The Prior Authorization FHIR 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.

Get available CDS Services

Retrieves the list of available Clinical Decision Support (CDS) services from the discovery endpoint following the CDS Hooks specification.

Coverage Requirement Discovery

The Coverage Requirement Discovery (CRD) API advises if prior authorization is needed for a treatment to be covered by insurance.

Determines whether prior authorization is required and retrieves coverage details for a requested service using FHIR-based CDS Hooks. The API evaluates member, provider, diagnosis, and service information to return real-time guidance, including prior authorization requirements, coverage insights, and links to initiate documentation workflows through DTR.

Documentation Templates and Rules

This Documentation Templates and Rules (DTR) API gives the EHR the exact forms/questions they need to fill for approval (based on the treatment and patient details).
In simple words, it’s like a guided form that asks the right questions step‑by‑step so all required info is collected correctly.

Get Document Reference

Retrieves metadata and access details for clinical and administrative documents associated with a prior authorization workflow. The API returns DocumentReference resources that describe available documentation (such as clinical notes, questionnaires, or supporting files), enabling systems to locate, reference, and use the appropriate information required for authorization, claims processing, or audit purposes.

Prior Authorization Support

Prior Authorization Support (PAS) is a healthcare authorization solution that streamlines the submission, review, tracking, and management of prior authorization requests between healthcare providers and payers. It helps ensure that requested treatments, medications, procedures, or services meet clinical and coverage requirements before approval is granted. Shows how you can use PAS APIs and what features are supported before you start submitting requests.

Clinical Data Exchange Submit

The Clinical Data Exchange (CDEx) Attachment Submission API enables submission of supporting clinical and administrative documentation to an existing prior authorization request using the FHIR submit-attachment operation. The API accepts structured attachment data (e.g., PDF, image, or document) and associates it to the correct authorization case, validating required identifiers and linkage details. A response is returned confirming successful processing and association, along with tracking metadata and any informational or error messages.

This API enables the operation to submit solicited and unsolicited attachments or additional clinical/administrative information to a prior authorization request. The submit-attachment operation accepts clinical and administrative attachments along with the information required to associate them with the correct prior authorization and returns an appropriate HTTP response.

For detailed information, please refer to FHIR Implementation Guide.