This asset is a component of MuleSoft Accelerator for Healthcare.
The MuleSoft Accelerator for Healthcare equips Payer, Provider, and Life Sciences organizations with foundational assets to accelerate their digital transformation journey. With our pre-built APIs, connectors, implementation templates, and reference architectures, IT teams can spend more time innovating rather than building from scratch.
Prior authorization (PA) is a process commonly used by payer organizations to manage healthcare costs. Providers need to receive advanced approval from payers before care delivery to ensure that patients/members receive treatments, testing, referrals, and devices appropriate for their specific conditions and that are covered by the specific health plan in which the member is enrolled.
The Documentation Templates and Rules (DTR) specifies how payer rules are executed in a provider context to ensure that documentation requirements are met. The goal of the DTR process is to collect clinical documentation and encourage the completion of documentation that demonstrates medical necessity for ordered items or services.
The API specification supports the following Resources on Documentation Templates and Rules (DTR):
|/Questionnaire||The Questionnaire resource is used to represent the information needs that a payer has to satisfy for their documentation requirements and/or rules.|
|/QuestionnaireResponse||The QuestionnaireResponse resource is used to represent a response to the Questionnaire presented by the payer.|
|/Task||The task resource is used to capture a request for additional actions that arise from the DTR flow.|
Customers can use this integration template to accelerate implementation.