Carelon integration

Prepare Prior Auth Preview

Perform Prepare Prior Auth Preview through Carelon.

View as Markdown

carelon_preview_prior_auth

writecarelon

Inputs

first_name
expressionrequired
First Name
Required literal value or workflow expression.
source_order_id
expressionrequired
Source Order Id
Required literal value or workflow expression.
last_name
expressionrequired
Last Name
Required literal value or workflow expression.
member_number
expressionrequired
Member Number
Required literal value or workflow expression.
date_of_birth
expressionrequired
Date Of Birth
Required literal value or workflow expression.
date_of_service
expressionrequired
Date Of Service
Required literal value or workflow expression.
cpt_code
expressionrequired
Cpt Code
Required literal value or workflow expression.
icd_code
expressionrequired
Icd Code
Required literal value or workflow expression.
solution_card_id
expressionrequired
Solution Card Id
Required literal value or workflow expression.
ordering_npi
expressionrequired
Ordering Npi
Required literal value or workflow expression.
ordering_state
expression
Ordering State
Optional literal value or workflow expression.
ordering_match
expression
Ordering Match
Optional literal value or workflow expression.
substitute_missing_ordering_provider
boolean
Substitute Missing Ordering Provider
Optional true-or-false value.
Default: false
servicing_npi
expressionrequired
Servicing Npi
Required literal value or workflow expression.
servicing_state
expression
Servicing State
Optional literal value or workflow expression.
servicing_match
expression
Servicing Match
Optional literal value or workflow expression.
phone_type
expression
Phone Type
Optional literal value or workflow expression.
phone
expression
Phone
Optional literal value or workflow expression.
document_ids
expression
Document Ids
Optional literal value or workflow expression.
supplied_answers
repeatable_group
Supplied Answers
Optional list of structured items.
- question_text
  expressionrequired
  Question Text
  Required literal value or workflow expression.
- kind
  selectrequired
  Kind
  Required selected identifier or value.
  Options: Single choice ("single_choice"), Multi-select ("multi_select"), Value entry ("value_entry")
- expected_options
  expression
  Expected Options
  Optional literal value or workflow expression.
- select
  expression
  Select
  Optional literal value or workflow expression.
- value
  expression
  Value
  Optional literal value or workflow expression.

Outputs

successSuccess
failure_categoryFailure Category
outcomeOutcome
dry_runDry Run
is_authorizedIs Authorized
retryableRetryable
manual_reviewManual Review
unanswered_question_idUnanswered Question Id
unanswered_question_textUnanswered Question Text
unanswered_question_kindUnanswered Question Kind
unanswered_question_optionsUnanswered Question Options
unanswered_question_exclusive_optionsUnanswered Question Exclusive Options
answered_question_countAnswered Question Count
answer_trailAnswer Trail
configured_answer_countConfigured Answer Count
supplied_answer_countSupplied Answer Count
derived_answer_countDerived Answer Count
lowest_derived_confidenceLowest Derived Confidence
clinical_outcomesClinical Outcomes
provider_substitutionProvider Substitution
substituted_ordering_npiSubstituted Ordering Npi
routeRoute
errorError

Output schema completeness: best_effort_declared

Safety

External effect: write
Confirmation recommended: No
Retry safe: No
Dry run supported: No

Schemas

These schemas are first-pass authoring guidance. Runtime validation remains authoritative.

Input schema

{
  "type": "object",
  "required": [
    "first_name",
    "source_order_id",
    "last_name",
    "member_number",
    "date_of_birth",
    "date_of_service",
    "cpt_code",
    "icd_code",
    "solution_card_id",
    "ordering_npi",
    "servicing_npi"
  ],
  "properties": {
    "phone": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "cpt_code": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "icd_code": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "last_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "first_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "phone_type": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "document_ids": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "ordering_npi": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "date_of_birth": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "member_number": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "servicing_npi": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "ordering_match": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "ordering_state": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "date_of_service": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "servicing_match": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "servicing_state": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "source_order_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "solution_card_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "supplied_answers": {
      "type": "array",
      "items": {
        "type": "object",
        "required": [
          "question_text",
          "kind"
        ],
        "properties": {
          "kind": {
            "enum": [
              "single_choice",
              "multi_select",
              "value_entry"
            ],
            "type": "string",
            "description": "Required selected identifier or value.",
            "x-workflow-field-type": "select"
          },
          "value": {
            "description": "Optional literal value or workflow expression.",
            "x-workflow-field-type": "expression"
          },
          "select": {
            "description": "Optional literal value or workflow expression.",
            "x-workflow-field-type": "expression"
          },
          "question_text": {
            "description": "Required literal value or workflow expression.",
            "x-workflow-field-type": "expression"
          },
          "expected_options": {
            "description": "Optional literal value or workflow expression.",
            "x-workflow-field-type": "expression"
          }
        },
        "additionalProperties": false
      },
      "description": "Optional list of structured items.",
      "x-workflow-field-type": "repeatable_group"
    },
    "substitute_missing_ordering_provider": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "route": {},
    "dry_run": {},
    "outcome": {},
    "success": {},
    "retryable": {},
    "answer_trail": {},
    "is_authorized": {},
    "manual_review": {},
    "failure_category": {},
    "clinical_outcomes": {},
    "derived_answer_count": {},
    "provider_substitution": {},
    "supplied_answer_count": {},
    "unanswered_question_id": {},
    "answered_question_count": {},
    "configured_answer_count": {},
    "substituted_ordering_npi": {},
    "unanswered_question_kind": {},
    "unanswered_question_text": {},
    "lowest_derived_confidence": {},
    "unanswered_question_options": {},
    "unanswered_question_exclusive_options": {}
  },
  "additionalProperties": true
}

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