HLS Payers Connections API
Overview
The HLS (Healthcare & Life Science) Payers Connections API allows displaying the health insurance details of its members. Through the Member 360 app, available on the Conversation App, agents can view the member’s information in various cards, such as:
- Member Details card.
- Plans card.
- Claims card.
- Prior Authorizations card.
Besides the Member 360 app, Talkdesk has APIs available to build virtual agent (VA) flows that allow customers to automate repetitive and easy-to-answer questions, so agents can focus on more complex and interactive requests.
Business Context
What Can Agents Achieve with the HLS Payers Connections API?
- Get detailed information about whom (member or provider) is calling.
- Check the health insurance claim’s status or prior authorization’s status with the respective ID.
Business Problems the HLS Payers Connections API Solves
- Knowing detailed information about who is calling will help the agent to support the person who calls in the most efficient way.
- The possibility of knowing the health insurance claim’s status or prior authorization status allows a contact center admin to build a VA to transfer simple calls that don’t need an agent.
What the HLS Payers Connections API doesn't Support
- To find out who is calling, it is necessary to know and have in the database some information like the contact’s phone number.
- To know the health insurance claim’s status or prior authorization’s status, it is necessary to know the respective claim ID.
Use CaseAs a real life example, consider the scenario where an agent receives a call for the HLS Connections API. It is useful for the agent to know some information about the member or the provider that is calling, so the agent is able to support the contact in the most efficient way.
For example, when a member calls, the agent needs to know who the member is (using member lookup) and when a provider is calling. The agent also needs to know who the provider is (using provider lookup) and if the provider is a contracted or a non contracted provider. This can be done by using a combination of the phone number that the contact uses to start the call with the date of birth or the member ID, for example.
A second feature of the HLS Payers Connections API is the ability to sync contacts. When a contact calls, the HLS Payers Connections API can update the contact's information saved inside Talkdesk.
Member lookup, Provider Lookup and Contact Sync are features used in a Studio flow that allow you to populate Member 360 to support the agent that received the call.
By using the HLS Payers Connections API, you can also retrieve the status of claims or prior authorizations based on the respective IDs. That way, a contact center admin can build a VA to transfer simple calls that don't need an agent: for example, a provider calling to know about a claim or prior-authorization status.
Usage
Member Lookup
Retrieve the best matching member searched by query parameters.
Contact Sync
Update contact by member ID and by phone number.
Claim Status by ID
Retrieves the status of a claim, given its ID.
Prior-authorization Status by ID
Retrieve the status of a prior authorization, given its ID.
Provider Lookup
Retrieve detailed information about a provider searched by query parameters.
Get Providers
Retrieve a list of the providers searched by query parameters.
Get Prior Authorizations
Retrieves an offset based list of prior authorizations.
API AvailabilityThe HLS Payers Connections API is only available for customers enrolled in Talkdesk's Early Access (EA) program. To enter the EA program, contact a Customer Success Manager.
The HLS Payers Connections API has been in EA since April 2023.
Troubleshooting
If you have questions or technical issues, please open a ticket using this form.