66.1.1Using the DTR (Documentation Templates and Rules) API

This tutorial demonstrates how an in-network provider can retrieve structured documentation templates (Questionnaire packages) from a payer to support prior authorization requests. It covers:

• Retrieving the payer’s Questionnaire package using the $questionnaire-package operation.

66.1.2Calling the Questionnaire Package

Providers call the $questionnaire-package FHIR operation to retrieve the payer’s structured documentation templates.

HTTP Request:

POST [PAYER_BASE_URL]/$questionnaire-package
Authorization: Bearer <ACCESS_TOKEN>
Content-Type: application/fhir+json
Accept: application/fhir+json

Request Body:

The body of the POST request must contain the Parameters resource with the following input parameters:

• coverage: One or more Coverage resources identifying the member and the type(s) of coverage for which additional information is needed.
• questionnaire: Optional. A list of canonical URLs of specific Questionnaire resources to retrieve.
• order: Optional. One or more ServiceRequest or Encounter resources to provide context.
• context: Optional. A context ID provided in a previous DTR session.
• changedsince: Optional. The meta.lastUpdated timestamp to retrieve updated QuestionnaireResponse resources.

For detailed definitions and constraints, refer to the DTR Questionnaire Package Input Parameters.

{
  "coverage": [
    {
      "reference": "Coverage/example-coverage-1"
    }
  ],
  "questionnaire": [
    "http://example.org/fhir/Questionnaire/example-questionnaire-1"
  ],
  "order": [
    {
      "reference": "ServiceRequest/example-order-1"
    }
  ],
  "context": "example-context-id",
  "changedsince": "2025-10-01T00:00:00Z"
}

Response Body:

The response to a successful $questionnaire-package operation is a Parameters resource with the following output parameters:

• PackageBundle: A collection of resources representing the retrieved Questionnaire package. This typically includes:
  • Questionnaire: The structured documentation template(s) to be completed.
  • QuestionnaireResponse: The corresponding response(s) to the Questionnaire.
  • Library: Any associated CQL libraries used for evaluation.
  • ValueSet: Any associated ValueSets referenced by the Questionnaire.

For detailed definitions and constraints, refer to the DTR Questionnaire Package Output Parameters.

Sample Response:

{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "PackageBundle",
      "resource": {
        "resourceType": "Bundle",
        "type": "collection",
        "entry": [
          {
            "resource": {
              "resourceType": "Questionnaire",
              "id": "aslp-sleep-study",
              "url": "http://example.org/fhir/Questionnaire/aslp-sleep-study",
              "status": "active",
              "title": "Home Sleep Study Questionnaire",
              "item": [
                {
                  "linkId": "1",
                  "text": "Patient Name",
                  "type": "string"
                },
                {
                  "linkId": "2",
                  "text": "Date of Sleep Study",
                  "type": "date"
                }
              ]
            }
          },
          {
            "resource": {
              "resourceType": "Library",
              "id": "sleep-study-cql",
              "url": "http://example.org/fhir/Library/sleep-study-cql",
              "status": "active"
            }
          },
          {
            "resource": {
              "resourceType": "ValueSet",
              "id": "sleep-study-values",
              "url": "http://example.org/fhir/ValueSet/sleep-study-values",
              "status": "active"
            }
          }
        ]
      }
    }
  ]
}