{"openapi":"3.1.0","info":{"description":"Receives prior authorization request data, including claim, coverage, provider, and other medical details, and forward the request to the downstream service ccx. The endpoint acts as a passthrough service, returning the CCX response, status, and any associated messages directly to the requesting application.","title":"Prior Authorization Support","version":"1.0.0"},"servers":[{"url":"https://sandbox-apigw.optum.com/abm","description":"Base URL"}],"components":{"securitySchemes":{"bearerAuth":{"type":"http","scheme":"bearer","bearerFormat":"JWT","description":"Bearer token issued by the auth token endpoint. Sent as `Authorization: Bearer `. Note: per the OpenAPI spec, the Authorization header is documented via a security scheme rather than as a plain header parameter."}}},"paths":{"/pas/v1":{"post":{"summary":"PAS API Endpoint","description":"Accepts a PAS FHIR request and returns PAS response","tags":["PAS API"],"security":[{"bearerAuth":[]}],"requestBody":{"required":true,"content":{"application/fhir+json":{"schema":{"type":"string","description":"FHIR R4 PAS Bundle, sent as raw JSON text. Server-side, this is received and passed through as a raw JSON string without deserialization into a typed object."},"examples":{"PAS Request Example":{"summary":"PAS Prior Authorization Request","value":"{\n \"resourceType\": \"Bundle\",\n \"identifier\": {\n \"system\": \"urn:pa-bundle-id\",\n \"value\": \"PA-2027-0001-BUNDLE\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2027-01-15T14:30:00Z\",\n \"entry\": [\n {\n \"fullUrl\": \"urn:claim\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"extension\": [\n {\n \"url\": \"urn:claim-referral-method\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"urn:referral-method\",\n \"code\": \"Interop\",\n \"display\": \"Interop\"\n }\n ]\n }\n },\n {\n \"url\": \"urn:claim-referral-source\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"urn:referral-source\",\n \"code\": \"4\",\n \"display\": \"Health Plan\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"urn:pa-request-id\",\n \"value\": \"PA-2027-0001\"\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"urn:claim-type\",\n \"code\": \"professional\",\n \"display\": \"Professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"urn:patient\"\n },\n \"created\": \"2027-01-15T14:30:00Z\",\n \"insurer\": {\n \"reference\": \"urn:payer-org\"\n },\n \"provider\": {\n \"reference\": \"urn:practitioner-role\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"urn:claim-process-priority\",\n \"code\": \"normal\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"urn:rendering-org\"\n }\n }\n ],\n \"diagnosis\": [\n {\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"urn:diagnosis-1\",\n \"code\": \"E11.9\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"urn:ex-diagnosistype\",\n \"code\": \"principal\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"urn:coverage\"\n }\n }\n ],\n \"item\": [\n {\n \"sequence\": 1,\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"urn:hcpcs\",\n \"code\": \"E0601\",\n \"display\": \"Continuous airway pressure (CPAP) device\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"urn:modifier-1\",\n \"code\": \"RR\",\n \"display\": \"Rental\"\n }\n ]\n }\n ],\n \"quantity\": {\n \"value\": 1\n },\n \"unitPrice\": {\n \"value\": 125,\n \"currency\": \"USD\"\n },\n \"servicedPeriod\": {\n \"start\": \"2027-02-01\",\n \"end\": \"2027-07-31\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:patient\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"name\": [\n {\n \"family\": \"Miller\",\n \"given\": [\n \"Robert\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1970-05-21\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4015550142\",\n \"use\": \"home\",\n \"rank\": 1\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"1 Main Street\"\n ],\n \"city\": \"Providence\",\n \"state\": \"RI\",\n \"postalCode\": \"02906\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:coverage\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"status\": \"active\",\n \"subscriberId\": \"M123456789\",\n \"beneficiary\": {\n \"reference\": \"urn:patient\"\n },\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"urn:subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n },\n \"period\": {\n \"start\": \"2027-01-01\",\n \"end\": \"2027-12-31\"\n },\n \"payor\": [\n {\n \"reference\": \"urn:payer-org\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:payer-org\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"identifier\": [\n {\n \"system\": \"urn:health-plan-id\",\n \"value\": \"TN12345\"\n }\n ],\n \"name\": \"BCBSABC\"\n }\n },\n {\n \"fullUrl\": \"urn:practitioner\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"identifier\": [\n {\n \"system\": \"urn:us-npi\",\n \"value\": \"1234567890\"\n }\n ],\n \"name\": [\n {\n \"family\": \"Smith\",\n \"given\": [\n \"John\"\n ],\n \"text\": \"John Smith MD\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4010000000\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"1 Main street\"\n ],\n \"city\": \"Providence\",\n \"state\": \"RI\",\n \"postalCode\": \"02906\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:practitioner-role\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"practitioner\": {\n \"reference\": \"urn:practitioner\"\n },\n \"specialty\": [\n {\n \"coding\": [\n {\n \"system\": \"urn:provider-taxonomy\",\n \"code\": \"207RP1001X\",\n \"display\": \"Pulmonary Disease\"\n }\n ]\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:rendering-org\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"identifier\": [\n {\n \"system\": \"urn:us-npi\",\n \"value\": \"1999999999\"\n }\n ],\n \"name\": \"ABC Medical Supply\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"401-555-0100\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"123 Supply Rd\"\n ],\n \"city\": \"Providence\",\n \"state\": \"RI\",\n \"postalCode\": \"02906\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:subscriber\",\n \"resource\": {\n \"resourceType\": \"RelatedPerson\",\n \"patient\": {\n \"reference\": \"urn:patient\"\n },\n \"name\": [\n {\n \"family\": \"Miller\",\n \"given\": [\n \"Susan\"\n ]\n }\n ],\n \"gender\": \"female\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4015550199\",\n \"use\": \"home\",\n \"rank\": 1\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"1 Main Street\"\n ],\n \"city\": \"Providence\",\n \"state\": \"RI\",\n \"postalCode\": \"02906\"\n }\n ]\n }\n }\n ]\n}"}}}}},"responses":{"200":{"content":{"application/fhir+json":{"examples":{"PAS Response Example":{"value":{"resourceType":"Claim","id":"claim-001","status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]},"use":"preauthorization","patient":{"reference":"Patient/patient-001"},"created":"2026-08-12T10:15:00-05:00","provider":{"reference":"Organization/org-001"},"priority":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/processpriority","code":"normal"}]},"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/coverage-001"}}],"item":[{"sequence":1,"productOrService":{"coding":[{"system":"https://bluebutton.cms.gov/resources/codesystem/hcpcs","code":"E0470"}]}}]}}}}},"description":"PAS response returned successfully"}}}}},"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}