Prior Authorization using CDS Hooks and SMART on FHIR
summary
A reference implementation that automates prior authorization using CDS Hooks and SMART on FHIR plus HL7 DaVinci guides, with three components: a Prior Authorization Determination Service (CDS Hooks API), a SMART-on-FHIR submission app that prefetches and pre-fills patient data into a FHIR Questionnaire and bundles a FHIR Claim, and a payer-side prior auth adjudication service. Prototype runs containerized on GCP Kubernetes, returns near‑real‑time claim responses (often pending for human review), and includes adapters to translate to X12/NCPDP and API mediation for multi‑payer scaling.
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chapters (5)
- 0:00Automating prior authorization
- 1:21Architecture components
- 4:21Reference implementation
- 6:31Clinical workflow demo
- 10:51Q&A and conclusion
