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Verification Status States

Benefit verifications progress through five distinct status states during their lifecycle:
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REQUESTED
status
Initial state when verification is first created
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AWAITING_SPIKE_CARE
status
Verification is being processed by Spike Care systems
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AWAITING_PROVIDER
status
An escalation has been created requiring provider action via the web portal
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COMPLETE
status
Processing finished successfully; verification details available via API (terminal state)
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WITHDRAWN
status
Verification has been cancelled and will not be processed further (terminal state)

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Standard Verification Workflow

Newly created benefit verifications automatically transition from REQUESTED to AWAITING_SPIKE_CARE status as processing begins. Upon successful completion, the status advances to COMPLETE, making the verification results accessible via API. If the verification process encounters issues requiring provider input—such as missing documentation or clarification needs—an escalation is generated and the status changes to AWAITING_PROVIDER. Once the escalation is resolved through the Spike Care web portal, the verification returns to AWAITING_SPIKE_CARE status to continue processing. Providers can manually transition verifications to WITHDRAWN status at any point if the verification is no longer needed. Both COMPLETE and WITHDRAWN are terminal states that indicate no further processing will occur.

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Creating Verifications for New Patients

To initiate a benefit verification for a patient not yet in the system, follow this workflow:
  1. Create Patient Record: Use the Create Patient API to establish the patient in the system
  2. Create Patient Plan: Use the patient ID from step 1 to create a patient plan via the Create Patient Plan API
  3. Create Benefit Verification: Use the patient plan ID from step 2 to initiate the verification via the Create Benefit Verification API
  4. Monitor Status: Poll the Get Benefit Verification API to track status changes
Processing time varies based on insurance provider requirements and can range from minutes to several days. Once the verification reaches COMPLETE status, generate and download the detailed benefit report using the Generate Benefit Verification Report API followed by the Get File API.

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Creating Verifications for Existing Patients

For patients already established in Spike Care, you have two approaches depending on whether you need to update patient information: Option 1: Update Patient Information If patient demographics or plan details have changed, use the Update Patient and Update Patient Plan APIs before creating the new verification request. Option 2: Verification Only If no patient or plan updates are needed, proceed directly to creating the benefit verification using the existing patient plan ID. When working with existing records, use the appropriate Get APIs if you need to retrieve the current patient or plan ID before proceeding.

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Real-Time Benefit Verifications

For supported insurance providers, Spike Care offers real-time benefit verification through pre-configured templates. Real-time verifications typically complete within seconds to one minute, significantly faster than standard processing. To enable real-time verification:
  1. Contact your Spike Care representative to establish a real-time template for your organization
  2. Retrieve your template ID using the Get Benefit Verification Templates API
  3. Include the template_id parameter when calling the Create Benefit Verification API
Note that real-time verification availability depends on insurance provider support and may not be available for all insurance plans.