Opkit Eligibility Inquiries API

openapi: 3.2.0
info:
  title: Opkit Eligibility Inquiries API
  description: REST API for Opkit, an automated health insurance verification platform for telehealth companies and virtual medical practices.
  contact:
    name: Opkit
    url: https://www.opkit.co
  version: '1.0'
servers:
- url: https://api.opkit.co/v1
  description: Opkit API v1 production base URL (host no longer resolving as of catalog date).
security:
- bearerAuth: []
tags:
- name: Eligibility Inquiries
  description: Create and retrieve real-time insurance eligibility inquiries.
paths:
  /eligibility-inquiries:
    get:
      operationId: listEligibilityInquiries
      tags:
      - Eligibility Inquiries
      summary: List eligibility inquiries
      description: Returns a paginated list of eligibility inquiries on the account.
      parameters:
      - $ref: '#/components/parameters/Limit'
      - $ref: '#/components/parameters/StartingAfter'
      responses:
        '200':
          description: A list of eligibility inquiries.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityInquiryList'
        '401':
          $ref: '#/components/responses/Unauthorized'
    post:
      operationId: createEligibilityInquiry
      tags:
      - Eligibility Inquiries
      summary: Create an eligibility inquiry
      description: Submits a real-time insurance eligibility inquiry for a patient against a payer. Inquiries are resolved asynchronously; poll the inquiry or subscribe to a webhook to receive the completed result and benefits.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/EligibilityInquiryCreateRequest'
      responses:
        '201':
          description: The created eligibility inquiry.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityInquiry'
        '400':
          $ref: '#/components/responses/BadRequest'
        '401':
          $ref: '#/components/responses/Unauthorized'
  /eligibility-inquiries/{id}:
    get:
      operationId: getEligibilityInquiry
      tags:
      - Eligibility Inquiries
      summary: Retrieve an eligibility inquiry
      description: Retrieves a single eligibility inquiry, including its status and benefits when complete.
      parameters:
      - $ref: '#/components/parameters/PathId'
      responses:
        '200':
          description: The requested eligibility inquiry.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityInquiry'
        '401':
          $ref: '#/components/responses/Unauthorized'
        '404':
          $ref: '#/components/responses/NotFound'
components:
  schemas:
    Error:
      type: object
      properties:
        error:
          type: object
          properties:
            type:
              type: string
              description: A machine-readable error type.
            message:
              type: string
              description: A human-readable description of the error.
    Benefit:
      type: object
      properties:
        id:
          type: string
        object:
          type: string
          example: benefit
        eligibility_inquiry_id:
          type: string
        coverage_status:
          type: string
          description: Whether the plan is active.
          enum:
          - active
          - inactive
          - unknown
        network_status:
          type: string
          description: Whether the patient is in- or out-of-network.
          enum:
          - in_network
          - out_of_network
          - unknown
        plan_name:
          type: string
        copay:
          type:
          - number
          - 'null'
        coinsurance:
          type:
          - number
          - 'null'
        deductible:
          type:
          - number
          - 'null'
        deductible_remaining:
          type:
          - number
          - 'null'
        out_of_pocket_max:
          type:
          - number
          - 'null'
    EligibilityInquiryList:
      type: object
      properties:
        object:
          type: string
          example: list
        data:
          type: array
          items:
            $ref: '#/components/schemas/EligibilityInquiry'
        has_more:
          type: boolean
    EligibilityInquiry:
      type: object
      properties:
        id:
          type: string
        object:
          type: string
          example: eligibility_inquiry
        status:
          type: string
          description: Lifecycle status of the inquiry.
          enum:
          - pending
          - processing
          - completed
          - error
        patient_id:
          type: string
        payer_id:
          type: string
        member_id:
          type: string
        benefits:
          type: array
          description: Structured benefits, populated once the inquiry completes.
          items:
            $ref: '#/components/schemas/Benefit'
        created_at:
          type: string
          format: date-time
        completed_at:
          type:
          - string
          - 'null'
          format: date-time
        metadata:
          type: object
          additionalProperties: true
    EligibilityInquiryCreateRequest:
      type: object
      required:
      - patient_id
      - payer_id
      properties:
        patient_id:
          type: string
          description: The id of the patient to verify.
        payer_id:
          type: string
          description: The id of the payer to verify coverage against.
        member_id:
          type: string
          description: The patient's member or subscriber identifier on the payer.
        service_type:
          type: string
          description: The benefit/service type to check (e.g. health benefit plan coverage).
        metadata:
          type: object
          additionalProperties: true
          description: Arbitrary key/value metadata to associate with the inquiry.
  parameters:
    StartingAfter:
      name: starting_after
      in: query
      required: false
      description: Cursor for pagination; the id of the last object on the previous page.
      schema:
        type: string
    PathId:
      name: id
      in: path
      required: true
      description: The unique identifier of the resource.
      schema:
        type: string
    Limit:
      name: limit
      in: query
      required: false
      description: Maximum number of records to return per page.
      schema:
        type: integer
        minimum: 1
        maximum: 100
        default: 20
  responses:
    BadRequest:
      description: The request was malformed or failed validation.
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    Unauthorized:
      description: Authentication failed or the API key is missing or invalid.
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    NotFound:
      description: The requested resource was not found.
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: 'Provide your Opkit API key as a Bearer token in the Authorization header: `Authorization: Bearer YOUR_API_KEY`.'