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49.111 Payer to Payer 49.113 Prior Authorization Documentation Templates and Requirements

49.112.1Prior 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

49.112.2Property: CDS Hook

Property Name	CDS Hook
Property Key
Property Type	JSON
Description	The CDS Service JSON including prefetch keys required for the above plan definition. The service id provided will be ignored.
Applies to Modules	Prior Auth CRD
Default Value	`{ "hook": "order-sign", "title": "Order sign request", "description": "CDS Hook for 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", "prefetch": { "patient": "Patient/{{context.patientId}}" } }`

49.112.3Property: 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`

49.112.4Property: 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`

49.112.5Property: 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`

49.112.6Property: 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/`

49.112.7Property: 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`

49.111 Payer to Payer 49.113 Prior Authorization Documentation Templates and Requirements