Electronic Health Record (EHR) Coverage Requirements Discovery (CRD)
CDS Hooks: order-select
Story:👩⚕️ Physician/clinician selects a 👤 patient and enters an order. The EHR calls the payer's CRD service via CDS Hooks. The payer returns a card indicating whether prior authorization is likely and provides a Launch DTR link when documentation is needed.
Documentation Templates and Rules (DTR)
SMART on FHIR
Story:👩⚕️ Clinician completes payer-required documentation with the 👤 patient context. Questions are adaptive and change based on the selected code and prior answers.
Use Launch DTR from a CRD card to open the documentation form.
Documentation template: demo
Prior Authorization Support (PAS)
FHIR Claim / ClaimResponse
Story: A 👩💼 payer clerk reviews the PAS request. If medical necessity is clearly established during DTR finalization, the request may be auto‑approved; otherwise the payer may pend for more info or deny with rationale.