The V1BenefitsCheckResource API from Silna — 2 operation(s) for v1benefitscheckresource.
openapi: 3.0.2
info:
title: Silna Public OldV1PriorAuthorizationResource V1BenefitsCheckResource API
version: '1.0'
servers:
- url: https://app.silnahealth.com/api
security:
- bearerAuth: []
tags:
- name: V1BenefitsCheckResource
paths:
/public/v1/benefits-checks/{benefits_check_id}:
get:
summary: Get Benefits Check V1
responses:
'200':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/V1BenefitsCheckResponse'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'404':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/ObjectNotFoundError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'429':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/TooManyRequestsError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'401':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/AuthenticationError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
parameters:
- in: path
name: benefits_check_id
required: true
schema:
type: string
operationId: V1BenefitsCheckResource.get
tags:
- V1BenefitsCheckResource
x-folder: public_api
/public/v1/benefits-checks/:
post:
summary: Create Benefits Check
responses:
'201':
description: "\n Benefits Check Create Response Schema\n "
content:
application/json:
schema:
$ref: '#/components/schemas/V1BenefitsCheckCreateResponse'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'400':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/ValidationError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'429':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/TooManyRequestsError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
'401':
description: ''
content:
application/json:
schema:
$ref: '#/components/schemas/AuthenticationError'
headers:
X-RateLimit-Limit:
schema:
type: integer
description: The maximum number of requests allowed in the time window
X-RateLimit-Remaining:
schema:
type: integer
description: The number of requests remaining in the current time window
X-RateLimit-Reset:
schema:
type: integer
description: The time when the rate limit will reset, in Unix timestamp
Retry-After:
schema:
type: number
description: The number of seconds to wait before making another request
parameters:
- in: header
name: idempotency-key
required: false
schema:
type: string
minLength: 1
maxLength: 255
description: Unique key to prevent duplicate requests. We support keys up to 255 characters.
example: 550e8400-e29b-41d4-a716-446655440000
operationId: V1BenefitsCheckResource.post
tags:
- V1BenefitsCheckResource
x-folder: public_api
requestBody:
required: true
content:
application/json:
schema:
$ref: '#/components/schemas/V1BenefitsCheckCreateBody'
description: "\n Benefits Check Create Request Schema\n "
components:
schemas:
BenefitsCheckEligibilityStatus:
type: string
enum:
- ELIGIBLE
- INELIGIBLE
x-folder: benefit_check
TooManyRequestsError:
type: object
required:
- message
properties:
message:
type: string
description: Human readable error message
x-folder: null
ValidationError:
type: object
required:
- message
properties:
message:
type: string
description: Human readable error message
x-folder: null
PublicSpecialty:
type: string
enum:
- 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
x-folder: specialty
V1BenefitsCheckSpecialtyData:
description: Benefits Check Specialty Data Response Schema
properties:
specialty:
$ref: '#/components/schemas/PublicSpecialty'
description: Specialty
auth_required:
description: Whether authorization is required
title: Auth Required
nullable: true
type: boolean
referral_required:
description: Whether referral is required
title: Referral Required
nullable: true
type: boolean
referral_info:
description: Referral information
title: Referral Info
nullable: true
type: string
requirement_time:
description: When authorization is required
nullable: true
$ref: '#/components/schemas/BenefitsCheckAuthRequiredTime'
requirement_quantity:
description: Authorization requirement quantity
title: Requirement Quantity
nullable: true
type: integer
requirement_unit:
description: Authorization requirement unit
nullable: true
$ref: '#/components/schemas/UnitType'
auth_company:
description: Authorization company
title: Auth Company
nullable: true
type: string
has_visit_limit:
description: Whether visit limit exists
title: Has Visit Limit
nullable: true
type: boolean
visit_limit_quantity:
description: Visit limit quantity
title: Visit Limit Quantity
nullable: true
type: integer
visits_used:
description: Number of visits used
title: Visits Used
nullable: true
type: integer
copay_amount:
description: Copay amount
title: Copay Amount
nullable: true
type: string
coinsurance_percentage:
description: Coinsurance percentage
title: Coinsurance Percentage
nullable: true
type: string
individual_deductible_amount:
description: Individual deductible amount
title: Individual Deductible Amount
nullable: true
type: string
individual_deductible_amount_met:
