PAS $inquire FHIR API Specification

Service Overview

InterSystems PAS (Prior Authorization Support) FHIR APIs are designed in compliance with the CMS-0057-F regulationsOpens in a new tab.

Refer to the Getting Started section for information on connectivity, authentication and how to get help. To use the FHIR APIs, you will need to know the base URL of the FHIR server you will be connecting to. You can also retrieve the PAS capability statement for the service.

As part of the PAS APIs, a provider can use the $inquire APIOpens in a new tab to make an inquiry for a previously-submitted prior authorization request. This request is sent as a FHIR Bundle containing a PAS Claim Inquiry and other referenced resources.

Workflow

A typical workflow involving the submit operation might be:

The provider gathers necessary identifiers, for example patient ID and claim ID
The provider's system sends an $inquire request to the payer's PAS API endpoint
The payer's system processes the inquiry and retrieves the status of the prior authorization
The payer's system creates a FHIR Bundle with the current status and any relevant information
The payer's system sends the response Bundle back to the provider's system
The provider's system receives and displays the status information for review

Endpoint: $inquire

URL

The URL for this API is:

<BaseURL>/csp/healthshare/<namespace-identifier>/pas-v<IG version>/Claim/$inquire

where <BaseURL> and <namespace-identifier> have been provided to you by the payer organization you are connecting with, and <IG version> is the version number of the PAS Implementation Guide you are working with. In the current version of this API, the supported version is 2.0.1.

Optional Capabilities

None.

Endpoint Prerequisites

None.

Required Header Settings

Content-Type: application/json+fhir
Accept: application/json+fhir

Request Methods

POST <BaseURL>/csp/healthshare/<namespace-identifier>/pas-v<IG version>/Claim/$inquire

Invokes $inquire with a specified PAS Request Bundle. A FHIR PAS Request BundleOpens in a new tab can be passed in through the request body.

Note:

The request body must contain both Bundle.identifier.system and Bundle.identifier.value.

The implementation guideOpens in a new tab specifies that the entire process of submitting a prior authorization request and receiving a response should take no more than 15 seconds. This time frame includes the network transmission time for both the request and the response. Faster processing times are preferable to improve efficiency and user experience.

Query Parameters

None.

Request Body

The body of the request is the FHIR PAS Request BundleOpens in a new tab.

Success Response

Status code 200

The request succeeded. The body of the response is the FHIR PAS Response BundleOpens in a new tab.

Error Responses

Status code 400 Bad Request

The request is incomplete or badly structured. The response body contains a FHIR OperationOutcome resource with further details.

Status code 401 Unauthorized

The authenticated user does not have access to a resource needed to process the request.

If the identifier parameter stored in _criteria.extension[x].valueString does not match the provider_identifier property of the OAuth 2.0 token, the error text will state “Authorization failed: JWT token claim does not match the payload provider identifier”.

Status code 403 Forbidden

Possible causes include:

Invalid OAuth scopes.
Authenticated user is not authorized to use the requested resource.

Status code 404 Not Found

Possible causes include:

Failed authorization.

Status code 406 Not Acceptable

Possible causes include:

Accept header does not include application/fhir+json.

Status code 415 Unsupported Media Type

Possible causes include:

Content-Type header is not application/fhir+json.

Status code 500 Internal Server Error

A generic error message, returned when no more specific message is suitable.