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Authentication

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

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Query Parameters

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tenant_id
integer
required
Your tenant ID.
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visit_number
string
required
The visit number to verify coverage for.

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Response

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visit_number
string
The visit number that was queried.
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status
string
Call status. One of completed, in_progress, or failed.
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patient_name
string
Patient name on the claim.
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payer_name
string
Name of the insurance payer.
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member_id
string
Patient’s member/subscriber ID.
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group_number
string
Insurance group number.
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plan_type
string
Type of insurance plan (e.g. PPO, HMO, EPO, POS).
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coverage_active
boolean
Whether the patient’s coverage is currently active.
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effective_date
string
Coverage effective date (YYYY-MM-DD).
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termination_date
string
Coverage termination date, if applicable (YYYY-MM-DD).
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copay
number
Copay amount for the service type.
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coinsurance_percent
number
Coinsurance percentage the patient is responsible for.
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deductible_remaining
number
Remaining deductible amount for the benefit period.
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out_of_pocket_remaining
number
Remaining out-of-pocket maximum for the benefit period.
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in_network
boolean
Whether the rendering provider is in-network for this plan.
curl -X GET "https://api.refactorbilling.com/verify-coverage?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "patient_name": "Jane Smith",
  "payer_name": "Blue Cross Blue Shield",
  "member_id": "BCB987654321",
  "group_number": "GRP-44210",
  "plan_type": "PPO",
  "coverage_active": true,
  "effective_date": "2025-01-01",
  "termination_date": null,
  "copay": 30.00,
  "coinsurance_percent": 20,
  "deductible_remaining": 450.00,
  "out_of_pocket_remaining": 3200.00,
  "in_network": true
}