Prior Authorization Support (PAS) API
Overview
The Aidbox Prior Authorization Support (PAS) API enables direct submission of prior authorization requests from EHR systems using FHIR. Built on the HL7 Da Vinci Prior Authorization Support Implementation Guide , it streamlines the authorization workflow between healthcare providers and payers.
When combined with Coverage Requirements Discovery (CRD) and Documentation Templates and Rules (DTR), PAS ensures authorizations are submitted when necessary with all required information for initial decision-making.
Supported Operations
All following PAS operations are NOT publicly accessible. If you want to access them from third party application read Application/Client Management — configure Client resources for programmatic API access with OAuth 2.0 flows or Basic Auth.
Claim/$submit
Submits a prior authorization request for adjudication.
Endpoint: POST [base]/fhir/Claim/$submit
Request: A FHIR Bundle containing a PAS Claim Request and all referenced resources.
Response: A FHIR Bundle containing the PAS Claim Response and referenced resources, or an OperationOutcome on error.
| Direction | Parameter | Type | Cardinality | Description |
|---|---|---|---|---|
| IN | resource | Bundle | 1..1 | PAS Request Bundle containing a single Claim and all referenced resources |
| OUT | return | Bundle | OperationOutcome | 1..1 | PAS Response Bundle with ClaimResponse, or OperationOutcome on error |
Example:
POST /fhir/Claim/$submit
Content-Type: application/json
Accept: application/json
{
"resourceType": "Bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
]
},
"type": "collection",
"identifier": {
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "test-bundle-3"
},
"timestamp": "2025-12-08T16:48:02.531010Z",
"entry": [
{
"fullUrl": "urn:uuid:claim-1765213116210",
"resource": {
"resourceType": "Claim",
"id": "claim-1765213116210",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
]
},
"identifier": [
{
"system": "http://example.org/claim-id",
"value": "claim-1765213116210"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/patient-1"
},
"created": "2025-12-08T16:58:36.210Z",
"insurer": {
"reference": "Organization/payer-org-1"
},
"provider": {
"reference": "Organization/requesting-org-1",
"display": "Acme Care Clinic"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/coverage-1"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "42",
"display": "Home Health Care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99213",
"display": "Established patient office visit"
}
]
},
"detail": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "E0250",
"display": "Hospital bed, fixed height, with mattress"
}
]
}
}
]
}
]
}
},
{
"fullUrl": "urn:uuid:patient-patient-1",
"resource": {
"resourceType": "Patient",
"id": "patient-1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary",
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
]
},
"identifier": [
{
"system": "http://hospital.example.org/patients",
"value": "MRN123456"
}
],
"active": true,
"name": [
{
"use": "official",
"family": "Smith",
"given": ["John", "Robert"]
}
],
"telecom": [
{
"system": "phone",
"value": "555-123-4567",
"use": "home"
}
],
"gender": "male",
"birthDate": "1970-05-15",
"address": [
{
"use": "home",
"line": ["123 Main Street"],
"city": "Springfield",
"state": "IL",
"postalCode": "62701",
"country": "USA"
}
]
}
},
{
"fullUrl": "urn:uuid:coverage-coverage-1",
"resource": {
"resourceType": "Coverage",
"id": "coverage-1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"
]
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "HIP",
"display": "health insurance plan policy"
}
]
},
"subscriber": {
"reference": "Patient/patient-1"
},
"beneficiary": {
"reference": "Patient/patient-1"
},
"payor": [
{
"reference": "Organization/payer-org-1"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan",
"display": "Plan"
}
]
},
"value": "GOLD-PLAN-001",
"name": "Gold Plus Plan"
}
]
}
},
{
"fullUrl": "urn:uuid:org-requesting-org-1",
"resource": {
"resourceType": "Organization",
"id": "requesting-org-1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "8189991234"
}
],
"active": true,
"name": "Acme Care Clinic",
"telecom": [
{
"system": "phone",
"value": "1-800-555-1234"
}
],
"address": [
{
"line": ["100 Market Street"],
"city": "Springfield",
"state": "IL",
"postalCode": "62701",
"country": "US"
}
]
}
},
{
"fullUrl": "urn:uuid:org-payer-org-1",
"resource": {
"resourceType": "Organization",
"id": "payer-org-1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1234567893"
}
],
"active": true,
"name": "Acme Health Insurance",
"telecom": [
{
"system": "phone",
"value": "1-800-555-ACME"
}
]
}
}
]
}
Claim/$inquire
Checks the status of a previously submitted prior authorization request.
Endpoint: POST [base]/fhir/Claim/$inquire
Request: A FHIR Bundle containing a PAS Claim Inquiry Request.
Response: A FHIR Bundle containing the PAS Claim Inquiry Response, or an OperationOutcome on error.
| Direction | Parameter | Type | Cardinality | Description |
|---|---|---|---|---|
| IN | resource | Bundle | 1..1 | PAS Inquiry Request Bundle containing inquiry criteria |
| OUT | return | Bundle | OperationOutcome | 1..1 | PAS Inquiry Response Bundle with status information |
Example:
POST /fhir/Claim/$inquire
Content-Type: application/json
Accept: application/json
{
"resourceType": "Bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle"
]
},
"type": "collection",
"identifier": {
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "test-bundle-3"
},
"timestamp": "2025-12-08T16:48:02.531010Z",
"entry": [
{
"fullUrl": "urn:uuid:claim-5d4963ef-8cd8-4fa7-b002-a5c67fa2f1da",
"resource": {
"resourceType": "Claim",
"id": "claim-1765213116210",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
]
},
"identifier": [
{
"system": "http://example.org/claim-id",
"value": "claim-1765213116210"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/patient-1"
},
"created": "2025-12-08T16:58:36.210Z",
"insurer": {
"reference": "Organization/payer-org-1"
},
"provider": {
"reference": "Organization/requesting-org-1",
"display": "Acme Care Clinic"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/coverage-1"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "42",
"display": "Home Health Care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99213",
"display": "Established patient office visit"
}
]
},
"detail": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "E0250",
"display": "Hospital bed, fixed height, with mattress"
}
]
}
}
]
}
]
}
}
]
}
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