Prior Authorization Support (PAS) API
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 prior authorization requests using FHIR® standards and receive payer responses in FHIR® format. When used in combination with Da Vinci CRD and DTR, the PAS API ensures that prior authorization requests are submitted only when necessary and include complete and relevant information on the first submission.
Capability Statement
Developers can access the Acentra Health FHIR server capabilities for Prior Authorization Support (PAS) API using the CapabilityStatement endpoint:
The capability statement describes the set of capabilities (behaviors) implemented by the FHIR Server to enable the Prior Authorization Support (PAS) API. For example, it describes the enabled profiles, interactions, and provides information about the authorization and token endpoints.
API Access Setup
FHIR 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.
The FHIR Base URL will be provided upon successful App Registration approval.
Getting Access Token
| Section | Key | Value |
|---|---|---|
| HTTP Method | POST | https://sb.fhir.mhbapp.com/sof/oauth2/token |
| HTTP Headers | content-type | application/json |
| accept | application/json | |
| authorization | Basic base 64({client_id}:{client_secret}) | |
| HTTP Body | code | {oauth code} |
| grant_type | authorization_code | |
| redirect_uri | {your_redirect_uri} |
Operations
Acentra Health Interoperability Solution’s Prior Authorization Support (PAS) API supports the following operations
| Operation | Endpoint |
|---|---|
| $submit | https://sb.fhir.mhbapp.com/priorauth/Claim/$submit |
| $inquire | https://sb.fhir.mhbapp.com/priorauth/Claim/$inquire |
Profiles
Acentra Health Interoperability Solution’s Prior Authorization Support (PAS) API supports the following profiles
| Profile |
|---|
| PAS Beneficiary Patient |
| PAS Claim |
| PAS Claim Response |
| PAS Communication Request |
| PAS Coverage |
| PAS Device Request |
| PAS Document Reference |
| PAS Insurer Organization |
| PAS Medication Request |
| PAS Nutrition Order |
| PAS Practitioner |
| PAS PractitionerRole |
| PAS Request Bundle |
| PAS Response Bundle |
| PAS Service Request |
| PAS Requestor Organization |
| PAS Encounter |
| PAS Subscriber Patient |
| PAS Inquiry Request Bundle |
| PAS Inquiry Response Bundle |
| PAS Subscription |
| PAS Claim Inquiry |
| PAS Claim Inquiry Response |
Request Headers
All requests for Prior Authorization Support (PAS) API profiles require the following headers
| Header | Value |
|---|---|
| content-type | application/json |
| accept | application/json |
| authorization | Bearer |
Sandbox Test Data Catalog
Acentra Health Interoperability Solution’s Sandbox environment provides synthetic yet reliable test data to facilitate testing Prior Authorization Support (PAS) API. The dataset is representative of real-world scenarios and ensures consistency across related resources. The identifiers provided can be used to construct API requests for testing different workflow interactions.
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 |