VerityVerity
Api

Validate claim coverage risk

Run a rule-level, non-PHI pre-submission validation for CPT/HCPCS procedure codes and optional ICD-10 diagnosis/context fields. Returns coverage status, prior-auth requirement, denial risk, and issues that should be resolved before authorization or claim submission.

POST
/claim-validation

Authorization

bearerAuth
AuthorizationBearer <token>

API keys are prefixed with vrt_live_ for production or vrt_test_ for testing. Example: vrt_live_abc123xyz

In: header

Header Parameters

X-Idempotency-Key?string

Unique request identifier for safe retries (recommended)

Request Body

application/json

payer?string

Optional payer or policy source label. Non-Medicare payer-specific logic may return explicit gaps.

Match^[A-Za-z0-9 &'().,/-]+$
Length1 <= length <= 100
plan_type?string
Value in"commercial" | "medicare_advantage" | "medicaid" | "traditional_medicare" | "exchange"
line_of_business?string

Optional rule-level line of business label

Match^[A-Za-z0-9 &'().,/-]+$
Length1 <= length <= 100
procedure_codes*array<>

CPT or HCPCS procedure codes

Items1 <= items <= 10
diagnosis_codes?array<>

Optional ICD-10-CM diagnosis codes

Itemsitems <= 20
modifiers?array<>

Optional two-character procedure modifiers

Itemsitems <= 5
state?string

Two-letter US state code for jurisdiction lookup

Match^[A-Z]{2}$
site_of_service?string
Value in"office" | "outpatient_hospital" | "asc" | "inpatient" | "home" | "telehealth"
provider_specialty?string

Optional rule-level provider specialty label

Match^[A-Za-z0-9 &'().,/-]+$
Length1 <= length <= 100
age_category?string
Value in"pediatric" | "adult" | "medicare_age"
sex_when_policy_relevant?string
Value in"female" | "male" | "other" | "unknown"

Response Body

application/json

application/json

application/json

application/json

application/json

application/json

curl -X POST "https://verity.backworkai.com/api/v1/claim-validation" \  -H "Content-Type: application/json" \  -d '{    "procedure_codes": [      "27447",      "E0601"    ]  }'
{
  "success": true,
  "data": {
    "payer": "string",
    "plan_type": "commercial",
    "line_of_business": "string",
    "state": "string",
    "site_of_service": "office",
    "provider_specialty": "string",
    "modifiers": [
      "string"
    ],
    "overall_risk": "low",
    "coverage_status": "covered",
    "prior_auth_required": true,
    "denial_risk": "low",
    "confidence": "high",
    "documentation_requirements": [
      "string"
    ],
    "policy_sources": [
      {
        "source_id": "string",
        "policy_id": "string",
        "title": "string",
        "policy_type": "string",
        "jurisdiction": "string",
        "source_url": "string",
        "effective_date": "string",
        "last_verified_at": "2019-08-24T14:15:22Z"
      }
    ],
    "effective_date": "string",
    "last_verified_at": "2019-08-24T14:15:22Z",
    "requires_manual_review": true,
    "known_gaps": [
      "string"
    ],
    "codes": [
      {
        "code": "string",
        "code_type": "string",
        "description": "string",
        "coverage_status": "covered",
        "prior_auth_required": true,
        "pa_required": true,
        "denial_risk": "low",
        "confidence": "high",
        "documentation_requirements": [
          "string"
        ],
        "policy_sources": [
          {
            "source_id": "string",
            "policy_id": "string",
            "title": "string",
            "policy_type": "string",
            "jurisdiction": "string",
            "source_url": "string",
            "effective_date": "string",
            "last_verified_at": "2019-08-24T14:15:22Z"
          }
        ],
        "effective_date": "string",
        "last_verified_at": "2019-08-24T14:15:22Z",
        "requires_manual_review": true,
        "known_gaps": [
          "string"
        ],
        "issues": [
          "string"
        ],
        "policy_count": 0
      }
    ],
    "mac": {
      "name": "string",
      "jurisdiction": "string"
    }
  },
  "meta": {
    "request_id": "string",
    "timestamp": "2019-08-24T14:15:22Z",
    "idempotency_key": "string",
    "cached": true
  }
}
{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}
{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}
{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}
{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}
{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}

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