Element5 Automation API

openapi: 3.2.0
info:
  title: Element5 Automation API
  description: 'Element5 APIs enables the clients to invoke and monitor Element5 Workflows. The E5 APIs are protected by API keys and the keys would be shared during the onboarding process. Due to the long running nature of workflows the current state of the workflows can be tracked either by polling E5 APIs for status or exposing a webhook which will be notified about progress. The below sections highlight the APIs and events which would be relevant for the current engagement.


    # Authentication


    <!-- ReDoc-Inject: <security-definitions> -->'
  contact:
    email: apisupport@e5.ai
  version: 2.2.0
  x-logo:
    url: https://cdn.prod.website-files.com/658c60c4ff902effa2174f77/668c43e2bfb9956a2995b419_e5-logo-gradient.png
    altText: Element5
    href: https://e5.ai
servers:
- url: https://api-qa.e5.ai
  description: Non-Production Server
- url: https://api.e5.ai
  description: Production Server
security:
- ApiKeyAuth: []
tags:
- name: Automation
  description: Generic E5 Task related APIs and Webhooks
paths: {}
webhooks:
  E5TaskEvents:
    post:
      tags:
      - Automation
      operationId: E5TaskEvent
      description: Due to the long running nature of workflows, Element5 has a webhook interface which sends out events at important junctures when a request is processed. The events would be posted to the Webhook URL which would be configured as part of the onboarding process. **Assumption:** The URLs and their access credentials would have been already shared to Element5 as part of the onboarding process.
      summary: Task Events (Callbacks)
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/Element5WebhookRequest'
        required: true
      responses:
        '200':
          description: Event delivered successfully
        4XX:
          description: Unable to deliver the event
        5XX:
          description: Unable to deliver the event
components:
  schemas:
    TaskStarted:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Processing'
        startedAt:
          $ref: '#/components/schemas/DateString'
        attempt:
          minimum: 1
          type: integer
          example: 1
    TaskStatus_Queued:
      type: string
      enum:
      - queued
    TaskQueued:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Queued'
    TaskFailures:
      oneOf:
      - $ref: '#/components/schemas/AuthorizationTaskFailures'
      - $ref: '#/components/schemas/EligibilityTaskFailures'
      discriminator:
        propertyName: taskName
        mapping:
          submit-authorization: '#/components/schemas/AuthorizationTaskFailures'
          submit-eligibility: '#/components/schemas/EligibilityTaskFailures'
    TaskRestarted:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Processing'
        startedAt:
          $ref: '#/components/schemas/DateString'
        attempt:
          minimum: 1
          type: integer
    TaskStatus_Failed:
      type: string
      enum:
      - failed
    SubmitEligibilityFailure_submitEligibility:
      type: object
      properties:
        failureReason:
          type: string
    TaskSucceeded:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Success'
        startedAt:
          $ref: '#/components/schemas/DateString'
        endedAt:
          $ref: '#/components/schemas/DateString'
        attempt:
          minimum: 1
          type: integer
        taskPayload:
          $ref: '#/components/schemas/TaskSuccesses'
    SubmitEligibilityFailure:
      type: object
      properties:
        submitEligibility:
          $ref: '#/components/schemas/SubmitEligibilityFailure_submitEligibility'
    DateString:
      type: string
      description: Date and time in ISO8601 format
      format: date-time
      example: '2017-07-21T17:32:28Z'
    SubmitAuthorizationFailure_submitAuthorization:
      type: object
      properties:
        failureReason:
          type: string
    SubmitEligibilityProgress_submitEligibility:
      type: object
      properties:
        progress:
          type: string
    EligibilityResponse:
      type: object
      properties:
        patientDetails:
          type: object
          description: Patient details from the payer's eligibility record
          properties:
            patientId:
              type: string
              description: 'Patient Unique ID - Eg: Medical Record number'
            firstName:
              type: string
              description: Patient's first name
            lastName:
              type: string
              description: Patient's last name
            middleName:
              type: string
              description: Patient's middle name
            dateOfBirth:
              type: string
              format: date
              description: Patient's date of birth. Date in ISO8601 format
            gender:
              type: string
              description: Gender of the patient from the payer's eligibility record
            patientAddress:
              type: object
              description: Patient's address
              properties:
                addressLine1:
                  type: string
                  description: Patient's address line 1
                addressLine2:
                  type: string
                  description: Patient's address line 2
                city:
                  type: string
                  description: Patient's city
                state:
                  type: string
                  description: Patient's state
                zip:
                  type: string
                  description: Patient's zip
            relationshipToSubscriber:
              type: string
              description: Patient Relationship to Subscriber
          required:
          - patientId
          - firstName
          - lastName
        subscriberDetails:
          type: object
          description: Subscriber details from the payer's eligibility record
          properties:
            firstName:
              type: string
              description: Subscriber's first name
            lastName:
              type: string
              description: Subscriber's last name
            middleName:
              type: string
