Prior Authorization Workflow
End-to-end guide to electronic prior authorization using the Da Vinci CRD, DTR, and PAS IGs: what each step does, what provider and payer systems must implement, and CMS-0057-F compliance obligations.
Resource Overview
Canonical Topics
View AllFHIR Profiling
Reference for FHIR conformance: profiles, extensions, terminology bindings, slicing, and how Implementation Guides define interoperable contracts.
Information Blocking Rule (ONC)
Reference for ONC's Information Blocking Rule under 21st Century Cures Act: definition, actors, eight exceptions, penalties, and enforcement mechanisms.
Patient
Reference for the FHIR Patient resource: demographics, identifiers, administrative status, and implementation considerations for identity and matching.
CMS Interoperability Rules Overview
Reference for CMS interoperability mandates: CMS-9115-F (2020), CMS-0057-F (2024), covered entities, data exchange APIs, compliance timelines, and penalties.
TEFCA — Trusted Exchange Framework and Common Agreement
Reference for TEFCA: the ONC framework for nationwide health information exchange, Qualified Health Information Networks (QHINs), the Common Agreement, exchange purposes, and participation model.
CDex — Clinical Data Exchange
End-to-end reference for the Da Vinci CDex IG: direct query, Task-based, and attachment exchange patterns; use cases for claims adjudication, prior authorization, and audit; Task workflow mechanics; and SMART Backend Services authentication.