Interoperability APIs built on FHIR Getting Started

Our interoperability APIs offer providers access to prior authorization requirements, documentation workflows, and patient clinical data across multiple payers in real time. Built on Fast Healthcare Interoperability Resources (FHIR®) and aligned with CMS-0057 (Advancing Interoperability and Improving Prior Authorization Processes) and applicable state regulations. These APIs reduce administrative burden, support continuity of care as members change plans, and improve coordination across the healthcare ecosystem.

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NOTE

Please note that our APIs are private and secure, and require unique credentials to generate a Bearer token and gain access to. Please see (generate a Bearer token based on your API environment) to obtain access to our APIs.

Workflow

• Documentation Templates and Rules (DTR) API → collects required information via forms and tells your system what form-related features (questions, flows, formats) are supported before you start using other FHIR APIs.
• Prior Authorization Support (PAS) API → submits request for decision and shows features supported before you start submitting requests.
• Clinical Data Exchange (CDex) → enables submission of supporting clinical and administrative documentation to an existing prior authorization request, and sends any additional documents if needed.
• Coverage Requirement Discovery (CRD) API→ checks if approval is needed.

For detailed information, please refer to FHIR Implementation Guide.