AI Phone Call API

Overview

The AI Phone Call API allows you to trigger automated phone calls for various healthcare administrative tasks including verification of benefits (VOB), claim status inquiries, prior authorizations, denials, and appeals. The system will automatically call the specified phone number and handle the conversation using AI.

Authentication

You must include the following headers in your request:

Authorization: Bearer token (obtained from the Token endpoint using your clientId and clientSecret from developer settings)

The organization ID is automatically determined from your authentication token, so you don’t need to include it in the request body.

Request Body

The request body varies based on the type of call you want to make. The callType field must be one of the following:

vob - Verification of Benefits
custom_vob_aba - Custom VOB for ABA (Applied Behavior Analysis)
podiatry_vob - Podiatry-specific Verification of Benefits
denial - Denied Claim Follow-up
claim_status_inquiry - General Claim Status Inquiry
claim_status_wc - Workers’ Compensation Claim Status
claim_status_auto_pip - Auto/PIP Claim Status
custom_claim_status - Custom Claim Status (used by iMagnum orgs)
prior_auth - Prior Authorization (Drug-based)
prior_auth_cpt - Prior Authorization (CPT-based)
prior_auth_status_nds - Prior Authorization Status Check (NDS)
prior_auth_status_cpt - Prior Authorization Status Check (CPT)
appeal - Appeal Call
credentialing_im - Credentialing - IM (Credentialing Inquiry for iMagnum)

Each call type requires different parameters in the callParameters object. Examples for common call types are provided below.

VOB Call Parameters

{
  "callType": "vob",
  "callParameters": {
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "isPrimaryPolicy": "yes",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "patientRelationshipToMember": "self",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderName": "Dr. Jane Smith",
    "cptCode1": "99213",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Denial Call Parameters

{
  "callType": "denial",
  "callParameters": {
    "beginningDateOfService": "2024-03-01",
    "billingProviderAddress": "123 Medical Center Dr, Suite 100",
    "billingProviderName": "Medical Group Inc",
    "billingProviderTaxId": "12-3456789",
    "claimChargeAmount": "250.00",
    "claimSubmittedDate": "2024-03-15",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "priorAuthorizationNumber": "AUTH123456",
    "renderingProviderAddress": "789 Provider St",
    "renderingProviderName": "Dr. Jane Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Claim Status Inquiry Call Parameters

{
  "callType": "claim_status_inquiry",
  "callParameters": {
    "beginningDateOfService": "2024-03-01",
    "billingProviderAddress": "123 Medical Center Dr, Suite 100",
    "billingProviderName": "Medical Group Inc",
    "billingProviderTaxId": "12-3456789",
    "claimChargeAmount": "250.00",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderName": "Dr. Jane Smith",
    "renderingProviderNpi": "9876543210",
    "serviceState": "CA",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Note: claim_status_wc and claim_status_auto_pip use the same parameters as claim_status_inquiry.

Custom Claim Status Call Parameters

This call type is used by iMagnum orgs and has different required fields than regular claim_status_inquiry. It includes additional required fields (billingProviderNpi, facilityAddress, patientAddress, renderingProviderAddress) and does NOT require serviceState.

{
  "callType": "custom_claim_status",
  "callParameters": {
    "beginningDateOfService": "2024-03-01",
    "billingProviderAddress": "123 Medical Center Dr, Suite 100",
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "claimChargeAmount": "250.00",
    "facilityAddress": "456 Facility Blvd",
    "memberId": "M123456789",
    "patientAddress": "789 Patient St, Apt 101",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderAddress": "321 Provider Ave",
    "renderingProviderName": "Dr. Jane Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Prior Authorization Call Parameters (Drug-based)

{
  "callType": "prior_auth",
  "callParameters": {
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "drugName": "Medication Name",
    "drugQuantity": "30",
    "memberDateOfBirth": "1985-05-15",
    "memberFirstName": "Jane",
    "memberId": "M123456789",
    "memberLastName": "Doe",
    "patientDateOfBirth": "1990-01-01",
    "patientPhoneNumber": "+1234567890",
    "patientZipCode": "90210",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderFirstName": "Jane",
    "renderingProviderLastName": "Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Prior Authorization Call Parameters (CPT-based)

{
  "callType": "prior_auth_cpt",
  "callParameters": {
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "cptCode1": "99213",
    "memberDateOfBirth": "1985-05-15",
    "memberFirstName": "Jane",
    "memberId": "M123456789",
    "memberLastName": "Doe",
    "patientDateOfBirth": "1990-01-01",
    "patientPhoneNumber": "+1234567890",
    "patientZipCode": "90210",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderFirstName": "Jane",
    "renderingProviderLastName": "Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Appeal Call Parameters

{
  "callType": "appeal",
  "callParameters": {
    "beginningDateOfService": "2024-03-01",
    "billingProviderName": "Medical Group Inc",
    "billingProviderTaxId": "12-3456789",
    "claimChargeAmount": "250.00",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderName": "Dr. Jane Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Custom VOB - ABA Call Parameters

{
  "callType": "custom_vob_aba",
  "callParameters": {
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "patientRelationshipToMember": "self",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderName": "Dr. Jane Smith",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Podiatry VOB Call Parameters

{
  "callType": "podiatry_vob",
  "callParameters": {
    "billingProviderAddress": "123 Medical Center Dr, Suite 100",
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "facilityAddress": "456 Clinic Way, Suite 200",
    "memberId": "M123456789",
    "patientDateOfBirth": "1990-01-01",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "patientRelationshipToMember": "self",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderAddress": "789 Provider St",
    "renderingProviderName": "Dr. Jane Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Prior Authorization Status Check (NDS) Call Parameters

