Automate prior authorization using the Da Vinci PAS (Prior Authorization Support) FHIR workflow

Steps

1. Implement the Da Vinci PAS workflow by constructing a FHIR Bundle containing a Claim resource (type 'preauthorization') with referenced resources: Coverage, Patient, Practitioner, Organization, and supporting clinical documents.
2. Populate Claim.item[] with the requested procedures or items: item.productOrService with CPT/HCPCS codes, item.diagnosisSequence referencing Claim.diagnosis[] entries, and item.quantity.
3. Include supporting information in Claim.supportingInfo[] for any required clinical documentation (e.g., diagnosis codes, prior treatments) as FHIR references or attachments.
4. POST the Bundle to the payer's PAS endpoint: POST [payer-base]/$submit; this operation accepts the Bundle and returns a ClaimResponse resource with an adjudication decision.
5. Parse the ClaimResponse: check ClaimResponse.outcome ('complete', 'partial', 'queued', 'error') and item[].adjudication[].category for the disposition; pended decisions require polling via GET [base]/ClaimResponse/[id].
6. Handle pended (queued) responses by subscribing to updates or polling ClaimResponse until outcome changes from 'queued' to a final decision; implement a maximum wait and escalation path for manual review cases.