ProviderAuthorizationResource
beneficiary object
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]
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]
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]