> For clean Markdown of any page, append .md to the page URL. > For a complete documentation index, see https://docs.taigabilling.com/llms.txt. > For AI client integration (Claude Code, Cursor, etc.), connect to the MCP server at https://docs.taigabilling.com/_mcp/server. # Create a managed prior authorization POST https://api.taigabilling.com/api/prior-authorizations/v1 Content-Type: application/json Queues a managed prior-authorization request for review and payer-portal submission. A 202 response means the request was received; it does not mean it was submitted to the payer. Reference: https://docs.taigabilling.com/api-reference/prior-authorizations/create-prior-authorization ## Authentication - `Authorization` header (bearer token, required) — Send your Taiga API key as a Bearer token. Create and manage keys in the Taiga developer portal. ## Servers - `https://api.taigabilling.com` (Production, default) - `https://api-staging.taigabilling.com` (Staging) ## Request ### Body (application/json) This endpoint expects a PriorAuthorizationCreate. - `PriorAuthorizationCreate` - `service_type`: `COMMUNITY_SUPPORTS` (Community Supports referral) - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `ecm_enrollment` (boolean, required) — Whether the member is enrolled in Enhanced Care Management. - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `services` (list of PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsServicesItems, required) — One entry per Community Support requested for this member. - `caregiver` (PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsCaregiver, optional) — Caregiver contact, when the member has one. - `clinical_notes` (string, optional) - `contact` (PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsContact, optional) — Clinic authorization contact for questions about this request. - `ordering_provider` (PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsOrderingProvider, optional) — Ordering clinician. This may be outside the partner organization's NPI scope. - `payer_specific_fields` (map from string to PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsPayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsPreviousAuthorization, optional) - `referring_provider` (PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsReferringProvider, optional) — Referring clinician. This may be outside the partner organization's NPI scope. - `request_type` (enum, optional, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `requesting_provider_npi` (string, optional) — NPI of the provider requesting the authorization. Optional at intake. When absent, a clinic-configured default requesting provider is used if one exists; ordering, referring, rendering, and billing providers are distinct roles and are never substituted. Without an explicit value or a configured default the request transitions to NEEDS_INFORMATION when the clinic runs its Availity readiness review. - `supporting_documents` (list of PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsSupportingDocumentsItems, optional) — Existing uploaded document IDs, typed to the payer's Community Supports attachment kinds. Upload the file first exactly as for a therapy request. - `test_mode` (boolean, optional) — Marks this as a test request. Test requests are never submitted to a payer or added to Taiga's review queue, and they can use the test-status endpoint to generate real webhook events. - `urgency` (enum, optional, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `urgency_reason` (string, optional) - `service_type`: `OCCUPATIONAL_THERAPY` (Outpatient therapy request) - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationTherapyCreatePlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationTherapyCreateServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `clinical_information` (PriorAuthorizationTherapyCreateClinicalInformation, optional) — Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION. - `clinical_notes` (string, optional) - `contact` (PriorAuthorizationTherapyCreateContact, optional) — Clinic authorization contact for questions about this request. - `ordering_provider` (PriorAuthorizationTherapyCreateOrderingProvider, optional) — Ordering clinician. This may be outside the partner organization's NPI scope. - `payer_specific_fields` (map from string to PriorAuthorizationTherapyCreatePayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationTherapyCreatePreviousAuthorization, optional) - `referring_provider` (PriorAuthorizationTherapyCreateReferringProvider, optional) — Referring clinician. This may be outside the partner organization's NPI scope. - `request_type` (enum, optional, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `requesting_provider_npi` (string, optional) — NPI of the provider requesting the authorization. Optional at intake. When absent, a clinic-configured default requesting provider is used if one exists; ordering, referring, rendering, and billing providers are distinct roles and are never substituted. Without an explicit value or a configured default the request transitions to NEEDS_INFORMATION when the clinic runs its Availity readiness review. - `supporting_documents` (list of PriorAuthorizationTherapyCreateSupportingDocumentsItems, optional, default: []) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, optional) — Marks this as a test request. Test requests are never submitted to a payer or added to Taiga's review queue, and they can use the test-status endpoint to generate real webhook events. - `therapy_attestations` (PriorAuthorizationTherapyCreateTherapyAttestations, optional, default: {}) - `urgency` (enum, optional, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `urgency_reason` (string, optional) - `service_type`: `OTHER` (Outpatient therapy request) - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationTherapyCreatePlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationTherapyCreateServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `clinical_information` (PriorAuthorizationTherapyCreateClinicalInformation, optional) — Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION. - `clinical_notes` (string, optional) - `contact` (PriorAuthorizationTherapyCreateContact, optional) — Clinic authorization contact for questions about this request. - `ordering_provider` (PriorAuthorizationTherapyCreateOrderingProvider, optional) — Ordering clinician. This may be outside the partner organization's NPI scope. - `payer_specific_fields` (map from string to PriorAuthorizationTherapyCreatePayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationTherapyCreatePreviousAuthorization, optional) - `referring_provider` (PriorAuthorizationTherapyCreateReferringProvider, optional) — Referring clinician. This may be outside the partner organization's NPI scope. - `request_type` (enum, optional, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `requesting_provider_npi` (string, optional) — NPI of the provider requesting the authorization. Optional at intake. When absent, a clinic-configured default requesting provider is used if one exists; ordering, referring, rendering, and billing providers are distinct roles and are never substituted. Without an explicit value or a configured default the request transitions to NEEDS_INFORMATION when the clinic runs its Availity readiness review. - `supporting_documents` (list of PriorAuthorizationTherapyCreateSupportingDocumentsItems, optional, default: []) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, optional) — Marks this as a test request. Test requests are never submitted to a payer or added to Taiga's review queue, and they can use the test-status endpoint to generate real webhook events. - `therapy_attestations` (PriorAuthorizationTherapyCreateTherapyAttestations, optional, default: {}) - `urgency` (enum, optional, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `urgency_reason` (string, optional) - `service_type`: `PHYSICAL_THERAPY` (Outpatient therapy request) - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationTherapyCreatePlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationTherapyCreateServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `clinical_information` (PriorAuthorizationTherapyCreateClinicalInformation, optional) — Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION. - `clinical_notes` (string, optional) - `contact` (PriorAuthorizationTherapyCreateContact, optional) — Clinic authorization contact for questions about this request. - `ordering_provider` (PriorAuthorizationTherapyCreateOrderingProvider, optional) — Ordering clinician. This may be outside the partner organization's NPI scope. - `payer_specific_fields` (map from string to PriorAuthorizationTherapyCreatePayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationTherapyCreatePreviousAuthorization, optional) - `referring_provider` (PriorAuthorizationTherapyCreateReferringProvider, optional) — Referring clinician. This may be outside the partner organization's NPI scope. - `request_type` (enum, optional, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `requesting_provider_npi` (string, optional) — NPI of the provider requesting the authorization. Optional at intake. When absent, a clinic-configured default requesting provider is used if one exists; ordering, referring, rendering, and billing providers are distinct roles and are never substituted. Without an explicit value or a configured default the request transitions to NEEDS_INFORMATION when the clinic runs its Availity readiness review. - `supporting_documents` (list of PriorAuthorizationTherapyCreateSupportingDocumentsItems, optional, default: []) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, optional) — Marks this as a test request. Test requests are never submitted to a payer or added to Taiga's review queue, and they can use the test-status endpoint to generate real webhook events. - `therapy_attestations` (PriorAuthorizationTherapyCreateTherapyAttestations, optional, default: {}) - `urgency` (enum, optional, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `urgency_reason` (string, optional) - `service_type`: `SPEECH_THERAPY` (Outpatient therapy request) - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationTherapyCreatePlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationTherapyCreateServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `clinical_information` (PriorAuthorizationTherapyCreateClinicalInformation, optional) — Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION. - `clinical_notes` (string, optional) - `contact` (PriorAuthorizationTherapyCreateContact, optional) — Clinic authorization contact for questions about this request. - `ordering_provider` (PriorAuthorizationTherapyCreateOrderingProvider, optional) — Ordering clinician. This may be outside the partner organization's NPI scope. - `payer_specific_fields` (map from string to PriorAuthorizationTherapyCreatePayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationTherapyCreatePreviousAuthorization, optional) - `referring_provider` (PriorAuthorizationTherapyCreateReferringProvider, optional) — Referring clinician. This may be outside the partner organization's NPI scope. - `request_type` (enum, optional, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `requesting_provider_npi` (string, optional) — NPI of the provider requesting the authorization. Optional at intake. When absent, a clinic-configured default requesting provider is used if one exists; ordering, referring, rendering, and billing providers are distinct roles and are never substituted. Without an explicit value or a configured default the request transitions to NEEDS_INFORMATION when the clinic runs its Availity readiness review. - `supporting_documents` (list of PriorAuthorizationTherapyCreateSupportingDocumentsItems, optional, default: []) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, optional) — Marks this as a test request. Test requests are never submitted to a payer or added to Taiga's review queue, and they can