description: Individual deductible amount met
title: Individual Deductible Amount Met
nullable: true
type: string
family_deductible_amount:
description: Family deductible amount
title: Family Deductible Amount
nullable: true
type: string
family_deductible_amount_met:
description: Family deductible amount met
title: Family Deductible Amount Met
nullable: true
type: string
individual_out_of_pocket_amount:
description: Individual out of pocket amount
title: Individual Out Of Pocket Amount
nullable: true
type: string
individual_out_of_pocket_amount_met:
description: Individual out of pocket amount met
title: Individual Out Of Pocket Amount Met
nullable: true
type: string
family_out_of_pocket_amount:
description: Family out of pocket amount
title: Family Out Of Pocket Amount
nullable: true
type: string
family_out_of_pocket_amount_met:
description: Family out of pocket amount met
title: Family Out Of Pocket Amount Met
nullable: true
type: string
medicare_dollars_used:
description: Medicare dollars used
title: Medicare Dollars Used
nullable: true
type: string
reimbursement_rate:
description: Reimbursement rate
title: Reimbursement Rate
nullable: true
type: string
exclusions_and_limitations:
description: Exclusions and limitations
title: Exclusions And Limitations
nullable: true
type: string
patient_cost_estimates:
description: List of patient cost estimates
items:
$ref: '#/components/schemas/V1PatientCostOfServiceEstimate'
title: Patient Cost Estimates
type: array
required:
- specialty
- auth_required
- referral_required
- referral_info
- requirement_time
- requirement_quantity
- requirement_unit
- auth_company
- has_visit_limit
- visit_limit_quantity
- visits_used
- copay_amount
- coinsurance_percentage
- individual_deductible_amount
- individual_deductible_amount_met
- family_deductible_amount
- family_deductible_amount_met
- individual_out_of_pocket_amount
- individual_out_of_pocket_amount_met
- family_out_of_pocket_amount
- family_out_of_pocket_amount_met
- medicare_dollars_used
- reimbursement_rate
- exclusions_and_limitations
title: V1BenefitsCheckSpecialtyData
type: object
x-folder: public_api
UnitType:
type: string
enum:
- VISITS
- CPT_UNITS
x-folder: units
V1BenefitsCheckCreateResponse:
description: Benefits Check Create Response Schema
properties:
benefits_check_ids:
description: List of created benefits check IDs
items:
format: uuid
type: string
title: Benefits Check Ids
type: array
required:
- benefits_check_ids
title: V1BenefitsCheckCreateResponse
type: object
x-folder: public_api
AuthenticationError:
type: object
required:
- message
properties:
message:
type: string
description: Human readable error message
type:
$ref: '#/components/schemas/PublicApiErrorType'
x-folder: null
V1BenefitsCheckCreateBody:
description: Benefits Check Create Request Schema
properties:
patient_plan_id:
description: Patient Plan ID
format: uuid
title: Patient Plan Id
type: string
specialties:
description: List of specialties to create benefits check for
items:
$ref: '#/components/schemas/PublicSpecialty'
title: Specialties
type: array
example:
- PHYSICAL_THERAPY
template_id:
default: null
description: Benefits Check Template ID
title: Template Id
nullable: true
format: uuid
type: string
network_status_override:
default: null
description: Override the network status for this benefits check. If provided, the benefits check will use this network status instead of determining it automatically.
nullable: true
$ref: '#/components/schemas/NetworkStatus'
required:
- patient_plan_id
- specialties
title: V1BenefitsCheckCreateBody
type: object
x-folder: public_api
ObjectNotFoundError:
type: object
required:
- message
properties:
message:
type: string
description: Human readable error message
x-folder: null
BenefitsCheckStatusPublic:
type: string
enum:
- REQUESTED
- AWAITING_SILNA
- AWAITING_PROVIDER
- COMPLETE
- WITHDRAWN
x-folder: benefit_check
RateDuration:
type: string
enum:
- PER_VISIT
- PER_HOUR
- PER_DAY
- PER_SESSION
- PER_MONTH
- PER_WEEK
- PER_PHASE
- NONE_HIDDEN
x-folder: provider
InsuranceType:
type: string
enum:
- COMMERCIAL
- MEDICARE
- MEDICAID
- REGIONAL_CENTER
- WORKERS_COMPENSATION
- AUTO_INSURANCE
x-folder: patient
BenefitsCheckAuthRequiredTime:
type: string
enum:
- BEFORE_SERVICES
- AFTER_SERVICES
x-folder: benefit_check
V1PatientCostOfServiceEstimate:
properties:
cost_estimate_name:
description: Name of the cost estimate
title: Cost Estimate Name
type: string
cost_of_service:
description: Cost of service
title: Cost Of Service
type: string
cost_of_service_duration:
default: null
description: Duration of the cost estimate (e.g., PER_VISIT, PER_DAY)
nullable: true
$ref: '#/components/schemas/RateDuration'
required:
- cost_estimate_name
- cost_of_service
title: V1PatientCostOfServiceEstimate
type: object
x-folder: public_api
NetworkStatus:
type: string
enum:
- IN_NETWORK
- OUT_OF_NETWORK
x-folder: payor_entity
BenefitsCheckPatientInformation:
