> ## Documentation Index > Fetch the complete documentation index at: https://docs.medera.info/llms.txt > Use this file to discover all available pages before exploring further. # Prior Authorization Agent > Evidence-based PA across a 17-state workflow.
**Category:** Clinical Operations  ·  **Voice agent:** PA Specialist (`agent type.PA_SPECIALIST`) The Prior Authorization Agent drives the PA lifecycle through a 17-state workflow with payer-specific rules and multi-channel submission. Voice agent The PA Specialist handles outbound peer-to-peer and status calls. ## Workflow states medera/pa-workflow\.svg17-state PA workflowPrior authorization · 17-state workflowPA\_INITIATEDCRITERIA\_EVALUATIONCRITERIA\_EVALUATEDDOCUMENTS\_READYSUBMITTEDIN\_REVIEWPENDEDINFO\_REQUESTEDAPPROVEDOn denialDENIEDAPPEALP2POVERTURNEDEXPIREDWITHDRAWNCLOSEDARCHIVEDSubmission channelsEPA\_APICLEARINGHOUSEPORTALFAXMANUALSame state machine across every channel · per-payer rules · evidence-anchored ## Payer rules stores rules for 10 payers (`PayerId` enum): `CARELON_ANTHEM`, `OPTUM_BH`, `MAGELLAN`, `EVERNORTH`, `UNITED_HEALTHCARE`, `AETNA`, `CIGNA`, `BLUE_CROSS`, `MEDICAID`, `MEDICARE`. returns: | Field | Values | | :------------- | :-------------------------------------------------------------- | | Recommendation | `AUTO_APPROVE`, `LIKELY_APPROVE`, `NEEDS_REVIEW`, `LIKELY_DENY` | | Match result | `ALL_MET`, `MOSTLY_MET`, `PARTIALLY_MET`, `NOT_MET` | ## Document generators | Document type | Producer | | :------------------------ | :------- | | `MEDICAL_NECESSITY` | | | `CLINICAL_SUMMARY` | | | `TREATMENT_PLAN` | | | `ASSESSMENT` | | | `PROGRESS_NOTE` | | | `DISCHARGE_SUMMARY` | | | X-12 EDI 278 (PA request) | | ## Submission channels Channel priority : medera/pa-channels.svgsubmission channelsSubmission channel priorityhighest available channel selected at submission timeEPA\_APIpreferred · automatedPRIMARYCLEARINGHOUSEautomated · asyncSECONDARYPORTALagent-drivenFALLBACKFAXagent-drivenFALLBACKMANUALhuman-in-the-loopFALLBACKSame state machine across every channel · per-payer rules · evidence-anchored ## Endpoints | Method | Path (Backend) | Path (AI Services) | | :----- | :---------------------------------------- | :----------------------------- | | POST | `/api/prior-auth/evaluate` | `/api/pa/evaluate` | | POST | `/api/prior-auth/evaluate/quick` | `/api/pa/evaluate/quick` | | POST | `/api/prior-auth/requests` | `/api/pa/requests` | | GET | `/api/prior-auth/requests/{id}` | `/api/pa/requests/{id}` | | POST | `/api/prior-auth/requests/{id}/submit` | `/api/pa/requests/{id}/submit` | | POST | `/api/prior-auth/requests/{id}/appeal` | `/api/pa/requests/{id}/appeal` | | GET | `/api/prior-auth/payers` | `/api/pa/payers` | | GET | `/api/prior-auth/payers/{id}/rules` | `/api/pa/payers/{id}/rules` | | POST | `/api/prior-auth/documents/generate` | `/api/pa/documents/generate` | | GET | `/api/prior-auth/channels` | `/api/pa/channels` | | POST | `/api/prior-auth/webhooks/payer-response` | `/api/pa/webhooks/status` | | POST | — | `/api/pa/coding-suggest` | ## Real-time coding suggestion runs during intake to flag PA-required codes. Detected CPT: `90832`, `90834`, `90837`, `99213`, `99214`, `99215`, `96127`. Detected ICD-10: `F32.1`, `F33.1`, `F41.1`, `F43.10`, `F11.20`. Each suggestion includes `pa_required`, `pa_urgency`, `payer_policy_url`, `evidence_excerpt`. ## Composable experts | Expert | Role | | :-------------------------- | :--------------------------------- | | **PubMed Expert** | Peer-reviewed evidence | | **Payer Policy Expert** | Carrier-specific rules + formulary | | **Clinical Scoring Expert** | PHQ-9, GAD-7, validated scores | | **Medical Coding Expert** | ICD-10 + procedure code validation | ## Compliance guarantees * Every PA letter carries explicit citations to chart and payer policy. - Letters are submitted only after clinician approval. - Payer webhooks are verified with per-payer HMAC secrets. *** ## Related Generate your first PA letter. REST surface. Appeal lifecycle. Pre-visit benefits.