Verify Auth Requirements

curl -X GET "https://api.refactorbilling.com/verify-auth-requirements?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "patient_name": "John Doe",
  "payer_name": "UnitedHealthcare",
  "procedure_code": "27447",
  "procedure_description": "Total knee replacement",
  "auth_required": true,
  "auth_submission_method": "portal",
  "auth_turnaround_days": 5,
  "required_documentation": [
    "Operative report",
    "Clinical notes demonstrating conservative treatment failure",
    "Imaging results (X-ray or MRI)"
  ],
  "notes": "Authorization valid for 60 days from approval date. Must be submitted at least 10 business days before scheduled procedure."
}

curl -X GET "https://api.refactorbilling.com/verify-auth-requirements?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "patient_name": "John Doe",
  "payer_name": "UnitedHealthcare",
  "procedure_code": "27447",
  "procedure_description": "Total knee replacement",
  "auth_required": true,
  "auth_submission_method": "portal",
  "auth_turnaround_days": 5,
  "required_documentation": [
    "Operative report",
    "Clinical notes demonstrating conservative treatment failure",
    "Imaging results (X-ray or MRI)"
  ],
  "notes": "Authorization valid for 60 days from approval date. Must be submitted at least 10 business days before scheduled procedure."
}

Authentication

All requests require an API key passed via the x-api-key header, along with a tenant_id query parameter.

string

required

Your tenant API key.

Query Parameters

integer

required

Your tenant ID.

string

required

The visit number to check authorization requirements for.

Response

string

The visit number that was queried.

string

Call status. One of completed, in_progress, or failed.

string

Patient name on the claim.

string

Name of the insurance payer.

string

CPT/HCPCS procedure code being checked.

string

Human-readable description of the procedure.

boolean

Whether prior authorization is required for this procedure.

string

How to submit the authorization request (e.g. portal, phone, fax).

integer

Expected turnaround time for authorization decision in business days.

string[]

List of documents required for the authorization request.

string

Additional notes or instructions from the payer representative.

curl -X GET "https://api.refactorbilling.com/verify-auth-requirements?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "patient_name": "John Doe",
  "payer_name": "UnitedHealthcare",
  "procedure_code": "27447",
  "procedure_description": "Total knee replacement",
  "auth_required": true,
  "auth_submission_method": "portal",
  "auth_turnaround_days": 5,
  "required_documentation": [
    "Operative report",
    "Clinical notes demonstrating conservative treatment failure",
    "Imaging results (X-ray or MRI)"
  ],
  "notes": "Authorization valid for 60 days from approval date. Must be submitted at least 10 business days before scheduled procedure."
}

Getting Started

Data Import

Pre-Service

Claim Follow-Up

Denial Management

Verify Auth Requirements

Authentication

Query Parameters

Response

​Authentication

​Query Parameters

​Response

Authentication

Query Parameters

Response