For delegated entities in MA, MMC, QHP, and CHIP programs.
FHIR-native Prior Auth Channel for Your Payers.
Aidbox adds a FHIR-native PA channel to your utilization management platform in as little as 3–6 months. Your rules engine stays. Your workflows stay. Your payers get the APIs they now require.
Prior Auth Is Operationally Complex.
Adding a FHIR Channel Shouldn't Make It Worse.
Delegated entities run high-volume, multi-payer prior authorization operations under strict SLAs. Now they're also being asked to expose standardized FHIR APIs and report PA data in real-time — without rebuilding the platforms their clinical teams depend on.
Operational reality today
- Thousands of PA requests processed daily across multiple payers and channels
- Phone, fax, portal, and X12 all in use simultaneously
- Different payer contracts mean different rules and requirements
- Clinical teams focused on decisions, not infrastructure
What's being asked of you now
- Add FHIR PA intake (CRD, DTR, PAS) alongside existing channels
- Surface PA outcomes in real time with structured reasons
- Support audit-ready metrics and reporting per decision
- Do all of this without disrupting existing rules and workflows
A Prior Auth FHIR Interface for Your UM Platform
Aidbox runs in your environment, acting as an embedded FHIR layer between providers and your utilization management platform.
Requests route to your coverage rules engine, questionnaire repository, and utilization management system — without changing clinical rules or disrupting your teams' current workflows.
Aidbox adds a FHIR-native intake channel to your platform. Your rules engine, questionnaire repository, case management system, and authorization logic remain exactly as-is.
Phone, portal, X12, and FHIR all route through the same decision logic. Consistent PA outcomes regardless of how a request arrives.
Native multi-tenancy means isolated workspaces, separate audit logs, and per-tenant access control — one deployment serving all your payers cleanly.
Aidbox handles the FHIR interface — You handle the decisions.
Aidbox is UM-vendor agnostic — it connects to existing utilization management platforms via X12, HL7v2, REST, and custom adapters — and deploys in your own cloud environment (AWS, GCP, or Azure) or on-premises. You control the infrastructure. No SaaS-only constraint, no data leaving your perimeter.
Everything You Need
to Run Prior Authorization
Production-grade FHIR server with all required data standards and API endpoints. The infrastructure layer that makes FHIR-based PA possible without building it from scratch.
Complete support for all three Da Vinci Prior Authorization Implementation Guides — the technical standard for electronic PA that payers and EHRs are aligning to.
Authorization status and decision updates pushed to providers the moment a decision is made. No polling, no manual follow-up, no delays in transparency.
Bidirectional conversion between your existing X12 transactions and FHIR. Hybrid X12 and FHIR workflows coexist cleanly — no forced migration.
Every authorization transaction logged, timestamped, and reportable. Built-in metrics dashboards and access controls for operational oversight and regulatory reporting.
Serve multiple payers from a single deployment with complete data isolation and per-tenant security. The operational model delegated entities actually run on.
Infrastructure You Own — Not a Network You Rent
The vendor landscape for PA modernization clusters into two patterns: network-dependent managed services that tie your data exchange to a proprietary toll road, and enterprise platforms built for large payers and health plans with 18-month implementation timelines. Neither was designed for how delegated entities actually operate.
From Pilot to Production in 3–6 Months
A phased approach that validates the integration against your real workflows before full rollout — reducing risk and avoiding surprises at go-live.
• Map existing UM intake channels, rules engine, and questionnaire inventory
• Confirm integration architecture, data model, and X12/FHIR conversion scope
• Output: approved technical design and pilot plan
• Configure CRD, DTR, and PAS flows end-to-end against a single patient condition
• Integrate rules engine decisions into FHIR responses and set up real-time subscriptions
• Expand to additional conditions and workflows based on pilot learnings
• Run end-to-end and load testing
• Refine metrics extraction with payer reporting requirements
• Complete compliance validation and production deployment
• Team training and ongoing support by Health Samurai
• Map existing UM intake channels, rules engine, and questionnaire inventory
• Confirm integration architecture, data model, and X12/FHIR conversion scope
• Output: approved technical design and pilot plan
• Configure CRD, DTR, and PAS flows end-to-end against a single patient condition
• Integrate rules engine decisions into FHIR responses and set up real-time subscriptions
• Expand to additional conditions and workflows based on pilot learnings
• Run end-to-end and load testing
• Refine metrics extraction with payer reporting requirements
• Complete compliance validation and production deployment
• Team training and ongoing support by Health Samurai
Beyond the Platform — Services That Close the Gaps
Additional Services
CRD and DTR require CDS Hooks support on the EHR side — a common implementation blocker. We scope and support the provider-side integration, including deployment of our white-label DTR SMART App, which enables documentation collection directly inside the provider's EHR workflow without additional development from your team.
Your existing prior authorization questionnaires — whether in PDF, Word, or Excel — converted to FHIR Questionnaire format, ready for DTR workflows. No internal FHIR expertise required. We handle the conversion, validation, and ongoing updates as your questionnaire library evolves.
Production PA systems need more than documentation. Every deployment includes a defined uptime SLA, incident response commitments, and a named support contact for critical system issues. We handle platform updates, Da Vinci IG version upgrades, and CMS compliance maintenance — so your team stays focused on utilization management, not infrastructure.
Built for CMS-0057-F — Because Your Payers Require It
CMS-0057-F makes the FHIR-based PA channel mandatory for Medicare Advantage, Medicaid managed care, and CHIP payers — and the compliance obligation flows through to delegated entities that execute PA on their behalf. Aidbox implements the FHIR APIs and workflows required by CMS-0057-F.
FHIR PA APIs (CRD, DTR, and PAS) must be live and operational. Aidbox implements all three Da Vinci IGs, satisfying the technical mandate without a custom build.
Aidbox ensures your platform continuously collects the structured PA metrics payers are now required to report publicly.
Denial logic must be captured and transmitted in FHIR-structured format. Aidbox logs every decision received from the UM platform — and its reason — in a structured FHIR format.
Payers bear regulatory responsibility, but delegated UM entities execute. Aidbox gives you the audit trail, access controls, and metrics to demonstrate compliance independently.
Predictable Infrastructure Pricing. No Transaction Fees.
A fixed platform license regardless of PA volume, member count, or number of payer contracts. As your prior authorization program grows, your infrastructure costs don't.
Free for prototyping, testing and development.
Prior Auth CMS-0057 Compliant Solution.
Multi-tenancy Support.