Smile CDR v2024.08.PRE

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46.110 Payer to Payer 46.112 Prior Authorization Support

46.111.1Prior Authorization Coverage Requirement Discovery

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

Coverage identifier system
DTR application URL
Payer source label
Payer source URL
Practitioner identifier system
Accepted CodeSystems URLs
System Action Questionnaire URL

46.111.2Property: 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	(no default)
Example Property	`module.[MODULE_ID].config.coverage_identifier_system =`

46.111.3Property: 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	(no default)
Example Property	`module.[MODULE_ID].config.dtr_app_url =`

46.111.4Property: 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	(no default)
Example Property	`module.[MODULE_ID].config.payer_source_label =`

46.111.5Property: 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	(no default)
Example Property	`module.[MODULE_ID].config.payer_source_url =`

46.111.6Property: 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	(no default)
Example Property	`module.[MODULE_ID].config.provider_identifier_system =`

46.111.7Property: Accepted CodeSystems URLs

Property Name	Accepted CodeSystems URLs
Property Key
Property Type	STRING_MULTILINE
Description	A list of code systems that are directly supported by the payer. CDS Hook requests with these codes will not need to be translated and can be processed directly.
Applies to Modules	Prior Auth CRD
Default Value	(no default)
Example Property	`module.[MODULE_ID].config.request_codesystem_urls =`

46.111.8Property: System Action Questionnaire URL

Property Name	System Action Questionnaire URL
Property Key
Property Type	STRING
Description	URL for System Action Questionnaire
Applies to Modules	Prior Auth CRD
Default Value	(no default)
Example Property	`module.[MODULE_ID].config.system_action_questionnaire_url =`

46.110 Payer to Payer 46.112 Prior Authorization Support