Use the Da Vinci PAS $inquire operation to check prior authorization status

domain: hl7.org/fhir/us/davinci-pas · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Review the Da Vinci PAS $inquire operation specification to understand the input Parameters structure: a Bundle containing a ClaimInquiry profile resource referencing the original request's tracking number or identifiers.
  2. Construct the PAS ClaimInquiry resource using the tracking number or identifiers from the original $submit response, populating the inquiry with the service line items that require a status check.
  3. POST the inquiry Bundle to [base]/Claim/$inquire on the payer or intermediary endpoint with the same authentication credentials used for $submit.
  4. Parse the ClaimInquiryResponse: extract the adjudication status (approved, denied, pended, modified) for each line item, the authorized service codes and quantities (which may differ from what was requested), and any denial reason codes.
  5. Handle partial responses where some line items are approved and others are denied or pended — implement line-item-level status tracking rather than a single claim-level status.
  6. Implement retry-with-backoff polling if the response remains pended, and define a maximum polling duration after which the authorization is escalated for manual follow-up.

Known gotchas

Related routes

Submit a prior authorization request using the Da Vinci PAS Claim $submit operation
hl7.org/fhir/us/davinci-pas · 6 steps · unrated
Submit a prior authorization request using Da Vinci PAS and interpret the X12 278 mapping
hl7.org/fhir/us/davinci-pas · 5 steps · unrated
Submit a prior authorization request using Da Vinci PAS (Prior Authorization Support) FHIR operations and handle pend/approve/deny responses
hl7.org/fhir/us/davinci-pas · 6 steps · unrated

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