API ReferencePrior Auth Outpatient

Create case

Creates a new Prior Auth outpatient case. Call this endpoint to initiate a Prior Auth outpatient workstream. The response will provide a URL which can be used to upload clinicals. After uploading clinicals to the provided URLs, use the **Run determinations** endpoint with the `caseUid` to start determinations. New cases require procedure (CPT/HCPCs) and diagnosis (ICD-10) codes, and a member name and DoB.

Authentication

X-API-Keystring
API Key authentication via header

Request

This endpoint expects an object.
codeslist of objectsRequired
Procedure and diagnosis codes for a case.
memberNamestringRequired
The full name of the member.
memberDobstringRequired
The member's date of birth.
memberIdstringOptional
The external Id of the member.
healthPlanNamestringOptional
The name of the health plan for this Prior Auth case.
clinicalsBase64list of stringsOptional

Clinicals for this case can be provided as base64-encoded files.

criteriaBase64list of stringsOptional

Criteria for this case that aren’t specified by the procedure or diagnosis codes may additionally be provided as base64-encoded files.

metadatamap from strings to stringsOptional

You can use this parameter to attach key-value data to this case.

You can specify up to 50 keys, with key names up to 40 characters long and values up to 500 characters long.

Don’t store any sensitive information (for example PHI) as metadata.

Response

This endpoint returns an object.
caseUidstring
A unique ID for this Prior Auth case.
memberNamestring
The full name of the member.
memberDobstring
The member's date of birth.
workstreamIdstring

Anterior workstream: prior-auth-op.

codeslist of objects
Procedure and diagnosis codes for a case.
statusenum
Status of a Prior Auth outpatient case: - `UNPREPARED` - The required clinicals or criteria have not yet been uploaded. - `PREPARED` - The case has required clinicals and criteria and a determination can be run. - `SCHEDULED` - The case has been scheduled for determination. - `RUNNING` - The case is being determined by Florence. - `COMPLETED` - Florence has reached determinations on the case. - `ERROR` - There was an error during case determination.
createdAtdatetime

Case creation timestamp (ISO 8601).

updatedAtdatetime

Case updated timestamp (ISO 8601).

memberIdstring or null
The external Id of the member.
healthPlanNamestring or null
The name of the health plan for this Prior Auth case.
clinicalsUploadobject or null
Clinicals for this case should be uploaded to this URL.
criteriaUploadobject or null
Criteria for this case that aren't specified by the procedure or diagnosis codes may additionally be uploaded to this URL.
metadatamap from strings to strings or null

You can use this parameter to attach key-value data to this case.

You can specify up to 50 keys, with key names up to 40 characters long and values up to 500 characters long.

Don’t store any sensitive information (for example PHI) as metadata.

requestedServiceslist of objects or null
criterialist of objects or null
clinicalslist of objects or null
determinationslist of objects or null
archivedAtdatetime or null

Case archive timestamp (ISO 8601).

Errors