Tross
CoverMyMeds

Create prior authorization

Create prior authorization in CoverMyMeds

POSThttps://api.ontross.com/api/integrations/covermymeds/create-prior-authorization
Request Fields
input.idempotency_key
string
required
Stable UUID for this intended draft; reuse it only for retries.
Example
"3f2504e0-4f89-11d3-9a0c-0305e82c3301"
input.form_id
integer
required
Exact ePA form ID from list-prior-auth-forms.
Example
84217
input.request_form_id
string
required
Request form ID from the same candidate.
Example
"aetna-commercial-general"
input.drug_ddid
string
required
Exact medication identifier obtained from the live picker.
Example
"184521"
input.patient
object
required
Demographic and contact information for the individual receiving treatment.
input.patient.first_name
string
required
Given name from the individual's demographic record.
Example
"Avery"
input.patient.last_name
string
required
Family name from the individual's demographic record.
Example
"Ellison"
input.patient.date_of_birth
string
required
Calendar day the individual was born, formatted as YYYY-MM-DD.
Example
"1986-04-17"
input.patient.state
string
required
Two-letter postal abbreviation for the individual's residence.
Example
"MA"
input.patient.zip
string
required
Five-digit or nine-digit postal code for the individual's residence.
Example
"02139"
input.patient.middle_initial
string
Abbreviated additional given name from the demographic record.
Example
"M"
input.patient.sex
string
Demographic classification recorded for the individual receiving treatment.
Example
"Female"
input.patient.phone
string
Primary telephone contact for the individual receiving treatment.
Example
"617-555-0142"
input.patient.mobile
string
Cellular telephone contact for the individual receiving treatment.
Example
"617-555-0183"
input.patient.email
string
Electronic contact address for the individual receiving treatment.
Example
"avery.ellison@example.com"
input.patient.street
string
Residential address line containing building number and road.
Example
"123 Example Avenue"
input.patient.city
string
Municipality listed in the individual's residential address.
Example
"Cambridge"
input.coverage
object
required
Insurance details used to select the exact authorization template.
input.coverage.payer_name
string
Insurance organization or plan used for exact form selection.
Example
"Aetna"
input.coverage.bin
string
Pharmacy routing code used for exact form selection.
Example
"610502"
input.coverage.pcn
string
Processor routing code from the pharmacy insurance card.
Example
"MEDDADV"
input.coverage.rx_group
string
Pharmacy benefit grouping code from the insurance card.
Example
"RXEXAMPLE01"
input.coverage.benefit_type
string
Coverage category associated with the individual's insurance benefits.
Example
"Pharmacy"
input.coverage.member_id
string
Insured individual's identifier printed on the insurance card.
Example
"WEXAMPLE001"
input.coverage.member_number
string
Insured individual's enrollment number from the coverage record.
Example
"EXAMPLE009182"
input.coverage.medicare_id
string
Beneficiary identifier printed on the federal insurance card.
Example
"1EG4TE5MK73"
input.diagnosis
object
Clinical condition supporting the requested medication authorization.
input.diagnosis.icd10
string
Standard clinical classification code for the condition being treated.
Example
"L40.0"
input.diagnosis.description
string
Human-readable clinical condition associated with the supplied classification code.
Example
"Psoriasis vulgaris"
input.ndc
string
National medication product code for the prescribed package.
Example
"00074055402"
input.prescriber_npi
string
Ten-digit national identifier for the clinician ordering treatment.
Example
"9999999995"
auth_id
string
required
Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.
Example
"00000000-0000-4000-8000-000000000000"
Output Fields
request_key
string
Portal identifier for the newly created authorization draft.
Example
"BEXAMPLE"
form_id
integer
Numeric template identifier associated with the created draft.
Example
84217
workflow_status
string
Portal stage reported for the created authorization draft.
Example
"draft"
lock_version
integer
Revision counter associated with the returned authorization draft.
Example
1
next_action
string
Required follow-up step for completing the created draft.
Example
"fill_request"
replayed
boolean
Whether this result came from an earlier identical operation.
Example
false
Code
curl --request POST \
  --url https://api.ontross.com/api/integrations/covermymeds/create-prior-authorization \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"idempotency_key":"3f2504e0-4f89-11d3-9a0c-0305e82c3301","form_id":84217,"request_form_id":"aetna-commercial-general","drug_ddid":"184521","patient":{"first_name":"Avery","last_name":"Ellison","date_of_birth":"1986-04-17","state":"MA","zip":"02139","middle_initial":"M","sex":"Female","phone":"617-555-0142","mobile":"617-555-0183","email":"avery.ellison@example.com","street":"123 Example Avenue","city":"Cambridge"},"coverage":{"payer_name":"Aetna","bin":"610502","pcn":"MEDDADV","rx_group":"RXEXAMPLE01","benefit_type":"Pharmacy","member_id":"WEXAMPLE001","member_number":"EXAMPLE009182","medicare_id":"1EG4TE5MK73"},"diagnosis":{"icd10":"L40.0","description":"Psoriasis vulgaris"},"ndc":"00074055402","prescriber_npi":"9999999995"},"auth_id":"auth_uuid_here"}'
Request BODY
{
  "input": {
    "idempotency_key": "3f2504e0-4f89-11d3-9a0c-0305e82c3301",
    "form_id": 84217,
    "request_form_id": "aetna-commercial-general",
    "drug_ddid": "184521",
    "patient": {
      "first_name": "Avery",
      "last_name": "Ellison",
      "date_of_birth": "1986-04-17",
      "state": "MA",
      "zip": "02139",
      "middle_initial": "M",
      "sex": "Female",
      "phone": "617-555-0142",
      "mobile": "617-555-0183",
      "email": "avery.ellison@example.com",
      "street": "123 Example Avenue",
      "city": "Cambridge"
    },
    "coverage": {
      "payer_name": "Aetna",
      "bin": "610502",
      "pcn": "MEDDADV",
      "rx_group": "RXEXAMPLE01",
      "benefit_type": "Pharmacy",
      "member_id": "WEXAMPLE001",
      "member_number": "EXAMPLE009182",
      "medicare_id": "1EG4TE5MK73"
    },
    "diagnosis": {
      "icd10": "L40.0",
      "description": "Psoriasis vulgaris"
    },
    "ndc": "00074055402",
    "prescriber_npi": "9999999995"
  },
  "auth_id": "auth_uuid_here"
}
Response BODY
{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "request_key": "BEXAMPLE",
    "form_id": 84217,
    "workflow_status": "draft",
    "lock_version": 1,
    "next_action": "fill_request",
    "replayed": false
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}