patient:
                  address:
                    street: 123 Health St.
                    city: Wellness
                    state_province: CA
                    zip_postal_code: '12345'
                    country: USA
                  date_of_birth: '1980-01-01'
                  email: johndoe@email.com
                  first_name: John
                  last_name: Doe
                  gender: male
                  internal_id: '123456'
                  phone: 123-456-7890
                insurance:
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                - file_content: iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z8BQDwAFgwJ/lzvN2QAAAABJRU5ErkJggg==
                prescription:
                  days_supply: 30
                  quantity: 2
                  directions: Inject subcutaneously once a week
                  drug_name: Wegovy
                  strength: 0.25 mg/0.5 mL (0.25 mg dose)
                  dose_form: injectable
                  route_of_administration: subcutaneous
                  extra:
                    prescribing_information: Prescribed for weight management in patients with obesity
                  prescription_date: '2024-02-14T05:46:07.764000'
                provider:
                  address:
                    street: 456 Care Blvd.
                    city: Healtown
                    state_province: CA
                    zip_postal_code: '67890'
                    country: USA
                  fax: 987-654-3211
                  first_name: Alice
                  internal_id: provider_12345
                  last_name: Smith
                  npi: '1234567890'
                  phone: 987-654-3210
                pharmacy:
                  name: Walgreens
                  address:
                    street: 789 Pharmacy Ave.
                    city: Medtown
                    state_province: MD
                    zip_postal_code: '12345'
                    country: USA
                questionnaires:
                - questions:
                  - answer: I usually eat a balanced diet and exercise 3 times a week.
                    question: Please describe your current diet and exercise routine.
                  - answer: Yes, I have tried metformin without significant results.
                    question: Have you previously tried other weight loss medications?
                  date_created: '2023-11-01T08:00:00'
                visit_notes:
                - content: Patient presents with a BMI of 32, indicating obesity. Recommended to start Wegovy for weight management.
                  date_created: '2023-11-10T10:00:00'
                priority: 2
        required: true
      responses:
        '200':
          description: Successful creation of a prior authorization
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CreatePriorAuthResponse'
              example:
                status: success
                data:
                  id: pa_sdkfj3f
        '400':
          description: API error during creation of the prior authorization request
          content:
            application/json:
              example:
                status: error
                error:
                  title: Unsupported Drug
                  description: The drug you submitted is not yet supported for prior authorization.
                  code: unsupported_drug
        '409':
          description: 'Conflict: prescription message already linked to existing prior authorization'
          content:
            application/json:
              example:
                status: error
                error:
                  title: Prescription Already Linked
                  description: The prescription_message_id provided is already linked to a prior authorization request that is in progress or has already been completed as approved. The existing PA request must be cancelled before submitting a new request for the same prescription.
                  code: prescription_message_already_linked
                  existing_prior_auth_request_id: par_example123
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
      security:
      - FronteggJWTAuthentication: []
  /prior-authorization/{id}:
    get:
      

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# Full source: https://raw.githubusercontent.com/api-evangelist/develop-health/refs/heads/main/openapi/develop-health-public-api-api-openapi.yml