Salesforce Health Cloud Developer Guide
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Care Services Review and Response
These RESTful APIs support data elements required for ANSI X12 278 format Health Care
Services Review and Response. Also referred to as ANSI 278 Authorization APIs, they enable payer
organizations to electronically receive prior authorization requests and referral requests from
providers. Other users of these APIs can be healthcare providers, payers, plan sponsors, or other
entities involved in health care services review, such as clearinghouses.
| User Permissions Needed | |
|---|---|
| To access care services APIs | Health Cloud Utilization Management Permission Set |
These APIs facilitate communication between two parties for the following cases:
- Appeals
- Drug Requests
- Admissions
- Healthcare Service Requests
- Referrals
- Complaints
- Grievances
- Create or Update Care Services Review Requests
- Depending on the type of care service review request (drug request, prior authorization, and so on), and the content of the request body, this API creates one or more records for Case, CareRequest, CareRequestExtension, CareRequestDrug, CareRequestItem, or CareRequestDiagnosis..
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The following diagram shows what happens when you make a POST request to this API, to create a care services review request.
- Get Care Services Review Responses
- You can get Care Services Review Response for one or more care service review requests, by either using their Salesforce IDs or external source system IDs. Use section query parameter to have granular filters. Some examples of valid values in section are, Subscriber, Patient, CareDiagnoses, CareRequestItems, CareRequestDrugs, TransportLocations, CareRequest, or CareRequestCase.