Webhook for PA (Pre Authorization) Requests

This document details the webhook payload that providers/EMRs receive whenever an insurer either approves or rejects a PA (Pre Authorization) request created by them.

Note

This feature is not generally available. Providers must reach out to the customer support team or the insurer to have it enabled. The insurer will add the provider's webhook URL to their dashboard to activate this feature.

Payload Structure

The payload sent to the provider's webhook URL is a JSON object with the following structure:

{
  "status": "approved/declined",
  "id_from_insurer": "string",
  "ref": "string",
  "pa_total_amount": "number",
  "pa_approved_amount": "number",
  "code": "string",
  "created_at": "datetime",
  "opened_at": "datetime",
  "closed_at": "datetime",
  "diagnoses": {
    "icd_code_1": "diagnosis_name_1",
    "icd_code_2": "diagnosis_name_2"
  },
  "services": ["service_name_1", "service_name_2"],
  "hmo": {
    "name": "string",
    "code": "string"
  },
  "floating_enrollee": "(optional, an object containing the floating enrollee details submitted)",
  "enrollee_insurance_no": "string (optional)",
  "enrollee_full_name": "string (optional, only if the enrollee is not a floating enrollee)",
  "reject_reason": "string (optional, only if status is declined)"
}

Payload Description

Field	Type	Description
status	string	The status of the PA request. It can be either Approved or Declined.
id_from_insurer	string	The unique identifier for the PA request assigned by the insurer.
ref	string	The reference/identifier passed when creating the PA request.
pa_total_amount	number	The total amount requested for the PA.
pa_approved_amount	number	The amount approved by the insurer.
code	string	The unique PA request code.
created_at	datetime	The datetime when the PA request was created.
opened_at	datetime	The datetime when the PA request was opened.
closed_at	datetime	The datetime when the PA request was closed.
diagnoses	object	An object containing the ICD codes and corresponding diagnosis names.
services	array	An array of strings, containing the names of each service requested in the PA request.
hmo.name	string	The name of the HMO/Insurer the PA request was created to
hmo.code	string	The code of the HMO/Insurer the PA request was created to
floating_enrollee	object	(Optional) If the PA request is for a floating enrollee, this field contains the details.
enrollee_insurance_no	string	(Optional) The insurance number of the enrollee if it's not a floating enrollee
enrollee_full_name	string	(Optional) The full name of the enrollee if it's not a floating enrollee
reject_reason	string	(Optional) The reason for rejection, provided only if the status is declined.

Example Payload

Here is an example of a webhook payload for an approved PA request:

{
  "status": "Approved",
  "id_from_insurer": "12345",
  "ref": "yourRef",
  "pa_total_amount": 5000,
  "pa_approved_amount": 4500,
  "code": "PA123456",
  "created_at": "2024-07-29T12:34:56Z",
  "opened_at": "2024-07-29T13:00:00Z",
  "closed_at": "2024-07-29T14:00:00Z",
  "diagnoses": {
    "A01": "Typhoid fever",
    "B02": "Zoster [herpes zoster]"
  },
  "services": ["Consultation", "Lab Test"],
  "hmo": {
    "name": "Wayne HMO",
    "code": "BruceW"
  },
  "enrollee_insurance_no": "INS123456",
  "enrollee_full_name": "John Doe"
}

And here is an example of a webhook payload for a rejected PA request:

{
  "status": "Declined",
  "id_from_insurer": "12345",
  "ref": "yourRef",
  "pa_total_amount": 5000,
  "pa_approved_amount": 0,
  "code": null,
  "created_at": "2024-07-29T12:34:56Z",
  "opened_at": "2024-07-29T13:00:00Z",
  "closed_at": "2024-07-29T14:00:00Z",
  "diagnoses": {
    "A01": "Typhoid fever",
    "B02": "Zoster [herpes zoster]"
  },
  "services": ["Consultation", "Lab Test"],
  "hmo": {
    "name": "Wayne HMO",
    "code": "BruceW"
  },
  "enrollee_insurance_no": "INS123456",
  "enrollee_full_name": "John Doe",
  "reject_reason": "Insufficient documentation provided"
}