Prior Authorization Support (PAS)

Direct electronic submission and status tracking of prior authorization requests from EHR systems to payers using FHIR® format.

Implementation GuideDa Vinci PAS

VersionV 2.2.0-ballot (STU 2.2 Ballot)open_in_new

SecuritySMART on FHIR

Base Path/priorauth/api/v1

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Overview

The Prior Authorization Support (PAS) API is a FHIR®-based interoperability API that enables the direct electronic submission and management of prior authorization requests, including status checks, from EHR systems to payers.

It allows EHR systems to submit requests using FHIR® standards and receive payer responses in FHIR® format. Combined with Da Vinci CRD and DTR, PAS ensures requests are submitted only when necessary and include complete, relevant information on the first submission.

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Capability Statement

Developers can access the Acentra Health FHIR server capabilities for the PAS API using the CapabilityStatement endpoint:

METAhttps://sb.fhir.mhbapp.com/priorauth/api/v1/metadata

View JSON

The CapabilityStatement describes the supported profiles, interactions, and authorization and token endpoints.

API Access Setup

settings_suggestFHIR SMART Configuration

Clients can retrieve SMART configuration details by invoking the SMART configuration endpoint at /.well-known/smart-configuration, appended to the FHIR Base URL.

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The FHIR Base URL is provided upon successful App Registration approval.

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Operations

The PAS API supports the following operations.

POST$submithttps://sb.fhir.mhbapp.com/priorauth/api/v1/Claim/$submit

POST$inquirehttps://sb.fhir.mhbapp.com/priorauth/api/v1/Claim/$inquire

attachment

For attachment submissions, the PAS API uses the PAS DocumentReference Profile, which requires document content to be provided as Base64-encoded data. Due to limitations imposed by the Acentra Health API Gateway, attachment payloads exceeding 10 MB are not supported through the PAS API. Documents or attachments larger than 10 MB must be submitted using the CDex API.

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Profiles

The PAS API supports the following profiles.

datasetPAS Beneficiary PatientdatasetPAS ClaimdatasetPAS Claim ResponsedatasetPAS Communication RequestdatasetPAS CoveragedatasetPAS Device RequestdatasetPAS Document ReferencedatasetPAS Insurer OrganizationdatasetPAS Medication RequestdatasetPAS Nutrition OrderdatasetPAS PractitionerdatasetPAS PractitionerRoledatasetPAS Request BundledatasetPAS Response BundledatasetPAS Service RequestdatasetPAS Requestor Organization

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Request Headers

All requests for PAS API profiles require the following headers:

Header	Value
content-type	application/json
accept	application/json
authorization	Bearer {access_token}

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Sample Responses & Data

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Important Information for EHR Systems

Topic	Reference
Privacy, Security and HIPAA	https://www.healthit.gov/topic/privacy-security-and-hipaa
ONC Model Privacy Notice	https://www.healthit.gov/topic/privacy-security-and-hipaa/model-privacy-notice-mpn