Referral authorization

The Referral authorization feature allows the user to interface with a patient's authorizations and referrals. Authorizations and referrals are attached to specific patient insurance policies; multiple authorizations and referrals can be added to a specific policy. Authorizations and referrals are identified using an authorization or referral number. Currently, PreCertification authorizations are not available via POST and PUT.

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Endpoints

Submit referral-authorizations

POST
/v1/{practiceid}/patients/{patientid}/referralauths
Adds new referral authorizations for a specific patient
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Input Parameters

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❙ required

practiceid integer practiceid
patientid integer patientid
Content-Type string Content type of the payload

❙ Request Body

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appointmentids array The appointment ID associated with this authorization.
departmentid integer The department ID associated with this authorization.
expirationdate string The expiration date of when the referral authorization is valid.
icd10diagnosiscodes array The ICD10 codes associated with this referral authorization.
icd9diagnosiscodes array The ICD9 codes associated with this referral authorization.
insuranceid integer The athena patient insurance ID.
noreferralrequired boolean If set to true, then the insurance authorization number is not required.
note string The note attached to this referral authorization.
notestoprovider string The notes for the provider.
procedurecodes array The procedure codes (CPT) associated with this referral authorization. Procedure Codes should be given in double quotes only. Example: ["00770","15000,AS","0147T"]
referralauthnumber string The referral authorization number. This input can by bypassed with the NOREFERRALREQUIRED parameter.
referringproviderid integer The athena referring provider ID associated with this authorization.
specifiesvisits boolean Determines whether or not this authorization specifies visits.
startdate string The start date of when the referral authorization is valid.
visitsapproved integer The number of visits approved by this authorization.
visitsleft integer The number of visits remaining from this authorization.

Output Parameters

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referralauthid integer The ID of the referral authorization created.
success string True if the API was successfully processed.
Example Code

Get referral-authorizations

GET
/v1/{practiceid}/patients/{patientid}/referralauths
Retrieves the list of authorizations and referrals for a specific patient
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Input Parameters

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❙ required

practiceid integer practiceid
patientid integer patientid
insuranceid integer The insurance ID.
showexpired boolean If set, results will include expired authorizations/referrals. This defaults to false.
limit integer Number of entries to return (default 1000, max 10000)Please note that this endpoint has a different default and max than normal.
offset integer Starting point of entries; 0-indexed

Output Parameters

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ansinamecode string This is the ANSI name and code for this referring provider's specialty.
ansispecialtycode string The ANSI specialty code for this referring provider.
appointmentids array The appointment ID associated with this authorization.
diagnosiscode string The diagnosis code(s).
enddate string The date the authorization/referral is no longer effective.
expired string Flag that specifies whether or not the authorization/referral is expired.
icd10diagnosiscode string The ICD-10 diagnosis code(s).
noreferralrequired string If set to true, then the insurance authorization number is not required.
note string The note attached to the authorization/referral.
notestoprovider string The notes for the provider.
procedurecode string The procedure code(s).
referralauthid integer The referral/authorization ID.
referralauthnumber string The referral authorization number. If this is passed in, then the REFERRINGPROVIDERID is required. This input can by bypassed with the NOREFERRALREQUIRED parameter.
referralauthtype string Determines whether the form is an AUTHORIZATION or REFERRAL.
referralauthunits string The unit (VISITS, UNITS) of count for this authorization/referral.
referredtoproviderid integer The referred-to provider ID.
referringproviderid integer The referring provider ID.
specialty string A friendly name for this provider's specialty.
specialtyid integer The specialty ID.
startdate string The starting date the authorization/referral is effective.
visitsapproved integer The number of visits/units approved. Please see field REFERRALAUTHUNITS for the type.
visitsleft integer The number of visits/units remaining. Please see field REFERRALAUTHUNITS for the type.
Example Code

Update single referral-authorization

PUT
/v1/{practiceid}/patients/{patientid}/referralauths/{referralauthid}
Modifies an existing record for specific referral authorizations
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Input Parameters

Expand all

❙ required

referralauthid integer referralauthid
practiceid integer practiceid
patientid integer patientid
Content-Type string Content type of the payload

❙ Request Body

Expand all
appointmentids array The appointment ID associated with this authorization. Any appointment IDs updated will add on to the list of associated appointments.
departmentid integer The department ID associated with this authorization.
expirationdate string The expiration date of when the referral authorization is valid.
icd10diagnosiscodes array The ICD10 codes associated with this referral authorization. Any updates will replace the current ICD10 diagnosis codes. Updates to ICD10DIAGNOSISCODES must also be made in tandem with ICD9DIAGNOSISCODES. IF ICD9 codes are not passed in along, existing ones will be removed
icd9diagnosiscodes array The ICD9 codes associated with this referral authorization. Any updates will replace the current ICD9 diagnosis codes. Updates to ICD9DIAGNOSISCODES must also be made in tandem with ICD10DIAGNOSISCODES. If ICD10 codes are not passed in along, existing ones will be removed.
insuranceid integer The athena patient insurance ID.
noreferralrequired boolean If set to true, then the insurance authorization number is not required.
notes string The note attached to this referral authorization.
notestoprovider string The notes for the provider.
procedurecodes array The procedure codes (CPT) associated with this referral authorization. Any updates will replace the current procedure codes. Procedure Codes should be given in double quotes only. Example: ["00770","15000,AS","0147T"]
referralauthnumber string The referral authorization number. If this is passed in, then the REFERRINGPROVIDERID is required. This input can by bypassed with the NOREFERRALREQUIRED parameter.
referringproviderid integer The athena referring provider ID associated with this authorization. Required if REFERRALAUTHNUMBER is passed in.
startdate string The start date of when the referral authorization is valid.
visits boolean Determines whether or not this authorization specifies visits.
visitsapproved integer The number of visits approved by this authorization.
visitsleft integer The number of visits remaining from this authorization.

Output Parameters

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referralauthid integer The ID of the referral authorization created.
success string True if the API was successfully processed.
Example Code