Run determinations

1 curl -X POST https://api.anterior.app/v2/workstreams/prior-auth-op/cases/caseUid/determinations/actions/run \ 2 -H "X-API-Key: <apiKey>"

1 { 2 "caseUid": "caseUid", 3 "memberName": "memberName", 4 "memberDob": "2021-06-20", 5 "workstreamId": "prior-auth-op", 6 "codes": [ 7 { 8 "category": "PROCEDURE", 9 "value": "99201-05", 10 "type": "CPT" 11 } 12 ], 13 "status": "UNPREPARED", 14 "createdAt": "2021-06-20T01:02:03Z", 15 "updatedAt": "2021-06-20T01:02:03Z", 16 "memberId": "memberId", 17 "healthPlanName": "healthPlanName", 18 "clinicalsUpload": { 19 "url": "https://files.anterior.app/upload/here", 20 "fields": { 21 "acl": "public-read", 22 "key": "my-key", 23 "signature": "my-signature", 24 "policy": "my-base64-encoded-policy" 25 } 26 }, 27 "criteriaUpload": { 28 "url": "https://files.anterior.app/upload/here", 29 "fields": { 30 "acl": "public-read", 31 "key": "my-key", 32 "signature": "my-signature", 33 "policy": "my-base64-encoded-policy" 34 } 35 }, 36 "metadata": { 37 "metadata": "metadata" 38 }, 39 "requestedServices": [ 40 { 41 "serviceUid": "serviceUid", 42 "createdAt": "2021-06-20T01:02:03Z", 43 "updatedAt": "2021-06-20T01:02:03Z", 44 "caseUid": "caseUid", 45 "workstreamId": "prior-auth-op", 46 "status": "SELECTED", 47 "codes": [ 48 { 49 "category": "PROCEDURE", 50 "value": "99201-05", 51 "type": "CPT" 52 } 53 ], 54 "criteriaUids": [ 55 "criteriaUids" 56 ] 57 } 58 ], 59 "criteria": [ 60 { 61 "criteriaUid": "criteriaUid", 62 "createdAt": "2021-06-20T01:02:03Z", 63 "updatedAt": "2021-06-20T01:02:03Z", 64 "caseUid": "caseUid", 65 "workstreamId": "prior-auth-op" 66 } 67 ], 68 "clinicals": [ 69 { 70 "clinicalsUid": "clinicalsUid", 71 "createdAt": "2021-06-20T01:02:03Z", 72 "updatedAt": "2021-06-20T01:02:03Z", 73 "caseUid": "caseUid", 74 "workstreamId": "prior-auth-op", 75 "clinicalsUrl": "clinicalsUrl", 76 "fileName": "fileName", 77 "mimeType": "application/pdf" 78 } 79 ], 80 "determinations": [ 81 { 82 "determinationUid": "determinationUid", 83 "requestedServices": [ 84 { 85 "serviceUid": "serviceUid", 86 "createdAt": "2021-06-20T01:02:03Z", 87 "updatedAt": "2021-06-20T01:02:03Z", 88 "workstreamId": "prior-auth-op", 89 "codes": [ 90 { 91 "category": "PROCEDURE", 92 "value": "99201-05", 93 "type": "CPT" 94 } 95 ] 96 } 97 ], 98 "criteria": [ 99 { 100 "criteriaUid": "criteriaUid", 101 "createdAt": "2021-06-20T01:02:03Z", 102 "updatedAt": "2021-06-20T01:02:03Z", 103 "workstreamId": "prior-auth-op" 104 } 105 ], 106 "createdAt": "2021-06-20T01:02:03Z", 107 "updatedAt": "2021-06-20T01:02:03Z", 108 "status": "SCHEDULED", 109 "determination": "PENDING", 110 "caseUid": "caseUid", 111 "workstreamId": "prior-auth-op", 112 "summary": "summary", 113 "editedSummary": "editedSummary", 114 "editedBy": "editedBy", 115 "anteriorUrl": "https://platform.anterior.app/case/determination" 116 } 117 ], 118 "archivedAt": "2021-06-20T01:02:03Z" 119 }

Runs determinations for a Prior Auth outpatient case.

Call this endpoint after creating a case and uploading all clinicals and any criteria to the URLs returned in the Create case response.

Case update events will be sent to any active webhook subscriptions. The case status and determination results can be fetched at any time from the Get case endpoint.

In the case that insufficient data has been provided to initiate a determination, if for example clinicals have not been uploaded, a 400 error will be returned from this endpoint.

Runs determinations for a Prior Auth outpatient case. Call this endpoint after creating a case and uploading all clinicals and any criteria to the URLs returned in the **Create case** response. Case update events will be sent to any active webhook subscriptions. The case status and determination results can be fetched at any time from the **Get case** endpoint. In the case that insufficient data has been provided to initiate a determination, if for example clinicals have not been uploaded, a `400` error will be returned from this endpoint.

Authentication

X-API-Keystring

API Key authentication via header

Path parameters

caseUidstringRequired

Case Uid

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.

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).

Authentication

Path parameters

Response

Errors