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Prior Authorization · CMS-0057F · Da Vinci CRD / DTR / PAS

Prior Authorization

Beta

Electronic prior authorization end-to-end: CRD fires from the EHR, DTR collects clinical evidence, PAS submits the claim and tracks decisions. All three Da Vinci surfaces under one tenant.

End-to-end flow

Three Da Vinci surfaces, in order. Each has its own conformance and credentialing model.

1

CRD

At order time

EHR fires a CDS Hook. Payer responds in real time with PA-needed indicator and a DTR launch URL. No extra round-trip for the clinician.

2

DTR

Clinical evidence

SMART app launched from the CRD card. Questionnaire pre-populates from EHR data via CQL. Clinician completes gaps; result is a QuestionnaireResponse.

3

PAS

Submit & track

$submit sends the claim with clinical evidence attached. ClaimResponse is polled or received via Subscription. Decision time SLA tracked per CMS-0057F.

Capabilities

What this API surface supports and current maturity level.

CapabilityStandardStatusDescription
CRD — Coverage Requirements DiscoveryDa Vinci CRD 2.1.0 + CDS Hooks 1.0BetaProvider creates an order in the EHR; CDS Hook fires to the payer for PA-needed indicator and SMART launch URL.
DTR — Documentation Templates and RulesDa Vinci DTR 2.0.1BetaSMART launch from CRD; QuestionnaireResponse with CQL pre-population, attachments, PDF export.
PAS — Prior Auth SubmitDa Vinci PAS 2.0.1Beta$submit / $inquire operations; ClaimResponse polling; Subscription on decision.
Provider authenticationOIDC + SMART EHR Launch 2.0.0LiveEHR onboarding, JWT, ACL, NPI sync from CMS.
Decision time SLACMS-0057FLiveStandard PA: 7 calendar days. Expedited: 72 hours. Tracked per request with audit log.