For AI agents: the documentation index is at /docs/payerbox/llms.txt. A Markdown version of this page is available at /docs/payerbox/prior-auth.md or by requesting it with the Accept: text/markdown header.
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Prior Auth (ePA) APIs

Prior Authorization flow, three rows for the three IGs. CRD: the EHR's CDS Hooks client calls Payerbox's CRD service on any of the four supported hooks, and the service forwards to the health plan's decision service for coverage rules. DTR: the EHR launches the DTR app via SMART App Launch, and Payerbox serves the Questionnaire with its FHIRPath prefill expressions. PAS: the EHR's PAS client submits the Claim Bundle to Payerbox's PAS endpoint, which validates it and forwards it to the plan's UM system; the decision lands on the ClaimResponse, which the EHR reads through $inquire or a Subscription notification.

Da Vinci electronic Prior Authorization stack. CMS-0057-F requires a FHIR-based Prior Authorization API by January 1, 2027. Payerbox implements the Da Vinci CRD, DTR, and PAS Implementation Guides.

PageIGRole
CRDDa Vinci CRDDiscover whether prior authorization is required at the point of order
DTRDa Vinci DTRCollect required documentation via questionnaires driven by CQL
PASDa Vinci PASSubmit the prior authorization request and receive the response

The three IGs compose: CRD identifies the rule, DTR collects the evidence, PAS submits the request.

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