              description: Subscriber's middle name
            dateOfBirth:
              type: string
              format: date
              description: Subscriber's date of birth. Date in ISO8601 format
            gender:
              type: string
              description: Gender of the Subscriber from the payer's eligibility record
            subscriberAddress:
              type: object
              description: Subscriber's address
              properties:
                addressLine1:
                  type: string
                  description: Subscriber's address line 1
                addressLine2:
                  type: string
                  description: Subscriber's address line 2
                city:
                  type: string
                  description: Subscriber's city
                state:
                  type: string
                  description: Subscriber's state
                zip:
                  type: string
                  description: Subscriber's zip
          required: []
        payerDetails:
          type: object
          description: Payer details from the payer's eligibility record
          properties:
            payerName:
              type: string
              description: Name of the Payer
            planName:
              type: string
              description: Name of the insurance plan
            payerType:
              type: string
              description: Type of payer (e.g., Medicare, Medicaid, Medicare Advantage)
            payerId:
              type: string
              description: Electronic 5-digit ID used for payer transactions
            memberId:
              type: string
              description: Member identification number returned from the payer
            MBI:
              type: string
              description: Medicare Beneficiary Identifier assigned by CMS
            medicaidID:
              type: string
              description: Medicaid ID, if applicable
            gateway:
              type: string
              description: Clearinghouse/Payor where eligibility was checked (e.g., Availity, Waystar. UHC).
          required:
          - gateway
        planDetails:
          type: object
          description: Plan details from the payer's eligibility record
          properties:
            planNumber:
              type: string
              description: Unique identifier assigned to the member's insurance plan
            planSponsor:
              type: string
              description: Organization or employer that offers or funds the health insurance plan.
            groupName:
              type: string
              description: Name of the employer or group associated with the insurance coverage.
            groupNumber:
              type: string
              description: Identifier used to group members under the same employer or plan contract.
            planType:
              type: string
              description: Type of health plan (e.g., HMO, PPO)
              example: HMO
            planAuthorizationRequired:
              type: string
              description: Indicates whether prior authorization is required for services under the plan.
            utilizationManagementOrganization:
              type: string
              description: Utilization Management Organization info
            CMSContractNumber:
              type: string
              description: CMS-issued contract number for the Medicare plan
          required: []
        planCoverage:
          type: object
          description: Plan coverage details from the payer's eligibility record
          properties:
            eligibilityCheckDate:
              type: string
              format: date
              description: Eligibility check date
              example: '1945-01-15'
            EligibilityInquiryId:
              type: string
              description: Reference number for the eligibility inquiry from CH/Payer
            coverageStatus:
              type: string
              description: Indicates whether the policy is active or inactive
            coverageDescription:
              type: string
              description: Coverage description from the payer
            policyStartDate:
              type: string
              description: Policy Start Date. Date in ISO8601 format
              format: date
              example: '1945-01-15'
            policyEndDate:
              type: string
              description: Policy End Date. Date in ISO8601 format
              format: date
              example: '1945-01-15'
            referralStatus:
              type: string
              description: Indicates if referrals are required under the plan
            serviceCareProviderNetworkStatus:
              type: string
              description: Service Care Provider Network Status
              example:
              - In-Network
              - Out-of-Network
          required:
          - eligibilityCheckDate
        planBenefits:
          type: array
          description: Plan benefits and plan level accumulator info
          items:
            type: object
            properties:
              network:
                type: string
                enum:
                - In-Network
                - Out-of-Network
                - General
              coverageLevel:
                type: string
                description: 'Coverage level of the benefits. Eg: ''Individual'', ''Family'', ''Employee Only'''
                example:
                - Individual
                - Family
                - Employee Only
              benefitStartDate:
                type: string
                description: Benefit Start Date. Date in ISO8601 format
                format: date
                example: '1945-01-15'
              benefitEndDate:
                type: string
                description: Benefit End Date. Date in ISO8601 format
                format: date
                example: '1945-01-15'
              deductible:
                type: array
                description: Deductible details
                items:
                  type: object
                  properties:
                    deductibleAmount:
                      type: string
