API Reference
Complete reference for the Backwork REST API. All endpoints are prefixed with https://backworkhealth.com/api/v1.
The Backwork API is a REST API that returns JSON. All endpoints require an API key passed as a Bearer token.
Authorization: Bearer bwk_live_YOUR_API_KEYGet your key at backworkhealth.com/keys. See Authentication for key types and scopes.
Infrastructure
Health check
Verify the API is operational and check version.
List jurisdictions
List all MAC contractor jurisdictions covered.
Certified Releases
Policies
Search and list policies
Search Medicare LCDs, Articles, NCDs, and commercial payer policies with filters.
Get policy by ID
Fetch the full structured content of a single policy.
Get policy change feed
Paginated feed of policy updates since a given date.
Compare policies across jurisdictions
Side-by-side coverage comparison for a procedure across MAC jurisdictions.
Code Lookup
Look up a medical code
Get RVU, coverage, and policy data for a single CPT, HCPCS, or ICD-10 code.
Batch code lookup
Look up up to 50 codes in a single request.
Get spending by code
Medicaid spending data by procedure code.
Search coverage criteria
Full-text search across extracted coverage criteria text.
Search drug formulary evidence
Search pharmacy-benefit evidence across major PBMs.
Coverage & Prior Auth
Evaluate coverage criteria
Evaluate structured criteria against patient-level inputs.
Check prior authorization
Determine if a procedure requires prior auth and what documentation is needed.
Validate claim
Pre-submission denial risk check for a single claim.
Validate coverage and denial risk
Batch denial risk validation across multiple procedure codes.
Research prior authorization
Trigger an async deep-research run for complex PA requirements.
Get prior auth research status
Poll for results from a prior auth research run.
Agent Tools
List agent tools
Fetch the manifest of available tools for coverage intelligence agents.
Invoke agent tool
Execute a named agent tool with validated inputs.
Webhooks
List webhooks
List all configured webhook endpoints for your account.
Create webhook
Register a new endpoint for real-time policy change notifications.
Update webhook
Modify an existing webhook's URL, events, or status.
Delete webhook
Remove a webhook endpoint.
Send test webhook
Fire a test payload to verify your endpoint is reachable.
Policy Change Compliance
List unreviewed changes
Changes that have not yet been acknowledged by your team.
Acknowledge a policy change
Mark a single policy diff as reviewed.
Bulk acknowledge changes
Acknowledge multiple diffs in one request.
Get compliance statistics
Review rates and outstanding acknowledgment counts.
Last updated on