AuthorizationWithoutClaimDetailResource
Insurance coverage type.
OUTPATIENT_CARE: ambulatory medical care.PRESCRIPTION_DRUGS: pharmacy drug coverage.DIAGNOSTIC_TESTS: imaging and diagnostic studies.EDUCATION,SPORTS,WELLNESS: non-medical benefits.CREDIT_CARD_BALANCE,PERMANENT_DISABILITY,UNEMPLOYMENT,FUNERAL_ASSISTANCE,PPI,TEMPORARY_DISABILITY: non-medical insurance benefits handled through OSIGU.MEDICAL_PROCEDURES: stand-alone medical procedures.SECOND_ASSESSMENT: second-opinion consultations.CANCER_DIAGNOSIS,DAILY_HOSPITALIZATION_INCOME,ACCIDENT_MEDICAL_REIMBURSEMENT,DIABETES_ACCIDENTAL_DEATH,DIABETES,CELL_PROTECTION,CASH_ROBBERY: specialized coverage lines.HOSPITAL_CARE,HOSPITALIZATION: inpatient care coverage.
Possible values: [OUTPATIENT_CARE, PRESCRIPTION_DRUGS, DIAGNOSTIC_TESTS, EDUCATION, SPORTS, WELLNESS, CREDIT_CARD_BALANCE, PERMANENT_DISABILITY, UNEMPLOYMENT, FUNERAL_ASSISTANCE, PPI, TEMPORARY_DISABILITY, MEDICAL_PROCEDURES, SECOND_ASSESSMENT, CANCER_DIAGNOSIS, DAILY_HOSPITALIZATION_INCOME, ACCIDENT_MEDICAL_REIMBURSEMENT, DIABETES_ACCIDENTAL_DEATH, DIABETES, CELL_PROTECTION, CASH_ROBBERY, HOSPITAL_CARE, HOSPITALIZATION]
authorization_inputs object[]
beneficiary object
Basic beneficiary information returned by lookup endpoints.
Beneficiary identifier. Long integer.
Beneficiary full name.
Type of identity document (for example, NATIONAL_IDENTITY_CARD, PASSPORT).
Identity document number.
Sponsor-side member code that identifies the beneficiary in the sponsor's system.
Slug of the sponsor providing coverage.
general_balance object
Aggregate benefit balance available to the beneficiary.
currency_code object
Total benefit granted for the coverage period. Decimal number.
Remaining benefit available for the coverage period. Decimal number.
Amount the beneficiary has paid out-of-pocket during the coverage period. Decimal number.
Amount accrued toward the beneficiary's deductible during the coverage period. Decimal number.
Beneficiary status (for example, ENABLED, DISABLED).
Minimum benefit amount the sponsor requires to be available before the beneficiary can be served.
doctor object
authorization_diagnoses object[]
Per-product decision inside an authorization.
APPROVED: the product is covered by the authorization.REJECTED: the product is not covered. 'reason' explains why.MANUAL_APPROVAL_REQUIRED: the product needs manual review by the sponsor before being approved or rejected.
Possible values: [APPROVED, REJECTED, MANUAL_APPROVAL_REQUIRED]
authorization_products object[]
Per-product decision inside an authorization.
APPROVED: the product is covered by the authorization.REJECTED: the product is not covered. 'reason' explains why.MANUAL_APPROVAL_REQUIRED: the product needs manual review by the sponsor before being approved or rejected.
Possible values: [APPROVED, REJECTED, MANUAL_APPROVAL_REQUIRED, PARTIALLY_CLAIMED, CLAIMED]