HomeTechnologyInsurance Verification

Insurance Verification APIs

Real-time practitioner and facility verification for claims processing, provider directories, and fraud prevention.

Insurance companies, TPAs, and health plans can integrate One Health Global's verification APIs to validate healthcare provider credentials in real-time during claims processing, provider enrollment, and fraud detection workflows.

Claims Verification

Verify practitioner and facility credentials during claims adjudication

Provider Directory

Maintain accurate, up-to-date provider directories with verified credentials

Fraud Detection

Receive real-time alerts for suspicious activity and credential anomalies

Claims Verification API

Verify practitioner and facility credentials during claims processing to prevent fraud and ensure compliance.

Request
POST /api/v1/insurance/verify-claim
Content-Type: application/json
Authorization: Bearer YOUR_API_KEY

{
  "claimId": "CLM-2025-001234",
  "practitionerId": "GH-PHY-12847",
  "facilityId": "GH-FAC-456",
  "serviceDate": "2025-01-15",
  "serviceCode": "99213",
  "amount": 150.00
}
Response (200 OK)
{
  "status": "verified",
  "practitioner": {
    "id": "GH-PHY-12847",
    "name": "Dr. Kwame Mensah",
    "specialty": "Internal Medicine",
    "licenseStatus": "active",
    "licenseExpiry": "2026-12-31",
    "verifiedAt": "2025-01-20T10:30:00Z"
  },
  "facility": {
    "id": "GH-FAC-456",
    "name": "Korle Bu Teaching Hospital",
    "type": "Teaching Hospital",
    "accreditationStatus": "active",
    "verifiedAt": "2025-01-20T10:30:00Z"
  },
  "fraudScore": 0.02,
  "riskLevel": "low",
  "recommendations": [
    "Claim approved for processing",
    "No fraud indicators detected"
  ]
}

Provider Directory API

Search and retrieve verified healthcare providers by specialty, location, and other criteria.

Request
GET /api/v1/insurance/providers?specialty=cardiology&location=accra&radius=10km
Authorization: Bearer YOUR_API_KEY
Response (200 OK)
{
  "total": 24,
  "providers": [
    {
      "id": "GH-PHY-8901",
      "name": "Dr. Ama Osei",
      "specialty": "Cardiology",
      "facility": "Ridge Hospital",
      "location": {
        "city": "Accra",
        "coordinates": [5.6037, -0.1870]
      },
      "licenseStatus": "active",
      "acceptingPatients": true,
      "verifiedAt": "2025-01-20T08:15:00Z"
    }
  ]
}

Fraud Signals Webhooks

Receive real-time notifications when our AI fraud detection system identifies suspicious activity.

Webhook Payload
POST https://your-server.com/webhooks/fraud-alert
Content-Type: application/json
X-OneHealth-Signature: sha256=...

{
  "eventType": "fraud.detected",
  "severity": "high",
  "practitionerId": "NG-PHY-5432",
  "facilityId": "NG-FAC-789",
  "fraudIndicators": [
    "Duplicate claim submission",
    "Service code mismatch",
    "Unusual billing pattern"
  ],
  "detectedAt": "2025-01-20T14:22:00Z",
  "recommendedAction": "suspend_claims_pending_review"
}

Webhook Security

All webhook requests include an X-OneHealth-Signature header for verification. See our Fraud Intelligence documentation for signature validation examples.

Insurer Console

Access a web-based dashboard to manage API keys, view verification analytics, configure fraud alerts, and download reports.

API Key Management

Generate, rotate, and revoke API keys with granular permissions

Verification Analytics

Track verification volumes, response times, and fraud detection rates

Alert Configuration

Customize fraud alert thresholds and notification preferences

Compliance Reports

Download audit logs and compliance reports for regulatory requirements

Complete API Documentation

Explore our full API reference with interactive examples, authentication guides, and integration tutorials.

View Full API Documentation

Ready to Integrate?

Contact our enterprise team to get started with insurance verification APIs.

Contact Sales
Talk with Us