{
  "callType": "prior_auth_status_nds",
  "callParameters": {
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "dxCodes": "E11.9, M79.3",
    "memberDateOfBirth": "1985-05-15",
    "memberFirstName": "Jane",
    "memberId": "M123456789",
    "memberLastName": "Doe",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderAddress": "789 Provider St",
    "renderingProviderFirstName": "Jane",
    "renderingProviderLastName": "Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Prior Authorization Status Check (CPT) Call Parameters

{
  "callType": "prior_auth_status_cpt",
  "callParameters": {
    "billingProviderName": "Medical Group Inc",
    "billingProviderNpi": "1234567890",
    "billingProviderTaxId": "12-3456789",
    "cptCode1": "99213",
    "memberDateOfBirth": "1985-05-15",
    "memberFirstName": "Jane",
    "memberId": "M123456789",
    "memberLastName": "Doe",
    "patientFirstName": "John",
    "patientLastName": "Doe",
    "payerName": "Blue Cross",
    "phoneNumber": "+1234567890",
    "renderingProviderAddress": "789 Provider St",
    "renderingProviderFirstName": "Jane",
    "renderingProviderLastName": "Smith",
    "renderingProviderNpi": "9876543210",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Credentialing - IM Call Parameters

Required: facilityAddress, groupName, groupTaxId, payerName, phoneNumber, providerName, providerNpi. Optional: applicationSubmittedDate (Application submitted date, YYYY-MM-DD), applicationId (Application ID#), ticketType (Application mode), facilityname (Service location).

{
  "callType": "credentialing_im",
  "callParameters": {
    "facilityAddress": "456 Clinic Way, Suite 200",
    "groupName": "ABC Medical Group",
    "groupTaxId": "123456789",
    "payerName": "Blue Cross Blue Shield",
    "phoneNumber": "+1234567890",
    "providerName": "Dr. Jane Smith",
    "providerNpi": "1234567890",
    "applicationSubmittedDate": "2024-01-15",
    "applicationId": "APP-001",
    "ticketType": "New",
    "facilityname": "Main Clinic",
    "webhookUrl": "https://your-server.com/webhook-endpoint"
  }
}

Required vs Optional Fields

All fields shown in the examples above are required unless explicitly marked as optional. The only optional field across all call types is webhookUrl. For credentialing_im, the optional fields are applicationSubmittedDate, applicationId, ticketType, and facilityname. All other fields must be provided for the API call to succeed. Date Format: All date fields must be in YYYY-MM-DD format (e.g., "1990-01-01"). NPI Format: All NPI fields must be exactly 10 digits (e.g., "1234567890"). All call types support an optional webhookUrl parameter in callParameters for receiving call status updates.

Response

Success Response

{
  "success": true,
  "callId": "call_123456"
}

Error Response

{
  "error": "Error message describing what went wrong"
}

For information about receiving call status updates, see the Webhook Delivery documentation.

Authorizations

Authorization

string

header

required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Headers

x-organization-id

string

required

Organization ID for authentication

Body

application/json

Call parameters for VOB or denial calls

callType

enum<string>

required

Type of call to make

Available options:

vob,

denial

orgId

string

required

Organization ID

callParameters

object

required

Option 1
Option 2

Show child attributes

Response

Call triggered successfully

success

boolean

callId

string

Unique identifier for the call

Overview

API Authentication

Eligibility

Enrollments/Providers

Claims

Claim AI Actions

Patient Chart Analysis

Webhooks

AI Phone Calls

Overview

Authentication

Request Body

VOB Call Parameters

Denial Call Parameters

Claim Status Inquiry Call Parameters

Custom Claim Status Call Parameters

Prior Authorization Call Parameters (Drug-based)

Prior Authorization Call Parameters (CPT-based)

Appeal Call Parameters

Custom VOB - ABA Call Parameters

Podiatry VOB Call Parameters

Prior Authorization Status Check (NDS) Call Parameters

Prior Authorization Status Check (CPT) Call Parameters

Credentialing - IM Call Parameters

Required vs Optional Fields

Response

Success Response

Error Response

Authorizations

Headers

Body

Response

Overview

API Authentication

Eligibility

Enrollments/Providers

Claims

Claim AI Actions

Patient Chart Analysis

Webhooks

AI Phone Calls

​Overview

​Authentication

​Request Body

​VOB Call Parameters

​Denial Call Parameters

​Claim Status Inquiry Call Parameters

​Custom Claim Status Call Parameters

​Prior Authorization Call Parameters (Drug-based)

​Prior Authorization Call Parameters (CPT-based)

​Appeal Call Parameters

​Custom VOB - ABA Call Parameters

​Podiatry VOB Call Parameters

​Prior Authorization Status Check (NDS) Call Parameters

​Prior Authorization Status Check (CPT) Call Parameters

​Credentialing - IM Call Parameters

​Required vs Optional Fields

​Response

​Success Response

​Error Response

Authorizations

Headers

Body

Response

Overview

Authentication

Request Body

VOB Call Parameters

Denial Call Parameters

Claim Status Inquiry Call Parameters

Custom Claim Status Call Parameters

Prior Authorization Call Parameters (Drug-based)

Prior Authorization Call Parameters (CPT-based)

Appeal Call Parameters

Custom VOB - ABA Call Parameters

Podiatry VOB Call Parameters

Prior Authorization Status Check (NDS) Call Parameters

Prior Authorization Status Check (CPT) Call Parameters

Credentialing - IM Call Parameters

Required vs Optional Fields

Response

Success Response

Error Response