API Documentation
Providers
Patients
Benefit Check
Eligibility Check
Prior Authorizations
curl --request GET \
--url https://api.silnahealth.com/public/v2/benefits-checks/{benefits_check_id} \
--header 'Authorization: Bearer <token>'{
"id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"status": "REQUESTED",
"patient_plan_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"patient_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"provider_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"created_at": "2023-11-07T05:31:56Z",
"specialty_fields": [
{
"specialty": "PHYSICAL_THERAPY",
"copay_fields": [
{
"value": 123,
"modifier": null
}
],
"coinsurance_fields": [
{
"value": 123,
"modifier": null
}
],
"deductible": null,
"out_of_pocket": null,
"visit_limits": [
{
"value": 123,
"modifier": null
}
],
"dollar_limits": [
{
"value": 123,
"modifier": null
}
],
"authorization_requirements": [
{
"value": false,
"modifier": null
}
],
"referral_requirements": [
{
"value": false,
"modifier": null
}
],
"exclusions": [
{
"value": false,
"modifier": null
}
],
"reimbursement_rate": null,
"medicare_dollars_used": null,
"exclusions_and_limitations": null,
"patient_cost_estimates": [
{
"cost_estimate_name": "<string>",
"cost_of_service": "<string>"
}
]
}
],
"eligibility_status": null,
"ineligibility_reason": null,
"reference": null,
"insurance_type": null,
"date_verified": null,
"network_status": null,
"plan_type": null,
"plan_start_date": null,
"plan_end_date": null,
"group_number": null,
"patient_information": null,
"other_payor_information": null,
"silna_url": null
}Get Benefits Check V2
curl --request GET \
--url https://api.silnahealth.com/public/v2/benefits-checks/{benefits_check_id} \
--header 'Authorization: Bearer <token>'{
"id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"status": "REQUESTED",
"patient_plan_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"patient_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"provider_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
"created_at": "2023-11-07T05:31:56Z",
"specialty_fields": [
{
"specialty": "PHYSICAL_THERAPY",
"copay_fields": [
{
"value": 123,
"modifier": null
}
],
"coinsurance_fields": [
{
"value": 123,
"modifier": null
}
],
"deductible": null,
"out_of_pocket": null,
"visit_limits": [
{
"value": 123,
"modifier": null
}
],
"dollar_limits": [
{
"value": 123,
"modifier": null
}
],
"authorization_requirements": [
{
"value": false,
"modifier": null
}
],
"referral_requirements": [
{
"value": false,
"modifier": null
}
],
"exclusions": [
{
"value": false,
"modifier": null
}
],
"reimbursement_rate": null,
"medicare_dollars_used": null,
"exclusions_and_limitations": null,
"patient_cost_estimates": [
{
"cost_estimate_name": "<string>",
"cost_of_service": "<string>"
}
]
}
],
"eligibility_status": null,
"ineligibility_reason": null,
"reference": null,
"insurance_type": null,
"date_verified": null,
"network_status": null,
"plan_type": null,
"plan_start_date": null,
"plan_end_date": null,
"group_number": null,
"patient_information": null,
"other_payor_information": null,
"silna_url": null
}Authorizations
Bearer authentication header of the form Bearer <token>, where <token> is your auth token.
Path Parameters
Response
Benefits Check ID
Benefits Check Status
REQUESTED, AWAITING_SILNA, AWAITING_PROVIDER, COMPLETE, WITHDRAWN Patient Plan ID
Patient ID
Provider ID
Created at timestamp
Specialty specific benefits data
Show child attributes
Show child attributes
Specialty
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 List of copay fields
Show child attributes
Show child attributes
Copay Amount
Copay modifier information
Show child attributes
Show child attributes
Timing information for when the copay is applicable
Show child attributes
Show child attributes
Specifies whether the modifier applies before or after a specific timeframe or accumulation
BEFORE, AFTER Numeric quantity associated with the timing
Unit of measurement for the quantity
VISITS, CPT_UNITS, DOLLARS, HOURS, DAYS, WEEKS, MONTHS, YEARS "MONTHS"
List of treatment codes for which the treatment code applies
Whether the copay applies to the deductible
Whether the copay applies before or after the deductible
The unit for which the copay applies. For example, the patient's copay is $25 per day
VISIT, DAY, YEAR, CPT_UNIT, EPISODE List of coinsurance fields
Show child attributes
Show child attributes
Coinsurance Percentage
Coinsurance modifier information
Show child attributes
Show child attributes
Timing information for when the coinsurance is applicable
Show child attributes
Show child attributes
Specifies whether the modifier applies before or after a specific timeframe or accumulation
BEFORE, AFTER Numeric quantity associated with the timing
Unit of measurement for the quantity
VISITS, CPT_UNITS, DOLLARS, HOURS, DAYS, WEEKS, MONTHS, YEARS "MONTHS"
List of treatment codes for which the co-insurance applies.
