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Documentation Index

Fetch the complete documentation index at: https://docs.silnahealth.com/llms.txt

Use this file to discover all available pages before exploring further.

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Benefits Check Status

  • REQUESTED
  • AWAITING_SILNA → Silna is working on the benefits check
  • AWAITING_PROVIDER → There is an open escalation on a benefits check which requires provider action
  • COMPLETE → The benefits check is finished and you can use the response from GET Benefits Check API. This is a terminal state.
  • WITHDRAWN → The benefits check will no longer be worked on. A benefits check can be withdrawn when a patient plan is archived or through the Silna app. This is a terminal state.

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Benefits Check Lifecycle

When you create a benefits check, it will move into the REQUESTED and then into the AWAITING_SILNA state automatically. When Silna is finished completing the benefits check, it will move to the COMPLETE state. This is the happy path! If there is a problem completing a benefits check, we might need to raise an escalation. When we raise an escalation for a benefits check, it will move to the AWAITING_PROVIDER state. Once a provider resolves the escalation, it will move back to the AWAITING_SILNA state. If a benefits check is no longer needed, then a provider can withdraw it. When this happens, it moves to a WITHDRAWN state.

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Creating Benefit Check for a New Patient

To create a benefit check, you will need to do the following steps:
  1. Follow the guide for Patient Creation to create a new patient.
  2. Use the patient_id from the response above to create a patient plan by following the guide for Patient Plan Creation.
  3. Use the patient_plan_id from the response above to create a benefit check by following the guide for Benefit Check Creation.
  4. It can take some time for Silna to complete a benefit check. We recommend polling the benefit check status by calling the Get Benefits Check API (with the benefits_check_id returned by the above API call). Terminal states for a Benefits Check are COMPLETE and WITHDRAWN. At times, it can take a couple of days for a benefits check to move to a terminal state so we recommend polling every hour or so.
  5. Once the benefits check is complete, you can get the benefits check pdf report by calling the Get Benefits Check Report API and then calling the Get File API with the file_id from the response.

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Creating a Benefit Check for an Existing Patient

To create a benefit check for an existing patient, you will take the same steps as above with the below modifications.
  • Instead of using the Create Patient API, you will use the Update Patient or Create or Update Patient API if you need to update any patient information. If you are storing the Silna patient_id in your system, then you can use the Update Patient API. If you are using your own id (source_id), then you should use the Create or Update Patient API. If this state of the patient in our system is unknown to you, then use the Create or Update Patient API.
  • If you want to create a benefits check for a new plan, you will need to follow the guide for Patient Plan Creation. If it’s for an existing plan, you will use the Get Patient Plans API or PUT Patient Plan API . Again, if the state of the patient plan in our system is unknown to you, then use the PUT Patient Plan API.

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(Near) Realtime Benefits

To use Silna’s realtime benefits checks, please reach out to your Silna contact to create a realtime template for you to use. They will then give you the name of the template. To get realtime benefits for a patient plan through the Silna API, you need to pass in the correct template_id to the Post Benefits Checks API. You can get the correct template_id by searching the Get Benefits Check Templates API with the template name provided by your Silna contact. Since template_ids can change, we recommend always using the Get Benefits Check Templates API to retrieve the latest template_id for the template name provided by your Silna contact. It usually takes a few seconds for a Silna realtime benefits checks to complete, but you should be prepared for it to take up to a minute in some cases.

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QA Testing

To test your benefits check integration without hitting real payors, see the QA Testing Guide. It covers how to use specially formatted member numbers to simulate different insurance types, requirement flags, and rejection scenarios in our QA environment.

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Blue Cross Blue Shield Benefit Checks

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Understanding Your Benefit Check: BCBS Plans & Prefixes

When you receive a completed Benefit Check from Silna for a Blue Cross Blue Shield (BCBS) client, you may occasionally see a “Home Plan” listed that is located in a different state than your facility. This is not an error—it is a specialized feature of Silna designed to ensure benefits are verified accurately.

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What is a “Home Plan”?

BCBS is a network of independent companies. A client might live in your state but have a policy issued by an employer in a different state.

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The Prefix

The first three letters/numbers of the Member ID (e.g., XOS, YLS, ZCD) is a prefix and acts as a “routing code” to identify which specific home plan a member belongs to. Silna’s technology reads this prefix to find the home plan to determine the client’s benefit details such as deductible, co-pay, and visit limits.

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Why does my Benefit Check show a different state plan?

If your facility is in Florida, for example, but the benefit check says BCBS of Illinois, it means the client’s policy is managed in Illinois.

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Why Silna lists the home plan instead of your local plan:

  • Verifying Benefits: The home plan decides the deductible, co-pay, and visit limits.
  • Valid Authorizations: To get a “Prior Auth,” we must contact the Home Plan to determine if they are required and how they are managed. If we requested an authorization from your local office instead of the Home Plan, that authorization would be invalid, and you would not get paid.

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How to Verify a Prefix

If you would like to double-check a client’s home plan yourself, you can use the official BCBS tool:
  • Identify the first 3 characters of the Member ID.
  • Visit the BCBS Member Services Tool.
  • Enter the prefix to see the specific plan name and contact details.