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ProviderAuthorizationAbridgedResource

beneficiary_idinteger<int64>
beneficiary object
idinteger<int64>
namestring
identity_document_typestring
identity_document_idstring
date_of_birthstring<date-time>
employer_namestring
policy_numberstring
certificatestring
policy_holder_namestring
codestring
sponsor_slugstring
doctor_medical_license_numberstring
coverage_typestring

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]

product_typestring

Kind of product covered by an authorization line.

  • DRUG: pharmacy medication.
  • LABORATORY: laboratory test.
  • DIAGNOSTIC_TEST: imaging or other diagnostic study.
  • MEDICAL_PROCEDURE: in-clinic medical procedure.

Possible values: [DRUG, LABORATORY, DIAGNOSTIC_TEST, MEDICAL_PROCEDURE]

statusstring

Overall lifecycle status of an authorization.

  • PENDING_REVIEW: awaiting sponsor manual review before it can be approved.
  • CREATED: created in OSIGU but not yet processed.
  • READY: approved and ready to be redeemed by the beneficiary.
  • PARTIALLY_CLAIMED: partially redeemed; remaining quantities are still available.
  • CLAIMED: fully redeemed.
  • VOIDED: cancelled; cannot be redeemed.
  • PAID: settlement to the provider has been confirmed by the sponsor.
  • ERROR: processing failed. Response contains a diagnostic reason.
  • REQUEST_IN_PROGRESS: still being processed by the authorization engine.
  • QUALIFICATION: undergoing sponsor coverage qualification.
  • INCOMPLETE: waiting for the provider to attach required documents or data.
  • REJECTED: rejected by the sponsor.
  • APPROVED: approved by the sponsor.
  • CANCELLED: cancelled by the sponsor.
  • USER_ERROR: request payload was invalid.
  • CANCELLED_BY_PATIENT: cancelled at the beneficiary's request.
  • PENDING_MEDICAL_REPORT: waiting for a medical report from the provider.
  • COMPLETED: workflow completed.
  • NOT_ATTENDED: the beneficiary did not attend the scheduled service.
  • SENT_TO_SPONSOR: dispatched to the sponsor for downstream processing.
  • PAYMENT_CONFIRMED: sponsor has confirmed payment to the provider.

Possible values: [PENDING_REVIEW, CREATED, READY, PARTIALLY_CLAIMED, CLAIMED, VOIDED, PAID, ERROR, REQUEST_IN_PROGRESS, QUALIFICATION, INCOMPLETE, REJECTED, APPROVED, CANCELLED, USER_ERROR, CANCELLED_BY_PATIENT, PENDING_MEDICAL_REPORT, COMPLETED, NOT_ATTENDED, SENT_TO_SPONSOR, PAYMENT_CONFIRMED]

activation_atstring<date-time>
expiration_atstring<date-time>
created_atstring<date-time>
links object[]
  • Array [
    • relstring

    Relation of this link to the current resource (for example, 'self', 'next', 'first', 'last').

    hrefstring

    Target URL.

    hreflangstring

    Language of the target resource, when applicable.

    mediastring

    Media type of the target resource, when applicable.

    titlestring

    Human-readable title of the link.

    typestring

    Content type of the target resource.

    deprecationstring

    Deprecation notice for the link, when applicable.

    profilestring

    Profile URI describing the semantics of the target resource.

    namestring

    Optional secondary identifier for the link.

  • ]