Submission for Prior Authorization

Prior authorization (PA) is a process used in the United States that requires providers 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 Integrations that are part of this asset, help provider systems (Salesforce Health Cloud) to send a DaVinci (a HL7 FHIR accelerator) aligned prior authorization request to a Clearing house or a Payer endpoint that supports a similar FHIR endpoint. It handles both submission of the request and enquiry about the request status. For details visit MuleSoft Exchange