Prior authorization on FHIR: CRD, DTR and PAS for health plans - Medblocks
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Prior authorization on FHIR: CRD, DTR and PAS for health plans

Build the prior authorization APIs CMS-0057-F requires by 2027. Starts with Da Vinci CRD and a server that passes Inferno. DTR and PAS modules to follow.

3 modules
8 lessons
2 Hours
Prior authorization on FHIR Course
Part 1

What the rule requires and how CRD, DTR and PAS works

This module covers CRD, DTR and PAS, it also covers the CDS Hooks specification it runs on, and how health plans handle multiple vendors under this rule.

  1. CMS-0057-F explained: what health plans have to build by 2027

    CMS-0057-F requires health plans in Medicare Advantage, CHIP and fee for service to run prior authorization APIs by January 1st 2027. What the rule actually asks for.

    14:29
  2. How CDS Hooks works, and how Da Vinci CRD uses it

    Coverage Requirements Discovery is a CDS Hooks service. This lesson covers the hook catalogue, discovery, prefetch, context templating and the time budget.

    17:56
  3. How a health plan splits CRD across prior authorization vendors

    Most health plans already delegate utilization management. Here is how to compose several vendors behind one CRD facade without forwarding the EHR's token.

    10:07
Part 2

Set up a CRD Server

Build a CRD server from nothing and get it passing the Inferno CRD 2.2.1 test suite.

  1. Passing the Inferno FHIR CRD tests: discovery, TLS, and JWT validation

    Build a /cds-services discovery endpoint and pass the Inferno FHIR CRD 2.2.1 suite: TLS 1.2, JWT bearer authentication and JWKS.

    9:43
  2. Da Vinci CRD extensions: version negotiation and configuration options

    How CRD extends CDS Hooks: davinci-crd-version vs crd-requested-version, configuration options, prefetch support, and order-select vs order-sign vs order-dispatch.

    10:37
Part 3

Send CRD responses back to the EHR

What a CRD server sends once it can accept a request: cards and system actions, all six response types demonstrated live against Inferno, and every hook a payer needs to implement.

  1. Cards and system actions: the CRD response types

    The six ways a CRD server can respond: external-reference, instruction, coverage-information, request-form-completion, update-coverage-records, and SMART app launch.

    19:19
  2. CRD response types on Inferno, with SMART on FHIR launch

    Every CRD response type run live against Inferno's Hook Response Demonstration test group, using the appointment-book hook, including a SMART on FHIR launch.

    16:45
  3. Every CRD hook, and unsolicited determination

    Every CRD hook - appointment-book, encounter-start, encounter-discharge, order-dispatch, order-select, order-sign - plus hook-level config and unsolicited determination

    16:27