Assess prior authorization packet readiness

Endpoint: POST /api/v1/prior-auth/readiness

Availability: Live in production.

Authentication: API key in Authorization: Bearer <key> with the read scope.

Assesses clinical documentation against payer documentation requirements using one batched TypeSafe AI (Jev) call: a probability judgment per requirement, a documentation-quality score, and an overall verdict. Requirements between confidence thresholds are marked uncertain and returned as gaps to investigate. Returns 503 (SERVER_UNAVAILABLE) when TypeSafe is not configured and approved for sensitive data, and 400 (PHI_NOT_ALLOWED) when documentation or requirement text contains patient identifiers.

Parameters

• documentation_requirements (body, required): Payer documentation requirements, shaped like prior-auth research output.
• clinical_documentation (body, required): De-identified clinical documentation text. Must not contain PHI.
• payer (body): Optional payer label.
• procedure_codes (body): Optional CPT or HCPCS procedure codes for context.

Example request

curl -X POST "https://backworkhealth.com/api/v1/prior-auth/readiness" \
  -H "Authorization: Bearer $BACKWORK_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{
  "documentation_requirements": [
    {
      "requirement": "string",
      "mandatory": true
    }
  ],
  "clinical_documentation": "string"
}'

Example response (200)

{
  "success": true,
  "data": {
    "verdict": "ready",
    "requirements": [
      {
        "requirement": "string",
        "mandatory": true,
        "probability": 0,
        "status": "satisfied"
      }
    ],
    "gaps": [
      {
        "requirement": "string",
        "mandatory": true,
        "probability": 0,
        "status": "violated"
      }
    ],
    "documentation_quality": {
      "score": 0,
      "confidence": 0,
      "legend": {}
    },
    "model": "string"
  },
  "meta": {
    "request_id": "string",
    "timestamp": "2026-01-15T10:30:00Z"
  }
}

curl -X POST "https://example.com/prior-auth/readiness" \  -H "Content-Type: application/json" \  -d '{    "documentation_requirements": [      {        "requirement": "string",        "mandatory": true      }    ],    "clinical_documentation": "string"  }'

{  "success": true,  "data": {    "verdict": "ready",    "requirements": [      {        "requirement": "string",        "mandatory": true,        "probability": 0,        "status": "satisfied"      }    ],    "gaps": [      {        "requirement": "string",        "mandatory": true,        "probability": 0,        "status": "violated"      }    ],    "documentation_quality": {      "score": 0,      "confidence": 0,      "legend": {        "property1": "string",        "property2": "string"      }    },    "model": "string"  },  "meta": {    "request_id": "string",    "timestamp": "2019-08-24T14:15:22Z"  }}

Last updated on