Skip to main content
POST
Get Provider Guidance

Authorizations

x-api-key
string
header
required

Body

application/json
note
string
required

Clinical encounter note

Maximum string length: 100000
Example:

"Patient presents with bilateral upper eyelid ptosis causing visual field obstruction..."

payer_id
string
required

Unique Stedi payer ID (see https://www.stedi.com/healthcare/network)

Examples:

"KMQTZ"

"HPQRS"

lob
enum<string>
required

Line-of-business category

Available options:
commercial,
medicare_part_a,
medicare_part_b,
medicare_advantage,
medicare_part_d,
medicaid,
individual_aca
Example:

"commercial"

state
enum<string>
required

Member state or jurisdiction code

Available options:
AL,
AK,
AZ,
AR,
CA,
CO,
CT,
DE,
FL,
GA,
HI,
ID,
IL,
IN,
IA,
KS,
KY,
LA,
ME,
MD,
MA,
MI,
MN,
MS,
MO,
MT,
NE,
NV,
NH,
NJ,
NM,
NY,
NC,
ND,
OH,
OK,
OR,
PA,
RI,
SC,
SD,
TN,
TX,
UT,
VT,
VA,
WA,
WV,
WI,
WY,
DC,
AS,
GU,
PR,
VI,
CNMI,
NF,
SF,
DN,
QN,
UN,
EM,
WM
Example:

"TX"

Response

Successful Response

status
enum<string>
required

Outcome of the analysis.

With a non-empty output:

  • medical_necessity_not_met — contradictions only
  • documentation_gaps — questions only
  • medical_necessity_not_met_and_documentation_gaps — both

With an empty output (disambiguated):

  • no_documentation_gaps — a relevant policy was found and every applicable criterion is already satisfied
  • no_applicable_policy — a procedure is planned but no policy directly authorizes it
  • no_procedure_planned — nothing is affirmatively planned in this encounter
Available options:
medical_necessity_not_met,
documentation_gaps,
medical_necessity_not_met_and_documentation_gaps,
no_documentation_gaps,
no_applicable_policy,
no_procedure_planned
Example:

"medical_necessity_not_met_and_documentation_gaps"

output
(ClinicalQuestionPublic · object | ClinicalContradictionPublic · object)[]
required

Contradiction findings (documented values that fail a criterion) followed by outstanding clinical questions (missing documentation), based on policy criteria. Contradictions always come first.

Example: