Operon proxies and measures UM decisions across the plan's PA vendors and internal review queues, exposing a conformant 278-equivalent FHIR surface.
Operon's Prior Authorization API capability surface vs Da Vinci PAS IG latest published. Verified 2026-05-10.
| Resource | Profile | Read | Search | Write | Notes |
|---|---|---|---|---|---|
| Claim | PAS Claim | Yes | Yes | Yes | PA submission |
| ClaimResponse | PAS ClaimResponse | Yes | Yes | No | |
| ServiceRequest | PAS ServiceRequest | Yes | Yes | Yes | |
| Coverage | CARIN BB Coverage | Yes | Yes | No | |
| Patient | US Core Patient | Yes | Yes | No | |
| Practitioner | US Core Practitioner | Yes | Yes | No |
Primary IG
Companion IGs
Authentication
OAuth 2.0 with system-to-system client-credentials flow between provider EHR and payer.
Supported FHIR Operations
POST /Claim/$submitPOST /Claim/$inquireGET /ClaimResponse/{id} Operon publishes a CapabilityStatement aligned to Da Vinci PAS IG. The current version ships in the Operon CMS-0057-F Testing Spec; a hosted metadata endpoint follows in v2.
The exact paths your testing partners hit. Each scenario maps to a concrete request shape, expected response, conformance checkpoints, and the readiness metric Operon emits.
Scenario 1
POST Claim with $submit operationScenario 2
POST $inquire with claim correlation idScenario 3
CRD service requestScenario 4
GET Questionnaire + POST QuestionnaireResponseScenario 5
POST Claim with priority codeScenario 6
POST ClaimWhat's Provisioned
Six PA scenarios spanning medical and pharmacy lines, expedited and standard SLAs, approval and denial paths, with CRD/DTR companion artifacts.
Sample bundle excerpts are included in the Operon CMS-0057-F Testing Spec PDF. Full bundles are loaded into your sandbox tenant when your testing window is provisioned.
Step 1
Submit org type, role, this API selection, target window, and system-of-record context.
Step 2
Provisioned within 2 business days; 60-minute joint kickoff confirms scenarios, conformance targets, and success criteria.
Step 3
1 to 4 weeks of live testing with daily conformance and latency telemetry, ending in a public-reporting-ready conformance and readiness report.
End-of-Engagement Report
Per-scenario conformance vs Da Vinci PAS, CRD, and DTR, SLA-clock report, denial-reason alignment report, and a pre-filled CMS public-reporting metric template.
Readiness Metrics Emitted
CARIN BB IG v2.0.0
Members access their claims, EOBs, encounters, and clinical data through authorized apps.
View Patient Access API Details →Da Vinci PDex Provider Access IG latest published
Providers under attribution agreement pull clinical, claims, and encounter data via group-based bulk export.
View Provider Access API Details →Da Vinci PDex Payer-to-Payer IG latest published
Concurrent and prior payers exchange member historical data via $member-match and historical bundle handoff.
View Payer-to-Payer API Details →Da Vinci CRD IG v2.0.1 / v2.1.0 / v2.2.1 concurrent
Plans expose CDS Hooks services so a provider EHR can surface prior-authorization requirements at order entry or order-sign time, before the claim is submitted.
View Coverage Requirements Discovery (CRD) Details →Da Vinci DTR IG v2.0.1 / v2.1.0 / v2.2.0 concurrent (Standard + Adaptive)
Plans expose payer-defined Questionnaires (Standard and Adaptive) that the provider EHR can launch from a CRD card, pre-populate from clinical data, and attach to the subsequent PA Claim.
View Document Templates and Rules (DTR) Details →30 minutes with our team. We'll ask about the systems you already run, where you are on the CMS-0057-F calendar, and what testing you need to ship.