                      description: Total deductible amount
                    deductibleUsed:
                      type: string
                      description: Used deductible amount
                    deductibleRemaining:
                      type: string
                      description: Remaining deductible amount
                    deductiblePayerNotes:
                      type: string
                      description: Deductible payer notes
              outOfPocket:
                type: array
                description: Out Of Pocket Maximum Details
                items:
                  type: object
                  properties:
                    outOfPocketMaximum:
                      type: string
                      description: Out of pocket maxiumum amount
                    outOfPocketUsed:
                      type: string
                      description: Out of pocket amount used
                    outOfPocketRemaining:
                      type: string
                      description: Out of pocket amount remaining
                    outOfPocketPayerNotes:
                      type: string
                      description: Out of pocket Payer notes
            required: []
        serviceLevelDetails:
          type: array
          description: Service level details from the payer's eligibility record
          items:
            type: object
            properties:
              serviceTypeCode:
                type: string
                description: Code representing the type of service (e.g., 42 for Home Health)
              serviceTypeDescription:
                type: string
                description: Description of the service associated with the code
              coverageStatus:
                type: string
                description: Coverage status for the service type
              coverageDescription:
                type: string
                description: Coverage description from the payer
              benefitStartDate:
                type: string
                description: Benefit Start Date. Date in ISO8601 format
                format: date
                example: '1945-01-15'
              benefitEndDate:
                type: string
                description: Benefit End Date. Date in ISO8601 format
                format: date
                example: '1945-01-15'
              serviceLevelBenefits:
                type: array
                description: Plan benefits and plan level accumulator info
                items:
                  type: object
                  properties:
                    network:
                      type: string
                      enum:
                      - In-Network
                      - Out-of-Network
                      - General
                    coverageLevel:
                      type: string
                      description: 'Coverage level of the benefits. Eg: ''Individual'', ''Family'', ''Employee Only'''
                      example:
                      - Individual
                      - Family
                      - Employee Only
                    coPayment:
                      type: array
                      description: Co-payment details for the service type.
                      items:
                        type: object
                        properties:
                          coPayAmount:
                            type: string
                            description: Co-Pay amount
                          coPayPayerNotes:
                            type: string
                            description: Co-Pay Payer Notes
                          authRequired:
                            type: string
                            description: Indicates if authorization is needed for the specified benefit.
                    coInsurance:
                      type: array
                      description: Co-Insurance details for the service type.
                      items:
                        type: object
                        properties:
                          coInsurancepercent:
                            type: string
                            description: Co-Insurance % for  service type.
                          coInsurancePayerNotes:
                            type: string
                            description: Co-Insurance Payer Notes
                          authRequired:
                            type: string
                            description: Indicates if authorization is needed for the specified benefit.
                    deductible:
                      type: array
                      description: Deductible requirements for service type.
                      items:
                        type: object
                        properties:
                          deductibleAmount:
                            type: string
                            description: Total deductible amount
                          deductibleUsed:
                            type: string
                            description: Used deductible amount
                          deductibleRemaining:
                            type: string
                            description: Remaining deductible amount
                          deductiblePayerNotes:
                            type: string
                            description: Deductible payer notes
                    visitLimitsAndDisciplineExclusionsDetails:
                      type: array
                      description: Visit Limits And Discipline Exclusions details for the service type.
                      items:
                        type: object
                        properties:
                          visitLimitsAndDisciplineExclusions:
                            type: string
                            description: Limits and exclusions for the service type.
                          visitLimitsAndExclusionsPayerNotes:
                            type: string
                            description: Visit limits and Exclusions Payer Notes
                          authRequired:
                            type: string
                            description: Indicates if authorization is needed for the specified benefit.
