Smile CDR v2024.08.PRE
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   46.107    Payer to Payer 46.109    Prior Auth DTR   

46.108.1Prior Authorization Coverage Requirement Discovery

 

The Prior Authorization Coverage Requirement Discovery configuration category includes the following configurable options:

  • CDS Hook

  • Coverage identifier system

  • DTR application URL

  • Payer source label

  • Payer source URL

  • Plan Definition ID

  • Practitioner identifier system

46.108.2Property: CDS Hook

 
Property Name CDS Hook
Property Key
Property Type JSON
Description The CDS hook including prefetch keys required for the above plan definition
Applies to Modules
  • Prior Auth CRD
Default Value { "hook": "order-sign", "title": "Order sign request", "description": "CDS Hook for order sign", "id": "order-sign", "prefetch": { "patient": "Patient/{{context.patientId}}" } }
Example Property
module.[MODULE_ID].config.cds_hook = {
"hook": "order-sign",
"title": "Order sign request",
"description": "CDS Hook for order sign",
"id": "order-sign",
"prefetch": {
"patient": "Patient/{{context.patientId}}"
}
}

46.108.3Property: Coverage identifier system

 
Property Name Coverage identifier system
Property Key
Property Type STRING
Description The system to match the provider Coverage resource with the payer Coverage resource
Applies to Modules
  • Prior Auth CRD
Default Value http://acme.org/fhir-ns/payer-coverage-identifier-system
Example Property
module.[MODULE_ID].config.coverage_identifier_system = http://acme.org/fhir-ns/payer-coverage-identifier-system

46.108.4Property: DTR application URL

 
Property Name DTR application URL
Property Key
Property Type STRING
Description URL for DTR application
Applies to Modules
  • Prior Auth CRD
Default Value http://dtr.app
Example Property
module.[MODULE_ID].config.dtr_app_url = http://dtr.app

46.108.5Property: Payer source label

 
Property Name Payer source label
Property Key
Property Type STRING
Description The name of the Payer as displayed in the CDS Hook response card
Applies to Modules
  • Prior Auth CRD
Default Value Health Level Seven International
Example Property
module.[MODULE_ID].config.payer_source_label = Health Level Seven International

46.108.6Property: Payer source URL

 
Property Name Payer source URL
Property Key
Property Type STRING
Description The URL of the Payer as returned in the CDS Hook response card
Applies to Modules
  • Prior Auth CRD
Default Value https://www.hl7.org/
Example Property
module.[MODULE_ID].config.payer_source_url = https://www.hl7.org/

46.108.7Property: Plan Definition ID

 
Property Name Plan Definition ID
Property Key
Property Type STRING
Description The plan definition to invoke when this hook is called
Applies to Modules
  • Prior Auth CRD
Default Value ASLPCrd-CdsHook
Example Property
module.[MODULE_ID].config.plan_definition_id = ASLPCrd-CdsHook

46.108.8Property: Practitioner identifier system

 
Property Name Practitioner identifier system
Property Key
Property Type STRING
Description The system to match the provider Practitioner resource with the payer Practitioner resource
Applies to Modules
  • Prior Auth CRD
Default Value http://hl7.org/fhir/sid/us-npi
Example Property
module.[MODULE_ID].config.provider_identifier_system = http://hl7.org/fhir/sid/us-npi
   46.107    Payer to Payer 46.109    Prior Auth DTR