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10 changes: 10 additions & 0 deletions docs/prior-auth/crd.md
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Expand Up @@ -49,6 +49,16 @@ CDS_ENABLED_HOOKS=order-sign-crd,order-select-crd

Valid ids are `order-sign-crd`, `order-select-crd`, `order-dispatch-crd`, `appointment-book-crd`; matching is case-insensitive. Default (unset) — all four hooks are exposed.

## Validation strictness

Hook-context resources (context and prefetch content) are validated before they reach the Decision Service. By default validation is strict: any error-level finding fails the hook request.

```
FHIR_VALIDATION_LENIENT=true
```

In lenient mode, terminology display-name mismatches, referenced-resource profile mismatches, and context references that cannot be resolved (the referenced resources may exist only in the EHR's own store) are logged as warnings and the hook proceeds; only structural and profile errors fail the request. Default (unset) — strict. The same flag also controls [PAS submission validation](pas.md#validation-strictness).

## Supported hooks

| Hook | When it fires | Reference |
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14 changes: 14 additions & 0 deletions docs/prior-auth/pas.md
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Expand Up @@ -71,6 +71,20 @@ Accept: application/json

Full Bundle profiles, all parameters, and edge cases: [Claim/$submit](../api-reference/operations/claim-submit.md). For status checks and attachment workflows: [Claim/$inquire](../api-reference/operations/claim-inquire.md), [$submit-attachment](../api-reference/operations/submit-attachment.md).

## Validation strictness

Every `Claim/$submit` Bundle is validated against the Da Vinci PAS profiles before anything is persisted. By default validation is strict: any error-level finding rejects the submission with `422` and an `OperationOutcome` listing all findings.

Operators can relax this per deployment:

```
FHIR_VALIDATION_LENIENT=true
```

In lenient mode, findings that do not affect the integrity of the submission — terminology display-name mismatches and referenced-resource profile mismatches — are logged as warnings instead of rejecting the request, and a `422` response body carries only the blocking findings. Structural errors, profile violations, and references to resources missing from the Bundle still reject the submission.

Lenient mode is intended for sandbox and onboarding environments, where trading partners iterate on their payloads and cosmetic findings should not block end-to-end testing. Keep production deployments strict. Default (unset) — strict. The same flag also controls [CRD hook-context validation](crd.md#validation-strictness).

## Forwarding to the payer's UM system

After `Claim/$submit` returns the queued `ClaimResponse`, Payerbox forwards the request to the payer's utilization management (UM) system for adjudication. Forwarding is configured per payer with a `UMTenantConfig` resource: incoming Claims are routed by matching `Claim.insurer` against the tenant's insurer reference or identifier, queued as a FHIR `Task`, and delivered by a background worker with retries.
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