Technical Reference Guide

Our Ancillary Benefits Management Prior Authorization Support (PAS) Technical Reference Guide is a companion guide that supplements, but does not replace, the HL7 Da Vinci Prior Authorization Support (PAS) Implementation Guide. The HL7 Da Vinci PAS Implementation Guide remains the authoritative source for PAS implementation requirements and should be followed for all standard PAS fields, structures, and processing expectations.

Our companion guide is intended solely to identify Optum Ancillary Benefit Management (ABM) specific requirements, supported values, situational requirements, constraints, and processing rules that are necessary for submitting PAS transactions to Optum ABM. Only fields for which Optum ABM has additional requirements, restrictions, or implementation-specific guidance are included.
Fields not referenced in this companion guide should be implemented in accordance with the HL7 Da Vinci PAS Implementation Guide.

Intended Audience
This guide is designed for:

• Health plan interoperability teams
• Vendor implementation teams
• PAS integration developers
• Trading partners submitting PAS transactions to Optum ABM

Scope
This guide provides implementation guidance for:

• ABM-required data elements
• Supported values and field constraints
• Situational submission requirements
• ABM-specific validation and processing rules

This document focuses exclusively on requirements specific to Optum ABM and is not intended to document every field, element, or requirement defined by the HL7 Da Vinci PAS Implementation Guide.

Companion Guide Inclusion Criteria
A PAS element is included in this guide when one or more of the following conditions apply:

• Required by Optum ABM
• Required under specific business or processing scenarios
• Limited to supported values or code sets
• Impacts PAS validation, routing, or processing behavior
• Differs from standard Da Vinci PAS implementation expectations

API Data Dictionary

• Instructions – Read Me First tab explains how to use this companion guide and clarifies that it supplements, but does not replace, the HL7 Da Vinci PAS Implementation Guide. It outlines the scope of ABM-specific requirements and the conventions used throughout this document.

• Bundle, Claim, Patient, Coverage, Diagnosis, Requested Services, Provider Participation and Supporting Information tabs document only those PAS elements where Optum ABM imposes implementation-specific requirements, supported value constraints, processing rules, or submission expectations that differ from or further clarify standard HL7 FHIR and Da Vinci PAS guidance.

• PAS Inquiry should be used to retrieve the current status and details of a previously submitted prior authorization request, including authorization decisions, review activity, approved service periods, and servicing provider information.
The elements are documented on this tab because they drive authorization status interpretation, review workflow management, and authorization utilization within Optum ABM and are therefore subject to ABM-specific processing expectations.

• PAS Response will be received by the system that invoked the PAS Submit API.
The elements included on this tab are because Optum ABM applies specific processing rules that determine how submitters should interpret PAS submission outcomes, response status, and validation results. These fields provide the information necessary to confirm receipt, monitor processing progress, and identify transactions or data quality issues requiring remediation.

API Endpoints