Coverage Requirements Discovery (CRD) System API

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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.

Coverage Requirements Discovery (CRD) is a part of the prior authorization process that helps integrate Clinical Decision Support (CDS) Clients (typically Electronic Health Record Systems or other health information systems) and CDS Services. Click here to learn more about CDS.

The API specification supports the following operations on CDS:

cds-servicesThe primary interaction supported by this implementation is fetching the support CDS hooks by the API. Supported method is GET and it returns the cds hooks and associated prefetch elements and bundles
cds-services/{id}Used to invoke the hooks specified by cds-services with a JSON formatted body including the hook instance and draft order bundle and the response demonstrates the response from a CDS Service with the details requested in the POST method

Customers can use this integration template to accelerate implementation.


Published by
MuleSoft Solutions
Published onOct 12, 2023
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