Whether the coinsurance applies to the deductible
Whether the coinsurance applies before the deductible
Deductible accumulation details
Show child attributes
Show child attributes
Individual accumulation field
Show child attributes
Show child attributes
Family accumulation field
Show child attributes
Show child attributes
Out of pocket accumulation details
Show child attributes
Show child attributes
Individual accumulation field
Show child attributes
Show child attributes
Family accumulation field
Show child attributes
Show child attributes
List of visit limit fields
Show child attributes
Show child attributes
Visit Limit
Visit limit modifier information
Show child attributes
Show child attributes
List of treatment codes for which the treatment codes applie
List of specialties for which the visit limit applies
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 Timing information for when the visit limit applies
Show child attributes
Show child attributes
Specifies whether the modifier applies before or after a specific timeframe or accumulation
BEFORE, AFTER Numeric quantity associated with the timing
Unit of measurement for the quantity
VISITS, CPT_UNITS, DOLLARS, HOURS, DAYS, WEEKS, MONTHS, YEARS "MONTHS"
List of dollar limit fields
Show child attributes
Show child attributes
Dollar Limit
Dollar limit modifier information
Show child attributes
Show child attributes
List of treatment codes for which the dollar limit applies.
List of specialties for which the dollar limit applies.
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 Timing information for when the dollar limit applies
Show child attributes
Show child attributes
Specifies whether the modifier applies before or after a specific timeframe or accumulation
BEFORE, AFTER Numeric quantity associated with the timing
Unit of measurement for the quantity
VISITS, CPT_UNITS, DOLLARS, HOURS, DAYS, WEEKS, MONTHS, YEARS "MONTHS"
List of authorization requirement fields
Show child attributes
Show child attributes
Whether an authorization is required.
Authorization modifier information
Show child attributes
Show child attributes
Name of the payor
Timing information for when the authorization is required
Show child attributes
Show child attributes
Specifies whether the modifier applies before or after a specific timeframe or accumulation
BEFORE, AFTER Numeric quantity associated with the timing
Unit of measurement for the quantity
VISITS, CPT_UNITS, DOLLARS, HOURS, DAYS, WEEKS, MONTHS, YEARS "MONTHS"
List of treatment codes for which the authorization requirement applies.
List of place of service codes for which the authorization requirement applies.
List of diagnosis codes for which the authorization requirement applies.
List of referral requirement fields
Show child attributes
Show child attributes
Whether a referral is required.
Referral modifier information
Show child attributes
Show child attributes
List of treatment codes for which the referral requirement applies.
List of place of services for which the referral requirement applies.
List of exclusion fields
Show child attributes
Show child attributes
Exclusion value
Exclusion modifier information
Show child attributes
Show child attributes
List of treatment codes for which the exclusion applies.
List of diagnosis codes for which the exclusion applies.
Reimbursement rate field
Show child attributes
Show child attributes
Reimbursement Rate
Reimbursement rate modifier information
Show child attributes
Show child attributes
Type of reimbursement rate
USUAL_CUSTOMARY_AND_REASONABLE, REASONABLE_AND_CUSTOMARY, FAIR_HEALTH_RATE, MEDICARE_COMPARABLE_RATE, RELATIVE_CUSTOMARY_RATE, REFERENCE_BASED_PRICING, ALLOWED_AMOUNT, MEDICALLY_NECESSARY_REASONABLE_AND_PROPER, NOT_SPECIFIED Exclusions and limitations text
Eligibility Status
ELIGIBLE, INELIGIBLE Reason for ineligibility
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 Reference number
Insurance type
COMMERCIAL, MEDICARE, MEDICAID, REGIONAL_CENTER, WORKERS_COMPENSATION, AUTO_INSURANCE Date verified
Network status
IN_NETWORK, OUT_OF_NETWORK Plan type
Plan start date
Plan end date
Plan group ID
Patient information
Show child attributes
Show child attributes
Subscriber first name
Subscriber last name
Subscriber date of birth
Subscriber address
Subscriber state
Subscriber city
Subscriber zip code
Subscriber Patient relationship
Silna benefits check URL