                required: []
        memberIdCard:
          type: object
          description: Member ID card details from the payer's eligibility record
          properties:
            payerId:
              type: string
              description: 5-digit payer ID from the insurance ID card
            providerPhoneNumber:
              type: string
              description: Customer or provider service number listed on the card
            medicareNationalNetworkStatus:
              type: string
              description: Network status specific to Medicare plans shown on the card
            levelFundedPlan:
              type: boolean
              description: Level funded plan identified on the ID card
          required: []
        additionalCoverageDetails:
          type: array
          description: Additional coverage details from the payer's eligibility record
          items:
            type: object
            properties:
              planName:
                type: string
                description: Name of the additional or secondary insurance plan
              payerId:
                type: string
                description: Payer ID of the secondary insurance
              coverageStartDate:
                type: string
                description: Start date for additional coverage . Date in ISO8601 format
                example: '2024-06-15'
              coverageEndDate:
                type: string
                description: End date for additional coverage. Date in ISO8601 format
                example: '2025-06-14'
              memberId:
                type: string
                description: Member identification number returned from the payer
            required: []
        primaryCareProviderDetails:
          type: array
          description: Primary care provider details from the payer's eligibility record
          items:
            type: object
            properties:
              pcpFirstName:
                type: string
                description: First name of the primary care provider (PCP)
              pcpLastName:
                type: string
                description: Last name of the primary care provider (PCP)
              pcpContactNumber:
                type: string
                description: Contact number for the PCP
              pcpAddress:
                type: object
                description: Address of the PCP
                properties:
                  addressLine1:
                    type: string
                    description: Address line 1
                  addressLine2:
                    type: string
                    description: Address line 2
                  city:
                    type: string
                    description: City
                  state:
                    type: string
                    description: State
                  zip:
                    type: string
                    description: Zip
              pcpType:
                type: string
                description: Type of PCP
              pcpNPI:
                type: string
                description: National Provider Identifier for the PCP
              pcpGroupNumber:
                type: string
                description: National Provider group number
          required: []
        contractedServiceProvider:
          type: object
          description: Contracted service provider details from the payer's eligibility record
          properties:
            contractedServiceProviderName:
              type: string
              description: Contracted Service Provider Name
            contractedServiceProviderAddress:
              type: object
              description: Contracted Service Provider address
              properties:
                addressLine1:
                  type: string
                  description: Address line 1
                addressLine2:
                  type: string
                  description: Address line 2
                city:
                  type: string
                  description: City
                state:
                  type: string
                  description: State
                zip:
                  type: string
                  description: Zip
          required: []
        eligibilityAlert:
          type: array
          description: Eligibility alert details from the payer's eligibility record
          items:
            type: object
            properties:
              eligibilityAlertType:
                type: string
                description: 'Alert type category - Eg: Patient data mismatch'
              alertDescription:
                type: string
                description: Payer/Clearing house alerts for the Eligibility transaction
            required: []
      required:
      - patientDetails
    TaskName:
      type: string
      enum:
      - submit-authorization
      - submit-eligibility
    EligibilityTaskFailures:
      oneOf:
      - $ref: '#/components/schemas/SubmitEligibilityFailure'
    TaskFailed:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Failed'
        startedAt:
          $ref: '#/components/schemas/DateString'
        endedAt:
          $ref: '#/components/schemas/DateString'
        attempt:
          minimum: 1
          type: integer
        taskPayload:
          $ref: '#/components/schemas/TaskFailures'
    SubmitEligibilityProgress:
      type: object
      properties:
        submitEligibility:
          $ref: '#/components/schemas/SubmitEligibilityProgress_submitEligibility'
    EligibilityTaskProgresses:
      oneOf:
      - $ref: '#/components/schemas/SubmitEligibilityProgress'
    SubmitEligibilitySuccessResponse:
      type: object
      properties:
        eligibilityResponse:
          $ref: '#/components/schemas/EligibilityResponse'
        eligibilityResponseDocs:
          type: array
          description: Documents which are received as part of the Eligibility Response
          items:
            type: object
            properties:
              url:
                type: string
                format: uri
                description: 'URL pointing to a file in Element5''s object store. '
              documentType:
                type: string
