diff --git a/SUMMARY.md b/SUMMARY.md index 0e7b063..b1cab40 100644 --- a/SUMMARY.md +++ b/SUMMARY.md @@ -46,7 +46,8 @@ * [Implementation Guides](api-reference/implementation-guides.md) * [Authentication](api-reference/authentication.md) * [Resources](api-reference/resources.md) - * [UMTenantConfig](api-reference/um-tenant-config.md) + * [Configuration resources](api-reference/configuration-resources/README.md) + * [UMTenantConfig](api-reference/configuration-resources/um-tenant-config.md) * [Operations](api-reference/operations/README.md) * [FHIR RESTful API](api-reference/operations/fhir-restful-api.md) * [$provider-member-match](api-reference/operations/provider-member-match.md) diff --git a/docs/api-reference/configuration-resources/README.md b/docs/api-reference/configuration-resources/README.md new file mode 100644 index 0000000..82127e9 --- /dev/null +++ b/docs/api-reference/configuration-resources/README.md @@ -0,0 +1,7 @@ +--- +description: Administrative FHIR resources used to configure Payerbox. +--- + +# Configuration resources + +Administrative FHIR resources that configure Payerbox behavior. Access is governed by Aidbox access policies. diff --git a/docs/api-reference/um-tenant-config.md b/docs/api-reference/configuration-resources/um-tenant-config.md similarity index 99% rename from docs/api-reference/um-tenant-config.md rename to docs/api-reference/configuration-resources/um-tenant-config.md index acf2040..fa15b0c 100644 --- a/docs/api-reference/um-tenant-config.md +++ b/docs/api-reference/configuration-resources/um-tenant-config.md @@ -6,11 +6,11 @@ description: Configuration resource that connects a payer to its utilization man Custom resource that configures forwarding of Prior Auth submissions to a payer's utilization management (UM) system. Its `StructureDefinition` is registered by Payerbox at startup; instances are managed over the FHIR REST API at `/fhir/UMTenantConfig`. -One instance per payer per UM system. Instances are re-read about once a minute, so changes apply without a restart. Narrative overview: [UM System Integration](../prior-auth/um-integration.md). +One instance per payer per UM system. Instances are re-read about once a minute, so changes apply without a restart. Narrative overview: [UM System Integration](../../prior-auth/um-integration.md). ## Authentication -`UMTenantConfig` is an administrative resource — access is governed by the same Aidbox access policies as any other resource, and is not part of the PAS partner-facing scope set. See [Authentication](authentication.md). +`UMTenantConfig` is an administrative resource — access is governed by the same Aidbox access policies as any other resource, and is not part of the PAS partner-facing scope set. See [Authentication](../authentication.md). ## Routing diff --git a/docs/prior-auth/pas.md b/docs/prior-auth/pas.md index 07f0dc4..2c7ec5f 100644 --- a/docs/prior-auth/pas.md +++ b/docs/prior-auth/pas.md @@ -87,7 +87,7 @@ Lenient mode is intended for sandbox and onboarding environments, where trading ## 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 and writes the decision back onto the same `ClaimResponse`. Forwarding is enabled per payer with a [`UMTenantConfig`](../api-reference/um-tenant-config.md) resource; with no matching config the request is stored and stays `queued`. +After `Claim/$submit` returns the queued `ClaimResponse`, Payerbox forwards the request to the payer's utilization management (UM) system for adjudication and writes the decision back onto the same `ClaimResponse`. Forwarding is enabled per payer with a [`UMTenantConfig`](../api-reference/configuration-resources/um-tenant-config.md) resource; with no matching config the request is stored and stays `queued`. See [UM System Integration](um-integration.md) for the connectors, the delivery lifecycle and its limitations. diff --git a/docs/prior-auth/um-integration.md b/docs/prior-auth/um-integration.md index 5047830..25b9cf1 100644 --- a/docs/prior-auth/um-integration.md +++ b/docs/prior-auth/um-integration.md @@ -6,7 +6,7 @@ description: Forwarding PAS prior authorization requests to the payer's utilizat Payerbox does not adjudicate. [`Claim/$submit`](../api-reference/operations/claim-submit.md) validates and stores the request, returns a `ClaimResponse` with `outcome = "queued"`, and forwards it to the payer's utilization management (UM) system, which produces the authoritative decision. Payerbox writes that decision back onto the same `ClaimResponse`, where [`Claim/$inquire`](../api-reference/operations/claim-inquire.md) and [Event Notifications](event-notifications.md) pick it up. -Forwarding is enabled per payer by a [`UMTenantConfig`](../api-reference/um-tenant-config.md) resource. With no matching config, Payerbox stores the request and returns `queued` — the UM leg is simply skipped. +Forwarding is enabled per payer by a [`UMTenantConfig`](../api-reference/configuration-resources/um-tenant-config.md) resource. With no matching config, Payerbox stores the request and returns `queued` — the UM leg is simply skipped. ## What Payerbox covers @@ -80,6 +80,6 @@ An `invalid` tenant is excluded from routing — its Claims are stored and retur ## Related -- [`UMTenantConfig`](../api-reference/um-tenant-config.md) — full element reference and examples +- [`UMTenantConfig`](../api-reference/configuration-resources/um-tenant-config.md) — full element reference and examples - [PAS](pas.md), [`Claim/$submit`](../api-reference/operations/claim-submit.md), [`Claim/$inquire`](../api-reference/operations/claim-inquire.md) - [Compliance / CMS-0057](../compliance/cms-0057.md) diff --git a/docs/releases.md b/docs/releases.md index 1f0958e..4c44507 100644 --- a/docs/releases.md +++ b/docs/releases.md @@ -6,6 +6,36 @@ description: "Notable changes across Payerbox: the Interop APIs, the Prior Auth This page tracks notable changes across Payerbox: the Interop APIs, the Prior Auth (ePA) APIs, and the FHIR App Portal. Releases are listed newest first. The apps run on an Aidbox FHIR server; each component heading links to its image on Docker Hub. +## July 2026 (`2607`) + +### Interop APIs [`2607`](https://hub.docker.com/r/healthsamurai/interop) + +**Payer-to-Payer and Provider Access** + +- [`$davinci-data-export`](api-reference/operations/davinci-data-export.md) now removes remittance and enrollee cost-sharing data from exported `ExplanationOfBenefit` and `Coverage` resources. All money elements are removed — including totals, payments, benefit balances, item/detail/subdetail/addItem prices and amounts, adjudication amounts, `costToBeneficiary`, and `subrogation` — while clinical and administrative content, extensions, and contained resources are retained. Filtered resources are tagged `SUBSETTED`. See [Payer-to-Payer](interop-apis/payer-to-payer.md) and [Provider Access](interop-apis/provider-access.md). + +### Prior Auth (ePA) APIs [`2607`](https://hub.docker.com/r/healthsamurai/prior-auth) + +**PAS** + +- Prior authorization requests can now be routed to an external utilization management (UM) system according to `Claim.insurer`. The `pas-passthrough` connector forwards requests to any conformant Da Vinci PAS delegate, using its `Claim/$submit` and `Claim/$inquire` endpoints, preserving request identifiers and preventing duplicate submissions during retries. Configure the delivery path with [`UMTenantConfig`](api-reference/configuration-resources/um-tenant-config.md). See [UM System Integration](prior-auth/um-integration.md) and [PAS](prior-auth/pas.md). +- Added an integration with HealthEdge GuidingCare for PAS decisioning. The `guidingcare` connector uses GuidingCare's REST API and payer-configured `ConceptMap` crosswalks to translate requests and decisions. See [UM System Integration](prior-auth/um-integration.md#choosing-a-connector) and [`UMTenantConfig`](api-reference/configuration-resources/um-tenant-config.md). +- Configurable lenient FHIR validation can treat display-name and referenced-resource profile mismatches as warnings. Structural, profile, and missing-reference errors remain blocking. See [PAS validation strictness](prior-auth/pas.md#validation-strictness). + +**CRD** + +- Configurable lenient FHIR validation can tolerate hook-context references that exist only in the EHR and cannot be resolved by Payerbox. See [CRD validation strictness](prior-auth/crd.md#validation-strictness). + +**Analytics** + +- The PAS metrics SQL-on-FHIR package (`io.healthsamurai.pas-metrics` 0.1.2) is available on request. Contact us to receive the package, which includes 10 `ViewDefinition` resources and 15 `Library` resources implementing metrics suggested by the PAS Implementation Guide. See [Analytics](analytics/README.md), [flat views](analytics/flat-views.md), and [SQL on FHIR data](analytics/sql-on-fhir.md). + +### FHIR App Portal [`2607`](https://hub.docker.com/r/healthsamurai/fhir-app-portal) + +- MPF pipeline configuration supports publishing the provider-directory `index.json` file. See [MPF Pipeline](run-payerbox/provider-directory-pipeline.md) and the [MPF endpoint reference](api-reference/operations/mpf-pipeline-api.md). +- The app-detail page now includes a **Policies and legal links** card for the developer's privacy policy and terms of service. Missing values are marked **Not provided**, and apps requesting patient data without a privacy policy display a warning. See [Admin Portal](fhir-app-portal/admin-portal.md). +- When declining an app, an administrator can add a free-text note alongside the preset reason; developers see both on the declined app. See [Admin Portal](fhir-app-portal/admin-portal.md). + ## June 2026 (`2606`) A new `payerbox` umbrella Helm chart deploys the full stack (portals, Interop APIs, Prior Auth, and Aidbox) to Kubernetes. See [Deploy](run-payerbox/deploy.md).