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 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:
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The provider gathers necessary identifiers, for example patient ID and claim ID
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The provider's system sends an $inquire request to the payer's PAS API endpoint
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The payer's system processes the inquiry and retrieves the status of the prior authorization
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The payer's system creates a FHIR Bundle with the current status and any relevant information
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The payer's system sends the response Bundle back to the provider's system
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The provider's system receives and displays the status information for review
Endpoint: $inquire
URL
The URL for this API is:
<BaseURL>/Claim/$inquire
Optional Capabilities
None.
Endpoint Prerequisites
None.
Required Header Settings
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Content-Type: application/json+fhir
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Accept: application/json+fhir
Request Methods
Invokes $inquire with a specified PAS Inquiry Request Bundle. A FHIR PAS Inquiry Request BundleOpens in a new tab can be passed in through the request body.
This method should be called synchronously. 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 Inquiry Request BundleOpens in a new tab.
Success Response
The request succeeded. The body of the response is the FHIR PAS Inquiry Response BundleOpens in a new tab.
Error Responses
Error due to a bad request. The response body contains a FHIR OperationOutcome resource with further details.
The authenticated user does not have access to a resource needed to process the request.
The authenticated user is not authorized to use the requested resource.
The server cannot process the request because the media type specified in the request's Content-Type or Accept headers, application/fhir+json, is not supported.
A generic error message, returned when no more specific message is suitable.