                description: 'Type of the docuement. Like PDF of eligibility info from payer, PDF of member ID card if available from payer, etc. '
                example: Eligibility PDF
    Element5Events:
      type: string
      enum:
      - task#queued
      - task#started
      - task#restarted
      - task#progressed
      - task#succeeded
      - task#failed
    TaskStatus_Success:
      type: string
      enum:
      - success
    SubmitAuthorizationSuccess:
      type: object
      properties:
        submitAuthorization:
          $ref: '#/components/schemas/SubmitAuthorizationSuccessResponse'
    SubmitAuthorizationFailure:
      type: object
      properties:
        submitAuthorization:
          $ref: '#/components/schemas/SubmitAuthorizationFailure_submitAuthorization'
    AuthorizationTaskSuccesses:
      oneOf:
      - $ref: '#/components/schemas/SubmitAuthorizationSuccess'
    TaskID:
      type: string
      format: uuid
      example: 55dfe5e9-725a-4ce0-ba41-925e588623c2
    TaskStatus_Processing:
      type: string
      enum:
      - processing
    SubmitAuthorizationSuccessResponse:
      type: object
      properties:
        authResponse:
          $ref: '#/components/schemas/AuthResponse'
    SubmitAuthorizationProgress:
      type: object
      properties:
        submitAuthorization:
          $ref: '#/components/schemas/SubmitAuthorizationProgress_submitAuthorization'
    TaskEvents:
      type: object
      properties:
        task:
          oneOf:
          - $ref: '#/components/schemas/TaskQueued'
          - $ref: '#/components/schemas/TaskStarted'
          - $ref: '#/components/schemas/TaskRestarted'
          - $ref: '#/components/schemas/TaskProgressed'
          - $ref: '#/components/schemas/TaskSucceeded'
          - $ref: '#/components/schemas/TaskFailed'
    TaskSuccesses:
      oneOf:
      - $ref: '#/components/schemas/AuthorizationTaskSuccesses'
      - $ref: '#/components/schemas/EligibilityTaskSuccesses'
      discriminator:
        propertyName: taskName
        mapping:
          submit-authorization: '#/components/schemas/AuthorizationTaskSuccesses'
          submit-eligibility: '#/components/schemas/EligibilityTaskSuccesses'
    EligibilityTaskSuccesses:
      oneOf:
      - $ref: '#/components/schemas/SubmitEligibilitySuccessResponse'
    TaskProgressed:
      type: object
      properties:
        taskId:
          $ref: '#/components/schemas/TaskID'
        taskName:
          $ref: '#/components/schemas/TaskName'
        createdAt:
          $ref: '#/components/schemas/DateString'
        status:
          $ref: '#/components/schemas/TaskStatus_Processing'
        startedAt:
          $ref: '#/components/schemas/DateString'
        attempt:
          minimum: 1
          type: integer
        taskPayload:
          $ref: '#/components/schemas/TaskProgresses'
    Element5WebhookRequest:
      type: object
      properties:
        eventName:
          $ref: '#/components/schemas/Element5Events'
        eventId:
          type: string
          format: uuid
        createdAt:
          $ref: '#/components/schemas/DateString'
        eventPayload:
          oneOf:
          - $ref: '#/components/schemas/TaskEvents'
    AuthorizationTaskProgresses:
      oneOf:
      - $ref: '#/components/schemas/SubmitAuthorizationProgress'
    SubmitAuthorizationProgress_submitAuthorization:
      type: object
      properties:
        progress:
          type: string
    AuthorizationTaskFailures:
      oneOf:
      - $ref: '#/components/schemas/SubmitAuthorizationFailure'
    AuthResponse:
      type: object
      properties:
        patientDetails:
          type: object
          description: Patient Details
          properties:
            firstName:
              type: string
              description: Patient first name
              maxLength: 50
              minLength: 1
              example: John
            lastName:
              type: string
              description: Patient last name
              maxLength: 50
              minLength: 1
              example: Smith
            middleName:
              type: string
              description: Patient middle name
              example: Edward
            patientId:
              type: string
              description: 'Patient Unique ID - Eg: Medical Record number'
              example: BOX00003977
          required:
          - firstName
          - lastName
          - patientId
        payerDetails:
          type: object
          description: Payer Details
          properties:
            memberId:
              type: string
              description: Member identification number/payer policy number
              example: W9837639
            payerPlanName:
              type: string
              description: Payer Plan name of the patient
              example: AARP® Medicare Advantage from UnitedHealthcare
            gateway:
              type: string
              description: Gateway in which the authorization was submitted
              example: UHC
          required:
          - memberId
          - payerPlanName
          - gateway
        authorizationResponse:
          description: Authorization Response Details
          type: object
          properties:
            authNumber:
              type: string
              description: Authorization number returned from the payer after the request is placed
            authStatus:
              type: string
              description: Status of the overall authorization request
              enum:
              - PENDING
              - APPROVED
              - DENIED
              - PARTIALLY APPROVED
              - EXCEPTION
              example: PENDING
            lastStatusCheck:
              type: string
              format: date
              description: Timestamp of the last attempt to submit or check the authorization in the portal. Date in ISO8601 format (YYYY-MM-DD)
              example: '2025-05-26'
            payerResponseDate:
              type: string
              format: date
              description: Date in which the payer gave a response of the request that is no longer pending. Date in ISO8601 format (YYYY-MM-DD)
              example: '2025-07-30'
            service

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