Prior Authorization API
A FHIR-based API that automates the prior-authorization workflow (checking requirements, gathering documentation, and exchanging decisions) as required by CMS-0057-F.
A Prior Authorization API is the mechanism by which the request-and-approve process for medical services moves from fax, phone, and portal into a structured, FHIR-based exchange. Under CMS-0057-F this is the PARDD API, one of the four APIs impacted payers must implement.
The API surface covers three interactions: discovering whether a service needs authorization and what rules apply (Da Vinci CRD), pulling the documentation templates and questions a payer needs (Da Vinci DTR), and submitting the authorization request and receiving a decision (Da Vinci PAS). Underneath, payers frequently still speak the X12 278 transaction, so a bridge is required.
Because prior authorization touches clinical documentation, coverage policy, and claims plumbing at once, it is a high-value but high-complexity surface, exactly where automation and AI-assisted documentation assembly pay off.
How this relates to Health1st
Health1st exposes a conformant Prior Authorization API surface while translating to and from the payer's existing X12 278 estate, so a payer can meet the CMS-0057-F requirement without ripping out the systems that already adjudicate authorizations.
Related terms
PARDD is the CMS-0057-F Prior Authorization API that lets providers query coverage requirements, gather documentation, and submit and track authorization decisions via FHIR.
CMS-0057-F requires impacted US payers to stand up four FHIR APIs: Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization (PARDD). API compliance is generally due January 1, 2027.
Da Vinci is the HL7 accelerator that publishes FHIR implementation guides for payer-provider workflows, including prior authorization, coverage, and data exchange.
X12 278 is the EDI transaction US payers use for prior-authorization and referral requests and responses.
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