Prior Authorization (X12 278)
A 5-step recipe with Availity. We can help you get access.
Recipe · 5 steps
Prior Authorization (X12 278)
with Availity · Eligibility & Benefits Verification
Check if auth is required, create the X12 278 review, attach clinicals, and read the decision.
- Submit the inquiry that determines whether the payer requires authorization for the requested services.
- Retrieve the auth-required determination by its Availity transaction id.
- Create the X12 278 service review request for the requested services.
- Attach supporting clinical documentation to substantiate the service review.
- Read back the X12 278 service review to obtain the authorization decision.
What you'll need to have ready
- authCheckRequest: The inquiry packet used to determine whether the payer requires authorization for the requested services.
- serviceReview: The X12 278 service review request packet (payer, provider, subscriber, and requested services).
- attachment: The supporting clinical documentation submitted to substantiate the authorization request.
For your developer
Arazzo workflow availity:prior-authorization, 5 operations: checkIsAuthRequired → getIsAuthRequiredResult → postAvailityIntelligentPayerNetworkV1ServiceReviews → submitAuthAttachment → getServiceReview. Specs on APIs.io.