Managed Care Authorization Tracking — Integration Documentation

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Overview

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Integration Points

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Platform Foundation Dependencies

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Same-Core Dependencies

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Cross-Core References

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Event Contracts

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Events Published

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Events Consumed

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API Contracts

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Edge Functions

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Validation API (pm-auth-claim-validation)

{
  claim_id: string;
  claim_lines: Array<{
    line_number: number;
    date_of_service: string;
    units: number;
    service_type: string;
  }>;
  organization_id: string;
}

{
  valid: boolean;
  results: Array<{
    line_number: number;
    status: 'pass' | 'fail';
    reason?: string;
    authorization_id?: string;
  }>;
}

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Platform Layer Usage

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Permission Keys

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Data Flow Diagram

PM-10 (PA Request)
  └── pm_prior_authorizations (approved)
       └── PM-47: pm_managed_care_authorizations (prior_auth_id FK)
            ├── Dashboard: expiration countdown, remaining units
            ├── Alerts: PF-10 notifications at 14/7/3/1 days
            ├── Concurrent reviews: pm_auth_concurrent_reviews
            ├── Retro-auth: structured workflow
            ├── Auth denial appeals: pm_auth_denial_appeals
            └── Validation gate → PM-08 claim submission
                 └── pm.claim.posted → used_units increment

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Validation Checklist

• All integration points documented
• Event contracts have payload schemas
• API contracts have request/response schemas
• Platform layer usage documented
• Permission keys listed
• Integration tests planned (see spec Testing Strategy)

• Spec: specs/pm/specs/PM-47-managed-care-authorization-tracking.md
• PM-10 Integration: docs/architecture/integrations/PM-10-prior-authorization-management-INTEGRATION.md
• PM-08 Integration: docs/architecture/integrations/PM-08-claims-management-submission-INTEGRATION.md
• PM-29 Integration: docs/architecture/integrations/PM-29-claims-denial-management-appeals-INTEGRATION.md
• PF-96 Integration: docs/architecture/integrations/PF-96-medicaid-state-compliance-configuration-INTEGRATION.md