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Immutability

Patient Plans cannot be modified via API after creation, except for the source_id field. To update a plan, you must delete and recreate it using one of two approaches:

Strategy 1 - PUT Method

Use the PUT Patient Plan API with conflict_behavior=REPLACE. This approach allows clients to use our managed lifecycle rules but can inadvertently remove plans and will withdraw all in-progress benefits checks and prior authorizations.

Strategy 2 - GET/DELETE/POST Method

Retrieve existing plans, delete the target plan, then create a new one. This provides greater control.

Recommendation

The documentation advises consulting PUT API documentation carefully. For those preferring direct control, the POST, PATCH, DELETE, and GET APIs are recommended instead.

Tracking Latest Benefits and Eligibility

latest_benefits_check
object
Displays the most recent completed benefits check; remains null until the first check completes
latest_eligibility_check
object
Functions similarly—null initially, then shows the most current completed eligibility check
plan_eligibility_status
string
Determined through a combination of the latest_benefits_check and latest_eligibility_check, whichever one was most recent

FAQ

Q: Can I update member numbers after creation? A: The system does not support changing member numbers post-creation because existing checks and authorizations could become misaligned with plan status.