use the test-status endpoint to generate real webhook events. - `therapy_attestations` (PriorAuthorizationTherapyCreateTherapyAttestations, optional, default: {}) - `urgency` (enum, optional, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `urgency_reason` (string, optional) ## Response ### 200 Idempotent replay - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationPlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `request_type` (enum, required, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `service_type` (enum, required, default: PHYSICAL_THERAPY) - Allowed values: `PHYSICAL_THERAPY`, `OCCUPATIONAL_THERAPY`, `SPEECH_THERAPY`, `OTHER` - `supporting_documents` (list of PriorAuthorizationSupportingDocumentsItems, required) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, required) - `urgency` (enum, required, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `created_at` (datetime, required) - `id` (string, required) - `last_status_at` (datetime, required) - `payer_id` (string, required) - `payer_name` (string, required) - `status` (enum, required) - Allowed values: `RECEIVED`, `NEEDS_INFORMATION`, `READY_FOR_REVIEW`, `AUTHORIZATION_NOT_REQUIRED`, `SUBMITTED`, `PENDING_PAYER`, `APPROVED`, `PARTIALLY_APPROVED`, `DENIED`, `CANCELLED` - `updated_at` (datetime, required) - `clinical_information` (PriorAuthorizationClinicalInformation, optional, nullable) - `clinical_notes` (string, optional, nullable) - `contact` (PriorAuthorizationContact, optional, nullable) - `ordering_provider` (PriorAuthorizationOrderingProvider, optional, nullable) - `payer_specific_fields` (map from string to PriorAuthorizationPayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationPreviousAuthorization, optional, nullable) - `referring_provider` (PriorAuthorizationReferringProvider, optional, nullable) - `requesting_provider_npi` (string, optional, nullable) - `therapy_attestations` (PriorAuthorizationTherapyAttestations, optional, default: {}) - `urgency_reason` (string, optional, nullable) - `approved_unit_type` (string, optional, nullable) - `approved_units` (integer, optional, nullable) - `authorized_service_lines` (list of PriorAuthorizationAuthorizedServiceLinesItems, optional) - `determined_at` (datetime, optional, nullable) - `effective_date` (date, optional, nullable) - `expiration_date` (date, optional, nullable) - `plan_name` (string, optional, nullable) - `plan_type` (string, optional, nullable) - `portal_reference_number` (string, optional, nullable) - `prior_authorization_number` (string, optional, nullable) - `requirements_checked_at` (datetime, optional, nullable) - `status_message` (string, optional, nullable) - `submission_channel` (enum, optional, nullable) - Allowed values: `PORTAL`, `PHONE`, `FAX`, `API`, `OTHER` - `submission_destination` (string, optional, nullable) - `submitted_at` (datetime, optional, nullable) ### 202 Request received - `billing_provider_npi` (string, required) - `coverage_id` (string, required) — Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage. - `diagnosis_codes` (list of string, required) - `external_id` (string, required) — Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409. - `patient_id` (string, required) - `place_of_service_code` (string, required) — Two-digit CMS place-of-service code for the requested care. - `plan_of_care` (PriorAuthorizationPlanOfCare, required) — Requested treatment window, visits, frequency, and evaluation date. - `rendering_provider_npi` (string, required) — Rendering therapist NPI. This NPI must be in the partner organization's scope. - `request_type` (enum, required, default: INITIAL) — REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode. - Allowed values: `INITIAL`, `REAUTHORIZATION`, `MODIFICATION`, `RETROSPECTIVE` - `service_facility_id` (string, required) - `service_lines` (list of PriorAuthorizationServiceLinesItems, required) — Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request. - `service_type` (enum, required, default: PHYSICAL_THERAPY) - Allowed values: `PHYSICAL_THERAPY`, `OCCUPATIONAL_THERAPY`, `SPEECH_THERAPY`, `OTHER` - `supporting_documents` (list of PriorAuthorizationSupportingDocumentsItems, required) — Existing uploaded document IDs with semantic types. Upload the file first: POST /images/v1 returns an id, a version and a signed\_url; PUT the bytes to that signed\_url; then PUT /images/v1/\{id}/\{version} with status UPLOADED, where the version segment is the current version plus 1 (so 1 for a freshly created image). Use the image id as document\_id. Documents are optional at intake; missing payer-required documents produce NEEDS\_INFORMATION. - `test_mode` (boolean, required) - `urgency` (enum, required, default: ROUTINE) — URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met. - Allowed values: `ROUTINE`, `URGENT` - `created_at` (datetime, required) - `id` (string, required) - `last_status_at` (datetime, required) - `payer_id` (string, required) - `payer_name` (string, required) - `status` (enum, required) - Allowed values: `RECEIVED`, `NEEDS_INFORMATION`, `READY_FOR_REVIEW`, `AUTHORIZATION_NOT_REQUIRED`, `SUBMITTED`, `PENDING_PAYER`, `APPROVED`, `PARTIALLY_APPROVED`, `DENIED`, `CANCELLED` - `updated_at` (datetime, required) - `clinical_information` (PriorAuthorizationClinicalInformation, optional, nullable) - `clinical_notes` (string, optional, nullable) - `contact` (PriorAuthorizationContact, optional, nullable) - `ordering_provider` (PriorAuthorizationOrderingProvider, optional, nullable) - `payer_specific_fields` (map from string to PriorAuthorizationPayerSpecificFields, optional, default: {}) — Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga. - `previous_authorization` (PriorAuthorizationPreviousAuthorization, optional, nullable) - `referring_provider` (PriorAuthorizationReferringProvider, optional, nullable) - `requesting_provider_npi` (string, optional, nullable) - `therapy_attestations` (PriorAuthorizationTherapyAttestations, optional, default: {}) - `urgency_reason` (string, optional, nullable) - `approved_unit_type` (string, optional, nullable) - `approved_units` (integer, optional, nullable) - `authorized_service_lines` (list of PriorAuthorizationAuthorizedServiceLinesItems, optional) - `determined_at` (datetime, optional, nullable) - `effective_date` (date, optional, nullable) - `expiration_date` (date, optional, nullable) - `plan_name` (string, optional, nullable) - `plan_type` (string, optional, nullable) - `portal_reference_number` (string, optional, nullable) - `prior_authorization_number` (string, optional, nullable) - `requirements_checked_at` (datetime, optional, nullable) - `status_message` (string, optional, nullable) - `submission_channel` (enum, optional, nullable) - Allowed values: `PORTAL`, `PHONE`, `FAX`, `API`, `OTHER` - `submission_destination` (string, optional, nullable) - `submitted_at` (datetime, optional, nullable) ## Errors ### 400 Bad Request Error The request could not be completed. - `message` (string, required) ### 401 Unauthorized Error The request could not be completed. - `message` (string, required) ### 404 Not Found Error The request could not be completed. - `message` (string, required) ### 409 Conflict Error The request could not be completed. - `message` (string, required) ### 503 Service Unavailable Error The request could not be completed. - `message` (string, required) ## Types ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsServicesItems - `chronic_conditions` (list of enum, required) — Nutrition-sensitive chronic condition categories. NONE cannot be combined with a named condition. - Allowed values: `DIABETES`, `CONGESTIVE_HEART_FAILURE`, `STROKE`, `CHRONIC_LUNG_DISORDERS`, `HIV`, `CANCER`, `GESTATIONAL_DIABETES_OR_HIGH_RISK_PERINATAL`, `CHRONIC_OR_DISABLING_MENTAL_BEHAVIORAL_HEALTH`, `OTHER`, `NONE` - `discharge_or_high_risk` (boolean, required) — Being discharged from a hospital or skilled nursing facility, or at high risk of hospitalization or nursing facility placement. - `extensive_care_coordination_needs` (boolean, required) - `mtm_types` (list of enum, required) — NUTRITION_EDUCATION is an add-on and cannot be the only value. - Allowed values: `HOME_DELIVERED_MEALS`, `VOUCHERS`, `BOX`, `NUTRITION_EDUCATION` - `service` (enum, required) - Allowed values: `MEDICALLY_TAILORED_MEALS` ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsCaregiver Caregiver contact, when the member has one. - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsContact Clinic authorization contact for questions about this request. - `name` (string, required) - `email` (string, optional) - `fax` (string, optional) - `phone` (string, optional) ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsOrderingProvider Ordering clinician. This may be outside the partner organization's NPI scope. - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsPayerSpecificFields - string - double - boolean - any - list of any ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsPreviousAuthorization - `prior_authorization_number` (string, required) - `approved_visits` (integer, optional) - `effective_date` (date, optional) - `expiration_date` (date, optional) - `used_visits` (integer, optional) ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsReferringProvider Referring clinician. This may be outside the partner organization's NPI scope. - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationCreateDiscriminatorMappingCommunitySupportsSupportingDocumentsItems - `document_id` (string, required) - `document_type` (enum, required) - Allowed values: `OFFICE_NOTES_DX`, `SN_DISCHARGE_PLAN`, `SUPPORTING_DOC`, `DISCHARGE_PAPERWORK`, `MEDICATION_TREATMENT_ORDERS` - `title` (string, optional) ### PriorAuthorizationTherapyCreatePlanOfCare Requested treatment window, visits, frequency, and evaluation date. - `end_date` (date, required) - `evaluation_date` (date, required) - `frequency` (PriorAuthorizationTherapyCreatePlanOfCareFrequency, required) - `requested_visits` (integer, required) — Total visits requested for the plan of care. This is the plan-level request and is never divided or copied across service lines; it is inherited by a service line only when the request has exactly one line with unit_type VISITS and no requested_units. - `start_date` (date, required) - `frequency_notes` (string, optional) ### PriorAuthorizationTherapyCreateServiceLinesItems - `procedure_code` (string, required) - `end_date` (date, optional) - `frequency` (string, optional) - `modifiers` (list of string, optional, default: []) - `place_of_service_code` (string, optional) - `requested_units` (integer, optional) — Requested quantity for this service line. Optional at intake; payers that authorize per service line require it on every line before submission. Sole exception: a request with exactly one service line whose unit_type is VISITS inherits plan_of_care.requested_visits. With multiple lines the plan total is never divided or copied — missing values result in a NEEDS_INFORMATION status naming the affected procedure codes when the clinic runs its Availity readiness review. - `start_date` (date, optional) - `unit_type` (enum, optional, default: VISITS) — Unit of the requested quantity. VISITS and UNITS have verified payer-portal quantity codes; other values are accepted at intake but produce a NEEDS_INFORMATION status when the clinic runs its Availity readiness review before submission. - Allowed values: `VISITS`, `UNITS`, `DAYS`, `PROCEDURES`, `OTHER` ### PriorAuthorizationTherapyCreateClinicalInformation Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION. - `accident_date` (date, optional) - `accident_state` (string, optional) - `accident_type` (enum, optional) - Allowed values: `AUTO`, `EMPLOYMENT`, `OTHER` - `body_regions` (list of string, optional) - `clinical_summary` (string, optional) - `comorbidities` (list of string, optional) - `cva_date` (date, optional) - `functional_limitations` (list of string, optional) - `home_exercise_program` (string, optional) - `laterality` (enum, optional) - Allowed values: `LEFT`, `RIGHT`, `BILATERAL`, `NOT_APPLICABLE` - `medical_necessity_rationale` (string, optional) - `objective_findings` (string, optional) - `onset_date` (date, optional) - `prior_treatments_and_response` (string, optional) - `prognosis` (string, optional) - `progress_summary` (string, optional) - `standardized_tests` (list of PriorAuthorizationTherapyCreateClinicalInformationStandardizedTestsItems, optional) - `surgery_date` (date, optional) - `surgery_procedure` (string, optional) - `treatment_goals` (list of string, optional) ### PriorAuthorizationTherapyCreateContact Clinic authorization contact for questions about this request. - `name` (string, required) - `email` (string, optional) - `fax` (string, optional) - `phone` (string, optional) ### PriorAuthorizationTherapyCreateOrderingProvider Ordering clinician. This may be outside the partner organization's NPI scope. - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationTherapyCreatePayerSpecificFields - string - double - boolean - any - list of any ### PriorAuthorizationTherapyCreatePreviousAuthorization - `prior_authorization_number` (string, required) - `approved_visits` (integer, optional) - `effective_date` (date, optional) - `expiration_date` (date, optional) - `used_visits` (integer, optional) ### PriorAuthorizationTherapyCreateReferringProvider Referring clinician. This may be outside the partner organization's NPI scope. - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationTherapyCreateSupportingDocumentsItems - `document_id` (string, required) - `document_type` (enum, required) - Allowed values: `INITIAL_EVALUATION`, `PLAN_OF_CARE`, `PHYSICIAN_ORDER`, `PROGRESS_NOTE`, `OUTCOME_MEASURE`, `IEP`, `IMAGING_REPORT`, `OPERATIVE_REPORT`, `OTHER` - `title` (string, optional) ### PriorAuthorizationTherapyCreateTherapyAttestations - `ordering_provider_approved_plan_of_care` (boolean, optional) - `ordering_provider_will_be_notified_at_discharge` (boolean, optional) - `plan_of_care_reviewed_with_patient` (boolean, optional) - `school_iep_unavailable_reason` (string, optional) ### PriorAuthorizationPlanOfCare Requested treatment window, visits, frequency, and evaluation date. - `end_date` (date, required) - `evaluation_date` (date, required) - `frequency` (PriorAuthorizationPlanOfCareFrequency, required) - `requested_visits` (integer, required) — Total visits requested for the plan of care. This is the plan-level request and is never divided or copied across service lines; it is inherited by a service line only when the request has exactly one line with unit_type VISITS and no requested_units. - `start_date` (date, required) - `frequency_notes` (string, optional) ### PriorAuthorizationServiceLinesItems - `procedure_code` (string, required) - `end_date` (date, optional) - `frequency` (string, optional) - `modifiers` (list of string, optional, default: []) - `place_of_service_code` (string, optional) - `requested_units` (integer, optional) — Requested quantity for this service line. Optional at intake; payers that authorize per service line require it on every line before submission. Sole exception: a request with exactly one service line whose unit_type is VISITS inherits plan_of_care.requested_visits. With multiple lines the plan total is never divided or copied — missing values result in a NEEDS_INFORMATION status naming the affected procedure codes when the clinic runs its Availity readiness review. - `start_date` (date, optional) - `unit_type` (enum, optional, default: VISITS) — Unit of the requested quantity. VISITS and UNITS have verified payer-portal quantity codes; other values are accepted at intake but produce a NEEDS_INFORMATION status when the clinic runs its Availity readiness review before submission. - Allowed values: `VISITS`, `UNITS`, `DAYS`, `PROCEDURES`, `OTHER` ### PriorAuthorizationSupportingDocumentsItems - `document_id` (string, required) - `document_type` (enum, required) - Allowed values: `INITIAL_EVALUATION`, `PLAN_OF_CARE`, `PHYSICIAN_ORDER`, `PROGRESS_NOTE`, `OUTCOME_MEASURE`, `IEP`, `IMAGING_REPORT`, `OPERATIVE_REPORT`, `OTHER` - `title` (string, optional) ### PriorAuthorizationClinicalInformation - `accident_date` (date, optional) - `accident_state` (string, optional) - `accident_type` (enum, optional) - Allowed values: `AUTO`, `EMPLOYMENT`, `OTHER` - `body_regions` (list of string, optional) - `clinical_summary` (string, optional) - `comorbidities` (list of string, optional) - `cva_date` (date, optional) - `functional_limitations` (list of string, optional) - `home_exercise_program` (string, optional) - `laterality` (enum, optional) - Allowed values: `LEFT`, `RIGHT`, `BILATERAL`, `NOT_APPLICABLE` - `medical_necessity_rationale` (string, optional) - `objective_findings` (string, optional) - `onset_date` (date, optional) - `prior_treatments_and_response` (string, optional) - `prognosis` (string, optional) - `progress_summary` (string, optional) - `standardized_tests` (list of PriorAuthorizationClinicalInformationStandardizedTestsItems, optional) - `surgery_date` (date, optional) - `surgery_procedure` (string, optional) - `treatment_goals` (list of string, optional) ### PriorAuthorizationContact - `name` (string, required) - `email` (string, optional) - `fax` (string, optional) - `phone` (string, optional) ### PriorAuthorizationOrderingProvider - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationPayerSpecificFields - string - double - boolean - any - list of any ### PriorAuthorizationPreviousAuthorization - `prior_authorization_number` (string, required) - `approved_visits` (integer, optional) - `effective_date` (date, optional) - `expiration_date` (date, optional) - `used_visits` (integer, optional) ### PriorAuthorizationReferringProvider - `npi` (string, required) - `contact_name` (string, optional) - `fax` (string, optional) - `name` (string, optional) - `phone` (string, optional) ### PriorAuthorizationTherapyAttestations - `ordering_provider_approved_plan_of_care` (boolean, optional) - `ordering_provider_will_be_notified_at_discharge` (boolean, optional) - `plan_of_care_reviewed_with_patient` (boolean, optional) - `school_iep_unavailable_reason` (string, optional) ### PriorAuthorizationAuthorizedServiceLinesItems - `approved_units` (integer, required) - `procedure_code` (string, required) - `unit_type` (enum, required) - Allowed values: `VISITS`, `UNITS`, `DAYS`, `PROCEDURES`, `OTHER` - `effective_date` (date, optional) - `expiration_date` (date, optional) - `modifiers` (list of string, optional) ### PriorAuthorizationTherapyCreatePlanOfCareFrequency - `count` (integer, required) - `period` (enum, required) - Allowed values: `WEEK`, `MONTH` ### PriorAuthorizationTherapyCreateClinicalInformationStandardizedTestsItems - `name` (string, required) - `result` (string, required) - `date` (date, optional) ### PriorAuthorizationPlanOfCareFrequency - `count` (integer, required) - `period` (enum, required) - Allowed values: `WEEK`, `MONTH` ### PriorAuthorizationClinicalInformationStandardizedTestsItems - `name` (string, required) - `result` (string, required) - `date` (date, optional) ## Examples ### Community Supports referral **Request** ```json { "service_type": "COMMUNITY_SUPPORTS", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "ecm_enrollment": false, "external_id": "cs-referral-123", "patient_id": "patient_xxx", "services": [ { "chronic_conditions": [ "DIABETES" ], "discharge_or_high_risk": false, "extensive_care_coordination_needs": false, "mtm_types": [ "HOME_DELIVERED_MEALS", "NUTRITION_EDUCATION" ], "service": "MEDICALLY_TAILORED_MEALS" } ], "caregiver": { "name": "Adult child", "phone": "9165550143" }, "contact": { "name": "Referral Team", "email": "referrals@example.com", "phone": "9165550122" }, "supporting_documents": [ { "document_id": "image_xxx", "document_type": "OFFICE_NOTES_DX" } ] } ``` **Response** ```json { "billing_provider_npi": "string", "coverage_id": "string", "diagnosis_codes": [ "string" ], "external_id": "string", "patient_id": "string", "place_of_service_code": "string", "plan_of_care": { "end_date": "2023-01-15", "evaluation_date": "2023-01-15", "frequency": { "count": 1, "period": "WEEK" }, "requested_visits": 1, "start_date": "2023-01-15", "frequency_notes": "string" }, "rendering_provider_npi": "string", "request_type": "INITIAL", "service_facility_id": "string", "service_lines": [ { "procedure_code": "string", "end_date": "2023-01-15", "frequency": "string", "modifiers": [ "string" ], "place_of_service_code": "string", "requested_units": 1, "start_date": "2023-01-15", "unit_type": "VISITS" } ], "service_type": "PHYSICAL_THERAPY", "supporting_documents": [ { "document_id": "string", "document_type": "INITIAL_EVALUATION", "title": "string" } ], "test_mode": true, "urgency": "ROUTINE", "created_at": "2024-01-15T09:30:00Z", "id": "string", "last_status_at": "2024-01-15T09:30:00Z", "payer_id": "string", "payer_name": "string", "status": "RECEIVED", "updated_at": "2024-01-15T09:30:00Z", "clinical_information": { "accident_date": "2023-01-15", "accident_state": "string", "accident_type": "AUTO", "body_regions": [ "string" ], "clinical_summary": "string", "comorbidities": [ "string" ], "cva_date": "2023-01-15", "functional_limitations": [ "string" ], "home_exercise_program": "string", "laterality": "LEFT", "medical_necessity_rationale": "string", "objective_findings": "string", "onset_date": "2023-01-15", "prior_treatments_and_response": "string", "prognosis": "string", "progress_summary": "string", "standardized_tests": [ { "name": "string", "result": "string", "date": "2023-01-15" } ], "surgery_date": "2023-01-15", "surgery_procedure": "string", "treatment_goals": [ "string" ] }, "clinical_notes": "string", "contact": { "name": "string", "email": "string", "fax": "string", "phone": "string" }, "ordering_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "payer_specific_fields": {}, "previous_authorization": { "prior_authorization_number": "string", "approved_visits": 1, "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "used_visits": 1 }, "referring_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "requesting_provider_npi": "string", "therapy_attestations": { "ordering_provider_approved_plan_of_care": true, "ordering_provider_will_be_notified_at_discharge": true, "plan_of_care_reviewed_with_patient": true, "school_iep_unavailable_reason": "string" }, "urgency_reason": "string", "approved_unit_type": "string", "approved_units": 1, "authorized_service_lines": [ { "approved_units": 1, "procedure_code": "string", "unit_type": "VISITS", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "modifiers": [ "string" ] } ], "determined_at": "2024-01-15T09:30:00Z", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "plan_name": "string", "plan_type": "string", "portal_reference_number": "string", "prior_authorization_number": "string", "requirements_checked_at": "2024-01-15T09:30:00Z", "status_message": "string", "submission_channel": "PORTAL", "submission_destination": "string", "submitted_at": "2024-01-15T09:30:00Z" } ``` **SDK Code** ```python Community Supports referral import requests url = "https://api.taigabilling.com/api/prior-authorizations/v1" payload = { "service_type": "COMMUNITY_SUPPORTS", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "ecm_enrollment": False, "external_id": "cs-referral-123", "patient_id": "patient_xxx", "services": [ { "chronic_conditions": ["DIABETES"], "discharge_or_high_risk": False, "extensive_care_coordination_needs": False, "mtm_types": ["HOME_DELIVERED_MEALS", "NUTRITION_EDUCATION"], "service": "MEDICALLY_TAILORED_MEALS" } ], "caregiver": { "name": "Adult child", "phone": "9165550143" }, "contact": { "name": "Referral Team", "email": "referrals@example.com", "phone": "9165550122" }, "supporting_documents": [ { "document_id": "image_xxx", "document_type": "OFFICE_NOTES_DX" } ] } headers = { "Authorization": "Bearer ", "Content-Type": "application/json" } response = requests.post(url, json=payload, headers=headers) print(response.json()) ``` ### Community Supports referral **Request** ```json { "service_type": "COMMUNITY_SUPPORTS", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "ecm_enrollment": false, "external_id": "cs-referral-123", "patient_id": "patient_xxx", "services": [ { "chronic_conditions": [ "DIABETES" ], "discharge_or_high_risk": false, "extensive_care_coordination_needs": false, "mtm_types": [ "HOME_DELIVERED_MEALS", "NUTRITION_EDUCATION" ], "service": "MEDICALLY_TAILORED_MEALS" } ], "caregiver": { "name": "Adult child", "phone": "9165550143" }, "contact": { "name": "Referral Team", "email": "referrals@example.com", "phone": "9165550122" }, "supporting_documents": [ { "document_id": "image_xxx", "document_type": "OFFICE_NOTES_DX" } ] } ``` **Response** ```json { "billing_provider_npi": "string", "coverage_id": "string", "diagnosis_codes": [ "string" ], "external_id": "string", "patient_id": "string", "place_of_service_code": "string", "plan_of_care": { "end_date": "2023-01-15", "evaluation_date": "2023-01-15", "frequency": { "count": 1, "period": "WEEK" }, "requested_visits": 1, "start_date": "2023-01-15", "frequency_notes": "string" }, "rendering_provider_npi": "string", "request_type": "INITIAL", "service_facility_id": "string", "service_lines": [ { "procedure_code": "string", "end_date": "2023-01-15", "frequency": "string", "modifiers": [ "string" ], "place_of_service_code": "string", "requested_units": 1, "start_date": "2023-01-15", "unit_type": "VISITS" } ], "service_type": "PHYSICAL_THERAPY", "supporting_documents": [ { "document_id": "string", "document_type": "INITIAL_EVALUATION", "title": "string" } ], "test_mode": true, "urgency": "ROUTINE", "created_at": "2024-01-15T09:30:00Z", "id": "string", "last_status_at": "2024-01-15T09:30:00Z", "payer_id": "string", "payer_name": "string", "status": "RECEIVED", "updated_at": "2024-01-15T09:30:00Z", "clinical_information": { "accident_date": "2023-01-15", "accident_state": "string", "accident_type": "AUTO", "body_regions": [ "string" ], "clinical_summary": "string", "comorbidities": [ "string" ], "cva_date": "2023-01-15", "functional_limitations": [ "string" ], "home_exercise_program": "string", "laterality": "LEFT", "medical_necessity_rationale": "string", "objective_findings": "string", "onset_date": "2023-01-15", "prior_treatments_and_response": "string", "prognosis": "string", "progress_summary": "string", "standardized_tests": [ { "name": "string", "result": "string", "date": "2023-01-15" } ], "surgery_date": "2023-01-15", "surgery_procedure": "string", "treatment_goals": [ "string" ] }, "clinical_notes": "string", "contact": { "name": "string", "email": "string", "fax": "string", "phone": "string" }, "ordering_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "payer_specific_fields": {}, "previous_authorization": { "prior_authorization_number": "string", "approved_visits": 1, "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "used_visits": 1 }, "referring_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "requesting_provider_npi": "string", "therapy_attestations": { "ordering_provider_approved_plan_of_care": true, "ordering_provider_will_be_notified_at_discharge": true, "plan_of_care_reviewed_with_patient": true, "school_iep_unavailable_reason": "string" }, "urgency_reason": "string", "approved_unit_type": "string", "approved_units": 1, "authorized_service_lines": [ { "approved_units": 1, "procedure_code": "string", "unit_type": "VISITS", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "modifiers": [ "string" ] } ], "determined_at": "2024-01-15T09:30:00Z", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "plan_name": "string", "plan_type": "string", "portal_reference_number": "string", "prior_authorization_number": "string", "requirements_checked_at": "2024-01-15T09:30:00Z", "status_message": "string", "submission_channel": "PORTAL", "submission_destination": "string", "submitted_at": "2024-01-15T09:30:00Z" } ``` **SDK Code** ```python Community Supports referral import requests url = "https://api.taigabilling.com/api/prior-authorizations/v1" payload = { "service_type": "COMMUNITY_SUPPORTS", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "ecm_enrollment": False, "external_id": "cs-referral-123", "patient_id": "patient_xxx", "services": [ { "chronic_conditions": ["DIABETES"], "discharge_or_high_risk": False, "extensive_care_coordination_needs": False, "mtm_types": ["HOME_DELIVERED_MEALS", "NUTRITION_EDUCATION"], "service": "MEDICALLY_TAILORED_MEALS" } ], "caregiver": { "name": "Adult child", "phone": "9165550143" }, "contact": { "name": "Referral Team", "email": "referrals@example.com", "phone": "9165550122" }, "supporting_documents": [ { "document_id": "image_xxx", "document_type": "OFFICE_NOTES_DX" } ] } headers = { "Authorization": "Bearer ", "Content-Type": "application/json" } response = requests.post(url, json=payload, headers=headers) print(response.json()) ``` ### Outpatient therapy request **Request** ```json { "service_type": "PHYSICAL_THERAPY", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "diagnosis_codes": [ "M25.561" ], "external_id": "rehab-auth-123", "patient_id": "patient_xxx", "place_of_service_code": "11", "plan_of_care": { "end_date": "2026-09-02", "evaluation_date": "2026-07-21", "frequency": { "count": 2, "period": "WEEK" }, "requested_visits": 12, "start_date": "2026-07-22" }, "rendering_provider_npi": "3456789012", "service_facility_id": "facility_xxx", "service_lines": [ { "procedure_code": "97110", "modifiers": [ "GP" ], "requested_units": 24, "unit_type": "UNITS" }, { "procedure_code": "97530", "modifiers": [ "GP" ] } ], "clinical_information": { "body_regions": [ "knee" ], "functional_limitations": [ "Unable to climb stairs without assistance" ], "home_exercise_program": "Daily mobility and strengthening program", "laterality": "RIGHT", "medical_necessity_rationale": "Skilled therapy is required to restore safe functional mobility.", "objective_findings": "Reduced knee range of motion and strength.", "onset_date": "2026-07-01", "standardized_tests": [ { "name": "Lower Extremity Functional Scale", "result": "31/80" } ], "treatment_goals": [ "Ascend and descend one flight of stairs safely within six weeks" ] }, "contact": { "name": "Authorization Team", "email": "authorizations@example.com", "phone": "2015550123" }, "ordering_provider": { "npi": "2345678901", "name": "Ordering Clinician", "phone": "2015550139" }, "request_type": "INITIAL", "supporting_documents": [ { "document_id": "image_evaluation_xxx", "document_type": "INITIAL_EVALUATION" }, { "document_id": "image_plan_xxx", "document_type": "PLAN_OF_CARE" } ], "therapy_attestations": { "ordering_provider_approved_plan_of_care": true, "plan_of_care_reviewed_with_patient": true }, "urgency": "ROUTINE" } ``` **Response** ```json { "billing_provider_npi": "string", "coverage_id": "string", "diagnosis_codes": [ "string" ], "external_id": "string", "patient_id": "string", "place_of_service_code": "string", "plan_of_care": { "end_date": "2023-01-15", "evaluation_date": "2023-01-15", "frequency": { "count": 1, "period": "WEEK" }, "requested_visits": 1, "start_date": "2023-01-15", "frequency_notes": "string" }, "rendering_provider_npi": "string", "request_type": "INITIAL", "service_facility_id": "string", "service_lines": [ { "procedure_code": "string", "end_date": "2023-01-15", "frequency": "string", "modifiers": [ "string" ], "place_of_service_code": "string", "requested_units": 1, "start_date": "2023-01-15", "unit_type": "VISITS" } ], "service_type": "PHYSICAL_THERAPY", "supporting_documents": [ { "document_id": "string", "document_type": "INITIAL_EVALUATION", "title": "string" } ], "test_mode": true, "urgency": "ROUTINE", "created_at": "2024-01-15T09:30:00Z", "id": "string", "last_status_at": "2024-01-15T09:30:00Z", "payer_id": "string", "payer_name": "string", "status": "RECEIVED", "updated_at": "2024-01-15T09:30:00Z", "clinical_information": { "accident_date": "2023-01-15", "accident_state": "string", "accident_type": "AUTO", "body_regions": [ "string" ], "clinical_summary": "string", "comorbidities": [ "string" ], "cva_date": "2023-01-15", "functional_limitations": [ "string" ], "home_exercise_program": "string", "laterality": "LEFT", "medical_necessity_rationale": "string", "objective_findings": "string", "onset_date": "2023-01-15", "prior_treatments_and_response": "string", "prognosis": "string", "progress_summary": "string", "standardized_tests": [ { "name": "string", "result": "string", "date": "2023-01-15" } ], "surgery_date": "2023-01-15", "surgery_procedure": "string", "treatment_goals": [ "string" ] }, "clinical_notes": "string", "contact": { "name": "string", "email": "string", "fax": "string", "phone": "string" }, "ordering_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "payer_specific_fields": {}, "previous_authorization": { "prior_authorization_number": "string", "approved_visits": 1, "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "used_visits": 1 }, "referring_provider": { "npi": "string", "contact_name": "string", "fax": "string", "name": "string", "phone": "string" }, "requesting_provider_npi": "string", "therapy_attestations": { "ordering_provider_approved_plan_of_care": true, "ordering_provider_will_be_notified_at_discharge": true, "plan_of_care_reviewed_with_patient": true, "school_iep_unavailable_reason": "string" }, "urgency_reason": "string", "approved_unit_type": "string", "approved_units": 1, "authorized_service_lines": [ { "approved_units": 1, "procedure_code": "string", "unit_type": "VISITS", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "modifiers": [ "string" ] } ], "determined_at": "2024-01-15T09:30:00Z", "effective_date": "2023-01-15", "expiration_date": "2023-01-15", "plan_name": "string", "plan_type": "string", "portal_reference_number": "string", "prior_authorization_number": "string", "requirements_checked_at": "2024-01-15T09:30:00Z", "status_message": "string", "submission_channel": "PORTAL", "submission_destination": "string", "submitted_at": "2024-01-15T09:30:00Z" } ``` **SDK Code** ```python Outpatient therapy request import requests url = "https://api.taigabilling.com/api/prior-authorizations/v1" payload = { "service_type": "PHYSICAL_THERAPY", "billing_provider_npi": "1234567890", "coverage_id": "coverage_xxx", "diagnosis_codes": ["M25.561"], "external_id": "rehab-auth-123", "patient_id": "patient_xxx", "place_of_service_code": "11", "plan_of_care": { "end_date": "2026-09-02", "evaluation_date": "2026-07-21", "frequency": { "count": 2, "period": "WEEK" }, "requested_visits": 12, "start_date": "2026-07-22" }, "rendering_provider_npi": "3456789012", "service_facility_id": "facility_xxx", "service_lines": [ { "procedure_code": "97110", "modifiers": ["GP"], "requested_units": 24, "unit_type": "UNITS" }, { "procedure_code": "97530", "modifiers": ["GP"] } ], "clinical_information": { "body_regions": ["knee"], "functional_limitations": ["Unable to climb stairs without assistance"], "home_exercise_program": "Daily mobility and strengthening program", "laterality": "RIGHT", "medical_necessity_rationale": "Skilled therapy is required to restore safe functional mobility.", "objective_findings": "Reduced knee range of motion and strength.", "onset_date": "2026-07-01", "standardized_tests": [ { "name": "Lower Extremity Functional Scale", "result": "31/80" } ], "treatment_goals": ["Ascend and descend one flight of stairs safely within six weeks"] }, "contact": { "name": "Authorization Team", "email": "authorizations@example.com", "phone": "2015550123" }, "ordering_provider": { "npi": "2345678901", "name": "Ordering Clinician", "phone": "2015550139" }, "request_type": "INITIAL", "supporting_documents": [ { "document_id": "image_evaluation_xxx", "document_type": "INITIAL_EVALUATION" }, { "document_id": "image_plan_xxx", "document_type": "PLAN_OF_CARE" } ], "therapy_attestations": { "ordering_provider_approved_plan_of_care": True, "plan_of_care_reviewed_with_patient": True }, "urgency": "ROUTINE" } headers = { "Authorization": "Bearer ", "Content-Type": "application/json" } response = requests.post(url, json=payload, headers=headers) print(response.json()) ```