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) — with API compliance 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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