Prior authorization feed: datasets, templates and conventions - #93
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September 11, 2026 19:39
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Summary
Adds the prior authorization feed to the Data Integration Reference: what a payer delivers so that prior authorization history can be served through Patient Access, Provider Access and Payer-to-Payer, in the shape of the Claims and Encounters pages.
data-integration/prior-authorization/README.md— one family page built to the Da Vinci PDex STU 2.1.0 PriorAuthorization profile: Datasets, Data conventions, and three datasets with column tables, notes and "Set by Payerbox":prior_auths(one row per authorization),prior_auth_items(one row per requested service),prior_auth_documents(one row per document submitted with the request, the file as an attachment).assets/data-integration/with example rows: an authorization approved with changes whose lines were decided three ways, a denial with its reason, a pending request, a retraction; their keys resolve against thepatients,coverage,practitionersandorganizationstemplates.record_id,patient_identifier,coverage_id,payer_org_npi,*_npi,*_codewith*_code_system,last_updated,is_deleted; Required values areYes,Recommended,If available,If <condition>,If retracting.SUMMARY.mdand the Feeds table ondata-integration/README.mdgain the new family.The decision model follows the profile:
review_action(X12 306) on every line and, for a denial of the whole request, on the authorization; a denial carries a CARC and the reason in words; the line's adjudication entry is chosen by the decision (allowedunits,denialreason,consumedunits), which is what the profile's closed slicing admits.Test plan
bun lintpasses (only pre-existing, unrelated warnings)bun assets:hashrun for the three new templates; references updated🤖 Generated with Claude Code