Insurance

The Insurance API enables coverage verification, eligibility checks, and claims submission for patients with health insurance coverage.

Endpoints

GET/api/v1/coverage/coverages/List patient coverages

GET/api/v1/coverage/coverages/{id}/Get coverage details

POST/api/v1/coverage/eligibility-requests/Check eligibility

GET/api/v1/coverage/eligibility-responses/Get eligibility responses

Check Coverage

Retrieve insurance coverage information for a patient.

GET/api/v1/coverage/coverages/

Query Parameters

patient_uhidstringrequired

Patient UHID

statusstringoptional

Filter by status (active, cancelled)

Request

bash

curl "https://api.mediloop.co/api/v1/coverage/coverages/?patient_uhid=UG123456789A&status=active" \
  -H "Authorization: Bearer sk_test_..."

RESPONSE200

{
  "count": 1,
  "results": [
    {
      "id": "cov-123-456",
      "patient_uhid": "UG123456789A",
      "status": "active",
      "payor_name": "Jubilee Insurance",
      "policy_number": "JUB-2024-12345",
      "plan_name": "Gold Health Plan",
      "coverage_type": "health",
      "period_start": "2024-01-01",
      "period_end": "2024-12-31",
      "copay_percentage": 20,
      "annual_limit": 50000000,
      "annual_used": 2500000
    }
  ]
}

Verify Eligibility

Check if a patient is eligible for coverage for a specific service.

POST/api/v1/coverage/eligibility-requests/

Request Body

patient_uhidstringrequired

Patient UHID

coverage_iduuidrequired

Coverage ID to check

service_codestringrequired

Service code to verify

service_datedateoptional

Date of service

Request

bash

curl -X POST https://api.mediloop.co/api/v1/coverage/eligibility-requests/ \
  -H "Authorization: Bearer sk_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "patient_uhid": "UG123456789A",
    "coverage_id": "cov-123-456",
    "service_code": "consultation",
    "service_date": "2024-01-20"
  }'

RESPONSE200

{
  "id": "elig-req-001",
  "status": "active",
  "eligible": true,
  "coverage_id": "cov-123-456",
  "service_code": "consultation",
  "copay_amount": 10000,
  "copay_currency": "UGX",
  "coverage_percentage": 80,
  "pre_auth_required": false,
  "message": "Patient is eligible for this service"
}

Coverage Status

Status	Description
`active`	Coverage is currently active
`cancelled`	Coverage has been cancelled
`draft`	Coverage is pending activation
`entered-in-error`	Coverage was entered in error