Eligibility & Pre-Auth API
Verify HMO insurance policies and corporate employee session allowances.
Eligibility & Pre-Authorization API
The Eligibility API enables HMOs, insurance administrators, and HR benefit managers to verify patient coverage in real time before scheduling physical therapy sessions.
Verify Policy / Member Coverage
POST /api/v1/partners/eligibility
Checks whether a patient's insurance policy or corporate benefit tier includes physiotherapy and returns the remaining approved session balance.
Request Body Parameters
| Parameter | Type | Required | Description |
|---|---|---|---|
policy_number | string | Yes | HMO Member ID or Corporate Staff ID |
member_phone | string | Yes | Member's verified phone number |
hmo_code | string | Yes | RELIANCE | AXA_MANSARD | HYGEIA | LEADWAY | BASTION |
procedure_code | string | No | Default: PHYSIO_STD_SESSION |
Example Request
Code
curl -X POST https://api.physioaroundme.com/api/v1/partners/eligibility \
-H "Authorization: Bearer sk_live_99281..." \
-H "Content-Type: application/json" \
-d '{
"policy_number": "REL-99218-B",
"member_phone": "+2348039988112",
"hmo_code": "RELIANCE",
"procedure_code": "PHYSIO_POST_SURGICAL"
}'Example Response (200 OK)
Code
{
"status": "eligible",
"member": {
"name": "Emeka Nnamdi",
"plan_tier": "Gold Comprehensive",
"policy_status": "active",
"expiry_date": "2027-01-31"
},
"coverage": {
"physiotherapy_covered": true,
"annual_session_limit": 12,
"sessions_remaining": 9,
"co_pay_amount_kobo": 0,
"pre_auth_required": false
},
"pre_auth_token": "auth_tok_881920aa1"
}Error Handling for Ineligible Members
If a member has exhausted their session allowance or their policy is inactive, Rehabify returns an ineligible status:
Code
{
"status": "ineligible",
"reason": "annual_limit_exceeded",
"message": "Member has utilized all 12 approved physiotherapy sessions for the current policy year.",
"fallback_option": {
"can_self_pay": true,
"negotiated_rate_kobo": 1200000
}
}