Prior Authorization Support API Getting Started V1

The Prior Authorization Support (PAS) API is a standards-based interoperability solution that enables healthcare providers, payers, Electronic Health Record (EHR) systems, and pharmacy applications to electronically submit, track, and manage prior authorization requests using the HL7® Fast Healthcare Interoperability Resources (FHIR®) framework.
The API streamlines the prior authorization process by providing real-time exchange of clinical, administrative, and coverage information, reducing manual workflows, minimizing delays, and improving transparency across the authorization lifecycle. It supports the electronic submission of authorization requests, retrieval of authorization status, exchange of supporting clinical documentation, and communication of approval, denial, or pending decisions.

The API includes the following real-time operations:

• Prior Authorization CDS services Determination/Discovery to publish CDS services
• Prior Authorization Claim Inquiry
• Prior Authorization Claim Submission
• Prior Authorization Claim Clinical/Administration Attachment Submission
  • Solicited (when responding to a Payer request for attachments or additional information
  • Unsolicited (invokes this operation before, concurrently, or after the claim or pre-authorization transaction))
• Prior Authorization Notice of Admission (NoA)

Endpoints

• /pas/inquire — a 275 request will be submitted to the payer or clearinghouse for a 278 response with a single X12 property that has a 215 EDI string.
• /pas/submit — formats the content in the JSON for a submission request. Accepts JSON with a single string X12 property that has a 278 EDI string and produces a JSON response with a single X12 property that has a 217 EDI string.