Skip to content
Merged
Show file tree
Hide file tree
Changes from all commits
Commits
File filter

Filter by extension

Filter by extension

Conversations
Failed to load comments.
Loading
Jump to
Jump to file
Failed to load files.
Loading
Diff view
Diff view
3 changes: 2 additions & 1 deletion SUMMARY.md
Original file line number Diff line number Diff line change
Expand Up @@ -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)
Expand Down
7 changes: 7 additions & 0 deletions docs/api-reference/configuration-resources/README.md
Original file line number Diff line number Diff line change
@@ -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.
Original file line number Diff line number Diff line change
Expand Up @@ -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 `<base>/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

Expand Down
2 changes: 1 addition & 1 deletion docs/prior-auth/pas.md
Original file line number Diff line number Diff line change
Expand Up @@ -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.

Expand Down
4 changes: 2 additions & 2 deletions docs/prior-auth/um-integration.md
Original file line number Diff line number Diff line change
Expand Up @@ -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

Expand Down Expand Up @@ -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)
30 changes: 30 additions & 0 deletions docs/releases.md
Original file line number Diff line number Diff line change
Expand Up @@ -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).
Expand Down
Loading