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PAS $submit FHIR API Specification

$submit 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 $submit APIOpens in a new tab to submit a prior authorization request. This request is sent as a FHIR Bundle containing a PAS Claim and other referenced resources for adjudication by a payer.

Workflow

A typical workflow involving the submit operation might be:

  • The provider collects necessary patient information, treatment details, and supporting documentation

  • The provider’s system prepares a FHIR Bundle containing a PAS Claim resource and DocumentReference resources with supporting documentation

  • The provider’s system sends the prepared Bundle to the payer’s PAS API endpoint using the $submit operation

  • The payer’s system receives the request, validates the Bundle, and processes the Claim

  • The payer’s system generates a PAS Claim ResponseOpens in a new tab resource with the adjudication decision and referenced resources, or an OperationOutcome resource

  • The response Bundle is returned to the provider’s system

  • The provider’s system receives the Claim Response, updates the patient’s record, and notifies the provider of the decision

Endpoint: $submit

URL

The URL for this API is:

<BaseURL>/Claim/$submit

Optional Capabilities

None.

Endpoint Prerequisites

None.

Required Header Settings

  • Content-Type: application/json+fhir

  • Accept: application/json+fhir

Request Methods

POST <BaseURL>/Claim/$submit

Invokes $submit with a specified PAS Request Bundle. A FHIR PAS 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 Request BundleOpens in a new tab, which contains a PAS Claim resource. Example PAS Claim resources can be found on the Resource Profile: PASClaim – ExamplesOpens in a new tab page.

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 OK

Error due to a bad request. 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.

Status code 403 Forbidden

The authenticated user is not authorized to use the requested resource.

Status code 415 Unsupported Media Type

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.

Status code 500 Internal Server Error

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

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