Prior authorization - RCIntel

Check whether a payer requires prior authorization before the service is ordered. This is the client PA API (/v1/prior-auth). Payer identity and filing rules live on Payer network. Cited coverage policy text is Payer policies.

Check a code

curl "https://api-dev.rcintell.com/v1/prior-auth/check?payer_slug=uhc&code=27447&state=KS" \
  -H "X-API-Key: kp_test_..."

Param	Required	Notes
`payer_slug`	yes	Slug or alias (`uhc`, `aetna`, `bcbs_ma`)
`code`	no	CPT/HCPCS — enables code-specific and range match
`service_category`	no	e.g. `advanced_imaging`, `orthopedic_surgery`
`plan_type`	no	Plan filter when the payer has multiple books
`state`	no	Two-letter. Also inferred from `ccn`
`place_of_service`	no	POS code
`visit_count`	no	Threshold-based payers
`ccn`	no	Fills state/POS from the facility and applies facility overrides

The response is a determination plus a rationale chain (code → range → category → payer default). Pass ccn when the facility is registered so overrides apply.

Documentation and vendors

curl "https://api-dev.rcintell.com/v1/prior-auth/documentation/uhc/27447" \
  -H "X-API-Key: kp_test_..."

curl "https://api-dev.rcintell.com/v1/prior-auth/requirements/uhc" \
  -H "X-API-Key: kp_test_..."

curl "https://api-dev.rcintell.com/v1/prior-auth/vendors" \
  -H "X-API-Key: kp_test_..."

Use documentation when you already know PA is required and need the packet. Use vendors when the payer delegates (e.g. radiology UM).

MCP

Tool	REST
`check_pa_required`	`GET /v1/prior-auth/check` (pass `ccn`, `state`, `plan_type`, `place_of_service` when you have them)
`get_pa_documentation`	`GET /v1/prior-auth/documentation/{payer}/{code}`
`find_pa_vendor`	`GET /v1/prior-auth/vendors`