description: Patient Information Schema - shared between V1 and V2
properties:
subscriber_first_name:
default: null
description: Subscriber first name
title: Subscriber First Name
nullable: true
type: string
subscriber_last_name:
default: null
description: Subscriber last name
title: Subscriber Last Name
nullable: true
type: string
subscriber_date_of_birth:
default: null
description: Subscriber date of birth
title: Subscriber Date Of Birth
nullable: true
format: date
type: string
subscriber_address:
default: null
description: Subscriber address
title: Subscriber Address
nullable: true
type: string
subscriber_state:
default: null
description: Subscriber state
title: Subscriber State
nullable: true
type: string
subscriber_city:
default: null
description: Subscriber city
title: Subscriber City
nullable: true
type: string
subscriber_zip_code:
default: null
description: Subscriber zip code
title: Subscriber Zip Code
nullable: true
type: string
subscriber_patient_relationship:
default: null
description: Subscriber Patient relationship
title: Subscriber Patient Relationship
nullable: true
type: string
title: BenefitsCheckPatientInformation
type: object
x-folder: public_api
BenefitsCheckOtherPayorInformation:
description: Other Payor Information Schema - shared between V1 and V2
properties:
payor_name:
default: null
description: Payor name
title: Payor Name
nullable: true
type: string
plan_order_number:
default: null
description: Plan order number
title: Plan Order Number
nullable: true
type: integer
title: BenefitsCheckOtherPayorInformation
type: object
x-folder: public_api
V1BenefitsCheckResponse:
properties:
id:
description: Benefits Check ID
format: uuid
title: Id
type: string
status:
$ref: '#/components/schemas/BenefitsCheckStatusPublic'
description: Benefits Check Status
eligibility_status:
default: null
description: Eligibility Status
nullable: true
$ref: '#/components/schemas/BenefitsCheckEligibilityStatus'
ineligibility_reason:
default: null
description: Reason for ineligibility
nullable: true
$ref: '#/components/schemas/BenefitsCheckIneligibilityReason'
reference:
default: null
description: Reference number
title: Reference
nullable: true
type: string
note:
default: null
description: Notes
title: Note
nullable: true
type: string
insurance_type:
default: null
description: Insurance type
nullable: true
$ref: '#/components/schemas/InsuranceType'
date_verified:
default: null
description: Date verified
title: Date Verified
nullable: true
format: date-time
type: string
patient_plan_id:
description: Patient Plan ID
format: uuid
title: Patient Plan Id
type: string
patient_id:
description: Patient ID
format: uuid
title: Patient Id
type: string
provider_id:
description: Provider ID
format: uuid
title: Provider Id
type: string
network_status:
default: null
description: Network status
nullable: true
$ref: '#/components/schemas/NetworkStatus'
plan_type:
default: null
description: Plan type
title: Plan Type
nullable: true
type: string
plan_start_date:
default: null
description: Plan start date
title: Plan Start Date
nullable: true
format: date
type: string
plan_end_date:
default: null
description: Plan end date
title: Plan End Date
nullable: true
format: date
type: string
group_number:
default: null
description: Plan group ID
title: Group Number
nullable: true
type: string
patient_information:
default: null
description: Patient information
nullable: true
$ref: '#/components/schemas/BenefitsCheckPatientInformation'
other_payor_information:
default: null
description: Other payor information
title: Other Payor Information
nullable: true
items:
$ref: '#/components/schemas/BenefitsCheckOtherPayorInformation'
type: array
other_payor_entity_name:
default: null
description: Name of the other insurance payor entity when ineligibility reason is patient has other insurance
title: Other Payor Entity Name
nullable: true
type: string
independent_physician_association_name:
default: null
description: Name of the Independent Physician Association (IPA) managing the provider network for the patient's plan
title: Independent Physician Association Name
nullable: true
type: string
created_at:
description: Created at timestamp
format: date-time
title: Created At
type: string
silna_url:
default: null
description: Silna benefits check URL
title: Silna Url
nullable: true
type: string
specialty_specific_data:
description: Specialty specific benefits data
items:
$ref: '#/components/schemas/V1BenefitsCheckSpecialtyData'
title: Specialty Specific Data
type: array
required:
- id
- status
- patient_plan_id
- patient_id
- provider_id
- created_at
- specialty_specific_data
title: V1BenefitsCheckResponse
type: object
x-folder: public_api
PublicApiErrorType:
type: string
enum:
- AUTH_INVALID_REQUEST_HEADER
- AUTH_INVALID_CREDENTIALS
x-folder: null
BenefitsCheckIneligibilityReason:
type: string
enum:
- 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
x-folder: benefit_check
securitySchemes:
bearerAuth:
type: http
scheme: bearer