Skip to main content
GET
CRD-style PA determination

Authorizations

X-API-Key
string
header
required

Query Parameters

payer_slug
string
required

Payer slug or alias

code
string | null

CPT/HCPCS code

service_category
string | null

Service category

plan_type
string | null

Plan type filter

state
string | null

State abbreviation

place_of_service
string | null

Place of service code

visit_count
integer | null

Current visit count

ccn
string | null

Facility CCN. When supplied, the engine auto-fills state/place-of-service from the facility profile and applies any facility-specific overrides (Tier 0) ahead of the shared payer rules.

Response

Successful Response

CRD-style PA determination with rationale chain.

confidence
number
required
determination
string
required
pa_required
boolean
required
payer_name
string
required
payer_slug
string
required
resolution_tier
string
required
auth_type
string | null
code
string | null
delegation_vendor
string | null
delegation_vendor_phone
string | null
delegation_vendor_portal
string | null
determination_id
string | null

Persisted determination ID for audit trail

pa_threshold
integer | null

Threshold at which PA becomes required (if applicable)

plan_type
string | null

Plan type used for resolution (commercial, medicaid, etc.)

rationale_chain
RationaleStep · object[]
required_documents
string[]
service_category
string | null
standard_turnaround_days
integer | null
submission_info
SubmissionInfo · object

Contact and portal information for PA submission.

threshold_remaining
integer | null

Remaining visits before PA threshold is reached

urgent_turnaround_hours
integer | null
visit_count
integer | null

Visit count supplied in the request