Insurance API Documentation

Base URL:https://api.docdroid.ai/api/v1/insurance

Authentication

All API requests must include a Bearer token in the Authorization header. API keys are provisioned through the insurance admin dashboard.

Authorization: Bearer your_api_key_here

Rate limit: 60 requests per minute per API key.

Member Access

GET/members

List all members who have granted consent to your insurance organization. Returns paginated results.

Parameters

pageintegerPage number (default: 1)

limitintegerResults per page (default: 20, max: 100)

searchstringSearch by member name or policy number

Response Example

{
  "data": [
    {
      "id": "mem_5a2c8f1d",
      "name": "Fatima Al-Hashemi",
      "policy_number": "INS-2026-00482",
      "date_of_birth": "1990-07-22",
      "consent_status": "active",
      "consent_granted_at": "2026-02-10T08:15:00Z",
      "last_report_date": "2026-03-25T11:30:00Z"
    },
    {
      "id": "mem_9d4e7b3a",
      "name": "Omar Khalid",
      "policy_number": "INS-2026-01205",
      "date_of_birth": "1978-11-03",
      "consent_status": "active",
      "consent_granted_at": "2026-03-01T14:00:00Z",
      "last_report_date": "2026-03-20T09:45:00Z"
    }
  ],
  "pagination": {
    "page": 1,
    "limit": 20,
    "total": 1284
  }
}

GET/members/:member_id/records

Retrieve health records for a consented member. Includes lab reports, extracted biomarkers, and AI interpretations.

Parameters

member_idstringThe unique member identifier

fromstringStart date filter (ISO 8601)

tostringEnd date filter (ISO 8601)

categorystringFilter by report category (e.g. blood, urine, imaging)

Response Example

{
  "data": [
    {
      "id": "rec_3f8a1c7e",
      "report_date": "2026-03-25T11:30:00Z",
      "category": "blood",
      "lab_name": "Mediclinic Lab",
      "biomarkers": [
        {
          "name": "Total Cholesterol",
          "value": 215,
          "unit": "mg/dL",
          "reference_range": "< 200",
          "status": "high"
        },
        {
          "name": "TSH",
          "value": 2.8,
          "unit": "mIU/L",
          "reference_range": "0.4-4.0",
          "status": "normal"
        }
      ],
      "ai_interpretation": "Total cholesterol is slightly elevated at 215 mg/dL. Thyroid function is within normal limits. Recommend lipid panel follow-up in 3 months."
    }
  ],
  "pagination": {
    "page": 1,
    "limit": 20,
    "total": 18
  }
}

Request Review

POST/members/:member_id/preauth

Submit a pre-authorization review request. DocDroid AI analyzes the member's health records to provide supporting evidence for the requested procedure or treatment.

Parameters

member_idstringThe unique member identifier

Request Body

{
  "procedure_code": "CPT-93306",
  "procedure_name": "Echocardiography, transthoracic",
  "diagnosis_codes": ["I10", "I25.10"],
  "referring_provider": "Dr. Sarah Ahmed",
  "clinical_notes": "Patient presents with persistent chest pain and elevated blood pressure readings over 3 months.",
  "urgency": "routine"
}

Response Example

{
  "id": "preauth_4b2e8c1f",
  "status": "completed",
  "created_at": "2026-03-29T11:00:00Z",
  "member_id": "mem_5a2c8f1d",
  "recommendation": "approve",
  "confidence": 0.92,
  "supporting_evidence": [
    "Blood pressure readings trending upward over 3 months (135/88 -> 148/95 mmHg)",
    "Total cholesterol elevated at 215 mg/dL with LDL at 142 mg/dL",
    "Family history of cardiovascular disease noted in records"
  ],
  "risk_factors": ["hypertension", "hyperlipidemia", "family_history_cvd"]
}

GET/members/:member_id/preauth/:preauth_id

Retrieve the results of a previously submitted pre-authorization review.

Parameters

member_idstringThe unique member identifier

preauth_idstringThe pre-authorization request identifier

Response Example

{
  "id": "preauth_4b2e8c1f",
  "status": "completed",
  "created_at": "2026-03-29T11:00:00Z",
  "member_id": "mem_5a2c8f1d",
  "procedure_code": "CPT-93306",
  "recommendation": "approve",
  "confidence": 0.92,
  "supporting_evidence": [...],
  "risk_factors": [...]
}

POST/members/:member_id/claims/analyze

Submit a claim for AI-powered analysis. Returns a health summary, relevant records, and a coverage recommendation.

Parameters

member_idstringThe unique member identifier

Request Body

{
  "claim_id": "CLM-2026-08741",
  "claim_type": "medical",
  "procedure_codes": ["CPT-99213", "CPT-80053"],
  "diagnosis_codes": ["E11.9"],
  "provider": "Dubai Health Clinic",
  "service_date": "2026-03-25",
  "billed_amount": 850.00
}

Response Example

{
  "id": "claim_analysis_6d3a9f2b",
  "status": "completed",
  "claim_id": "CLM-2026-08741",
  "member_id": "mem_5a2c8f1d",
  "health_summary": "Member has documented Type 2 diabetes (diagnosed 2024). Regular monitoring with quarterly comprehensive metabolic panels. Current HbA1c is 7.2%, showing slight improvement from 7.8% six months prior.",
  "relevant_records": [
    {
      "record_id": "rec_3f8a1c7e",
      "date": "2026-03-25",
      "relevance": "Direct match - metabolic panel from service date"
    }
  ],
  "recommendation": "approve",
  "confidence": 0.97,
  "notes": "Claim is consistent with documented ongoing diabetes management. Procedure codes match expected monitoring protocol."
}

GET/requests

List all pre-authorization and claim analysis requests made by your organization.

Parameters

typestringFilter by type: preauth, claim_analysis

statusstringFilter by status: processing, completed, failed

pageintegerPage number (default: 1)

limitintegerResults per page (default: 20)

Response Example

{
  "data": [
    {
      "id": "preauth_4b2e8c1f",
      "type": "preauth",
      "member_id": "mem_5a2c8f1d",
      "status": "completed",
      "recommendation": "approve",
      "created_at": "2026-03-29T11:00:00Z"
    },
    {
      "id": "claim_analysis_6d3a9f2b",
      "type": "claim_analysis",
      "member_id": "mem_5a2c8f1d",
      "status": "completed",
      "recommendation": "approve",
      "created_at": "2026-03-29T11:30:00Z"
    }
  ],
  "pagination": {
    "page": 1,
    "limit": 20,
    "total": 456
  }
}