PriorAuthdocs

Start here

You send us a patient and a procedure. We work out whether it needs prior authorization, assemble the request, get it in front of a clinician for release, submit it, chase the payer, and tell you what came back.

#Who this is for

You are building something that needs prior authorizations done - an EHR assistant, a revenue-cycle workflow, a scheduling agent, or an orchestration platform like IBM watsonx Orchestrate. You do not want to learn X12, and you should not have to.

You never touch a clearinghouse
You do not need an Availity account, a trading partner agreement, or any knowledge of the 278 transaction. Those are ours. You send a task and read a result.

#The one thing that will shape your integration

Every authorization stops for a human
A licensed clinician at the practice releases each submission before it reaches a payer. Your integration cannot skip it, approve it, or configure it away - and neither can we. Expect a task to sit in input-required for minutes or hours, and design for that rather than around it.

This is the single most common thing integrators get wrong. See When it waits for a human.

#What you need before you start

ThingWho provides itWhy
A signed agreementYou and usCovers the data flow. Nothing connects before it exists.
A BAAYou and us, or you and the practiceYou will be handling protected health information.
Client credentialsUs, after the agreementA client id and secret scoped to your integration.
A practice that has authorised youThe practiceYour credentials reach only the practices that granted you access, with only the scopes they granted.
A sandbox runYouEvery integration starts against synthetic data. No exceptions.

#How long it takes

  1. Day one
    Credentials, sandbox access, first successful call against synthetic data.
  2. Week one
    The full lifecycle end to end in sandbox, including a task that waits for a release and one that comes back denied.
  3. Before production
    Your handling of input-required reviewed, your retry behaviour checked, and the first practices connected on canary.

#Where to go next

Connect
Credentials, tokens, and what a practice grants you.
Your first request
A complete worked example, start to finish.
When it waits for a human
The part most integrations get wrong.
What you can ask for
The tasks we accept, in plain terms.