A common use-case for Opkit is contacting patients’ insurance companies to verify their coverage and benefits. In this use-case, the user provides context about the patient, subscriber, and provider and instructs Opkit to contact the relevant insurance company and collect the following pieces of information:

  • Plan status
  • Provider network status
  • Coverage start and end dates
  • Overall deductible
  • Overall out-of-pocket maximum
  • Copayment for CPT code 99202 (in cents)
  • Coinsurance for CPT code 99202
  • Prior authorization requirement for CPT code 99202

Example values for task components are included below.

Target:

United Healthcare (+18009999)

Context:

[
  {
    "name": "Patient details",
    "items": [
      {
        "name": "Name",
        "value": "John Smith"
      },
      {
        "name": "Date of birth",
        "value": "1990-01-01"
      },
      {
        "name": "Relationship to subscriber",
        "value": "self"
      }
    ]
  },
  {
    "name": "Subscriber details",
    "items": [
      {
        "name": "Name",
        "value": "John Smith"
      },
      {
        "name": "Date of birth",
        "value": "1990-01-01"
      },
      {
        "name": "Member ID",
        "value": "123456"
      }
    ]
  },
  {
    "name": "Provider details",
    "items": [
      {
        "name": "Name",
        "value": "Jane Doe"
      },
      {
        "name": "NPI number",
        "value": "123456"
      },
      {
        "name": "Tax ID",
        "value": "123456"
      }
    ]
  }
]

Objectives:

[
  {
    "name": "Plan status",
    "type": "enum",
    "enum": ["active", "inactive"]
  },
  {
    "name": "Provider network status",
    "type": "enum",
    "enum": ["in_network", "out_of_network"]
  },
  {
    "name": "Coverage start date",
    "type": "date"
  },
  {
    "name": "Coverage end date",
    "type": "date"
  },
  {
    "name": "Overall deductible cents",
    "type": "number"
  },
  {
    "name": "Overall deductible spent cents",
    "type": "number"
  },
  {
    "name": "Overall deductible remaining cents",
    "type": "number"
  },
  {
    "name": "Overall out-of-pocket maximum cents",
    "type": "number"
  },
  {
    "name": "Overall out-of-pocket maximum spent cents",
    "type": "number"
  },
  {
    "name": "Overall out-of-pocket maximum remaining cents",
    "type": "number"
  },
  {
    "name": "Copayment for CPT code 99202 cents",
    "type": "number"
  },
  {
    "name": "Coinsurance for CPT code 99202 percent",
    "type": "number"
  },
  {
    "name": "Prior authorization requirement for CPT code 99202",
    "type": "boolean"
  }
]

Results:

Results are only available on completed tasks.

[
  {
    "name": "Plan status",
    "value": "active"
  },
  {
    "name": "Provider network status",
    "value": "in_network"
  },
  {
    "name": "Coverage start date",
    "value": "2021-01-01"
  },
  {
    "name": "Coverage end date",
    "value": "2022-01-01"
  },
  {
    "name": "Overall deductible cents",
    "value": 70000
  },
  {
    "name": "Overall deductible spent cents",
    "value": 25000
  },
  {
    "name": "Overall deductible remaining cents",
    "value": 45000
  },
  {
    "name": "Overall out-of-pocket maximum cents",
    "value": 500000
  },
  {
    "name": "Overall out-of-pocket maximum spent cents",
    "value": 25000
  },
  {
    "name": "Overall out-of-pocket maximum remaining cents",
    "value": 475000
  },
  {
    "name": "Copayment for CPT code 99202 cents",
    "value": 2500
  },
  {
    "name": "Coinsurance for CPT code 99202 percent",
    "value": 15
  },
  {
    "name": "Prior authorization requirement for CPT code 99202",
    "value": false
  }
]
Appointment RemindersPrior Authorization