Seeking Supporting Information

Seeking supporting information related to an original request (pre-auth or claim)

If a payer requires supporting information or documentation from the provider or beneficiary for pre-auth or claim adjudication, the payer can utilise the communication API pair to initiate and fulfil the data exchange. The communication reason codes for getting supporting information are outlined in the HCX IG.

The typical workflow for stakeholders to seek and share the required supporting information during pre-auth is as follows :

Following subsection provide details of the seeking beneficiary consent use case.