PACS Technology & Information Systems in Prior Authorization 3

Question 1

What is the purpose of the HL7 Da Vinci Prior Authorization Support (PAS) FHIR Implementation Guide?

Accepted Answer

To define FHIR-based workflows enabling providers to submit and manage PA requests directly from their EHR to payer systems

Answer

The Da Vinci PAS FHIR Implementation Guide defines standardized FHIR-based workflows that enable providers to submit, track, and manage prior authorization requests directly from EHR systems, improving interoperability with payer systems.

Question 2

Step therapy requirements managed through PA systems require providers to document what before a higher-cost treatment can be authorized?

Accepted Answer

That the patient tried and failed clinically appropriate lower-cost or preferred treatments before the alternative is authorized

Answer

Step therapy (fail-first) protocols managed through PA systems require providers to document that a patient has tried and not responded to first-line treatments before a payer will authorize a more expensive alternative therapy.

Question 3

What is the primary role of audit logging in prior authorization information systems?

Accepted Answer

To create a traceable, time-stamped record of all PA transactions for compliance, fraud detection, and accountability

Answer

Audit logging in PA systems creates a comprehensive, traceable record of all transactions — including submissions, reviews, decisions, and appeals — essential for regulatory compliance, fraud detection, and organizational accountability.

Question 4

Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), what are the required PA decision timeframes for impacted payers?

Accepted Answer

72 hours for urgent (expedited) requests and 7 calendar days for standard requests

Answer

CMS-0057-F requires impacted payers to provide PA decisions within 72 hours for urgent (expedited) requests and 7 calendar days for standard requests, and to include specific reasons when requests are denied.

Question 5

What is the purpose of a Prior Authorization Requirements, Documentation, and Decision (PARDD) API in PA technology systems?

Accepted Answer

To enable providers to query a payer's PA requirements, submit clinical documentation, and receive PA decisions electronically in real time

Answer

A PARDD API enables providers to query payer systems in real time for PA requirements, submit required clinical documentation electronically, and receive PA decisions — streamlining the entire prior authorization workflow from within their own systems.

(PACS) Prior Authorization Certified Specialist Practice Test

(PACS) Prior Authorization Certified Specialist Practice Test

PACS Technology & Information Systems in Prior Authorization 3