Quickstart — Prior Authorization

The PA workflow runs through 17 documented states with payer-specific rules and 5-channel submission. Voice agent The PA Specialist handles outbound peer-to-peer calls.

State machine

Evaluate criteria

bash cURL curl -X POST https://api.medera.info/api/prior-auth/evaluate \ -H "X-API-Key: $MEDERA_API_KEY" \ -d '{ "patient_data": { "diagnosis_codes": ["F32.1"], "phq9_score": 14 }, "procedure_codes": ["90834"], "payer_id": "AETNA" }'

| LIKELY_APPROVE | NEEDS_REVIEW | LIKELY_DENY

python Python result = client.pa.evaluate(patient_data={"diagnosis_codes": ["F32.1"], "phq9_score": 14}, procedure_codes=["90834"], payer_id="AETNA",)

Create the PA request

bash cURL curl -X POST https://api.medera.info/api/prior-auth/requests \ -H "X-API-Key: $MEDERA_API_KEY" \ -d '{ "patient_id": "pat_abc", "diagnosis_codes": ["F32.1"], "procedure_codes": ["90834"], "clinical_justification": "...", "payer_id": "AETNA" }'

typescript JavaScript const req = await client.pa.createRequest({ patient_id: 'pat_abc', diagnosis_codes: ['F32.1'], procedure_codes: ['90834'], clinical_justification: '...', payer_id: 'AETNA', });

python Python req = client.pa.create_request(patient_id="pat_abc", diagnosis_codes=["F32.1"], procedure_codes=["90834"], clinical_justification="...", payer_id="AETNA",)

Initial state: PA_INITIATED.

Generate documents

bash cURL curl -X POST https://api.medera.info/api/prior-auth/documents/generate \ -H "X-API-Key: $MEDERA_API_KEY" \ -d '{ "request_id": "pa_abc", "document_types": ["MEDICAL_NECESSITY", "CLINICAL_SUMMARY"] }'

typescript JavaScript await client.pa.generateDocuments({ request_id: req.pa_id, document_types: ['MEDICAL_NECESSITY', 'CLINICAL_SUMMARY'], });

Submit

Submission selects the highest-priority available channel:

EPA_API → CLEARINGHOUSE → PORTAL → FAX → MANUAL

bash curl -X POST https://api.medera.info/api/prior-auth/requests/{id}/submit \ -H "X-API-Key: $MEDERA_API_KEY"

Track and appeal

Poll status; if denied, generate the appeal with new evidence.

bash curl https://api.medera.info/api/prior-auth/requests/{id} \ -H "X-API-Key: $MEDERA_API_KEY" # If denied: curl -X POST https://api.medera.info/api/prior-auth/requests/{id}/appeal \ -H "X-API-Key: $MEDERA_API_KEY"

Supported payers

CARELON_ANTHEM, OPTUM_BH, MAGELLAN, EVERNORTH, UNITED_HEALTHCARE, AETNA, CIGNA, BLUE_CROSS, MEDICAID, MEDICARE.

Document types

MEDICAL_NECESSITY, CLINICAL_SUMMARY, TREATMENT_PLAN, ASSESSMENT, PROGRESS_NOTE, DISCHARGE_SUMMARY — plus X-12 EDI 278 for clearinghouse submission.

What’s next

Prior Authorization Agent

Agent-level documentation.

PA API

Full REST surface.

Denial Appeals

Appeal lifecycle.

Eligibility

Pre-visit benefits.

​State machine

​Supported payers

​Document types

​What’s next