Authorizations Out Integration Point
The Authorization Out Integration Point supports:
-
receiving a request for information on an Authorization
-
responding to that request by sending information on that Authorization through a response message.
Oracle Health Insurance Authorizations, as a source system for authorizations, detects when an authorization reaches the status 'APPROVED' or 'DENIED' and then maintains a log of these changes. The target system, for example Claims, actively monitors this log and decides on requesting more detailed information on the event. If more information is required the target system sends a request to the Oracle Health Insurance Authorizations resource that is exposed for this purpose. The resource then returns a response message to the target system of the authorization as is; because version information is restricted to Oracle Health Insurance Authorizations, this is not sent out. The target system will process the information to update its database.
Request
Each request is for a single authorization. This Integration Point does not enable the handling of multiple requests ('File Based Import' ) in one go.
Use the URI /authorizations/{id} to send in a request for information on the authorization with a specific id for example "/authorizations/1234". The id is the primary key reference of the authorization.
Failure Message
If the authorization is not found the HTTP API service sends a response message with the error message AUT-IP-AUTO-001 "Authorization id \{} is unknown"
Response Message
If the authorization is found the HTTP API service sends an authorization response message in the following structure:
<authorization
code=""
authorizationType=""
formCode=""
brandCode=""
requesterRelationCode=""
providerGroupScope=""
serviceSpecialtyCode=""
requesterAuthorizationReference=""
startDate=""
endDate=""
status=""
requestedRenewalReference=""
requestedRenewalPeriodLength=""
requestedRenewalPeriodUnitOfMeasure=""
renewalReference=""
renewalPeriodLength=""
renewalPeriodUnitOfMeasure=""
requestedNumberOfUnits=""
requestedServiceDays=""
authorizedNumberOfUnits=""
authorizedServiceDays=""
indOverrideCoverLimits=""
internalRemarks=""
dataAccessGroupCode=""
>
<insurableEntityType.usageName
code=""
/>
<requestedAmount
currency="">
{value}
</requestedAmount>
<authorizedAmount
currency="">
{value}
</authorizedAmount>
<requesterProvider
flexCodeDefinitionCode="" code="" />
<!-- </requestedBy>-->
<serviceProvider
flexCodeDefinitionCode="" code="" />
<locationProvider
flexCodeDefinitionCode="" code="" />
<authorizationBasketList>
<authorizationBasket
code=""
startDate=""
endDate=""
/>
...
</authorizationBasketList>
<authorizationServiceTypeList>
<authorizationServiceType
code=""
/>
...
</authorizationServiceTypeList>
<authorizationLineList>
<authorizationLine
code=""
startDate=""
endDate=""
procedureGroupCode=""
requestedRenewalReference=""
requestedRenewalPeriodLength=""
requestedRenewalPeriodUnitOfMeasure=""
renewalReference=""
renewalPeriodLength=""
renewalPeriodUnitOfMeasure=""
requestedNumberOfUnits=""
requestedServiceDays=""
authorizedNumberOfUnits=""
authorizedServiceDays=""
>
<requestedAmount
currency="">
{value}
</requestedAmount>
<authorizedAmount
currency="">
{value}
</authorizedAmount>
<procedure
flexCodeDefinitionCode=""
code=""
/>
</authorizationLine>
...
</authorizationLineList>
<authorizationDiagnosisList>
<authorizationDiagnosis>
<diagnosis
flexCodeDefinitionCode="" code="" />
</authorizationDiagnosis>
...
</authorizationDiagnosisList>
<authorizationMessageList>
<authorizationMessage
code=""
indInherit=""
value0=""
value1=""
value2=""
value3=""
value4=""
value5=""
value6=""
value7=""
value8=""
value9=""
/>
...
</authorizationMessageList>
</authorization>
Requester
The requester is the person or organization or provider requesting the authorization for services. Therefore only the requesterRelationCode or the <requesterProvider> element will be filled.
Insurable Entity
The insurable entity is the person or object for which the authorization is requested. If the insurable entity is of insurable entity type PERSON, the insurable entity code is filled with the relation code. If the insurable entity is of insurable entity type OBJECT#, the insurable entity code is filled with the insurable object code.
Authorization Messages
Only authorization messages with the Processing Indicator = No are included.
A given implementation of the Oracle Health Insurance application could have dynamic fields and records added to entities that need to be interfaced. For details on how external interfaces can provide values for dynamic fields and records in request messages and how they are handled by the Oracle Health Insurance application, refer to the concepts in the Configuration Guide. This IP only supports the migration of dynamic fields for the Authorization, the Authorization Basket, the Authorization Line, the Authorization Diagnosis and the Authorization Service Type and dynamic records for the Authorization and Authorization Line.