Create prior authorization

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.

Authorization

BearerAuth

AuthorizationBearer <token>

Send your Taiga API key as a Bearer token. Create and manage keys in the Taiga developer portal.

In: header

Request Body

application/json

TypeScript Definitions

Use the request body type in TypeScript.

An outpatient therapy authorization request. The API still accepts a body with service_type omitted and treats it as PHYSICAL_THERAPY, for compatibility with integrations that predate Community Supports; new integrations should always send it.

billing_provider_npi*string

Match^\d{10}$

clinical_information?

Clinical facts used to establish medical necessity. Optional at intake; Taiga requests any payer-required missing facts through NEEDS_INFORMATION.

clinical_notes?string

Lengthlength <= 10000

contact?

Clinic authorization contact for questions about this request.

coverage_id*string

Existing patient coverage. Taiga resolves payer, plan, member, and routing details from this coverage.

diagnosis_codes*array<string>

Items1 <= items <= 24

external_id*string

Partner-generated idempotency key. Replays with an identical body return the existing request; a different body returns 409.

Lengthlength <= 100

ordering_provider?

Ordering clinician. This may be outside the partner organization's NPI scope.

patient_id*string

payer_specific_fields?

Escape hatch for payer questions discovered during requirements review. Use stable snake_case keys supplied by Taiga.

Default{}

place_of_service_code*string

Two-digit CMS place-of-service code for the requested care.

Match^\d{2}$

plan_of_care*

Requested treatment window, visits, frequency, and evaluation date.

previous_authorization?

referring_provider?

Referring clinician. This may be outside the partner organization's NPI scope.

rendering_provider_npi*string

Rendering therapist NPI. This NPI must be in the partner organization's scope.

Match^\d{10}$

request_type?string

REAUTHORIZATION also requires previous_authorization. INITIAL is used for a new patient, condition, or payer-defined new episode.

Default"INITIAL"

Value in

"INITIAL"
"REAUTHORIZATION"
"MODIFICATION"
"RETROSPECTIVE"

requesting_provider_npi?string

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.

Match^\d{10}$

service_facility_id*string

service_lines*array<>

Requested CPT/HCPCS codes. Procedure-level units and dates are optional when the plan_of_care supplies the visit-level request.

Items1 <= items <= 50

service_type*string

Default"PHYSICAL_THERAPY"

Value in

"PHYSICAL_THERAPY"
"OCCUPATIONAL_THERAPY"
"SPEECH_THERAPY"
"OTHER"

supporting_documents?array<>

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.

Itemsitems <= 30

Default[]

test_mode?true

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.

Value in

true

therapy_attestations?

Default{}

urgency?string

URGENT requires urgency_reason and should only be used when the payer's expedited-review standard is met.

Default"ROUTINE"

Value in

"ROUTINE"
"URGENT"

urgency_reason?string

Lengthlength <= 2000

Response Body

`application/json`

curl -X POST "https://example.com/api/prior-authorizations/v1" \  -H "Content-Type: application/json" \  -d '{    "billing_provider_npi": "1234567890",    "caregiver": {      "name": "Adult child",      "phone": "9165550143"    },    "contact": {      "email": "referrals@example.com",      "name": "Referral Team",      "phone": "9165550122"    },    "coverage_id": "coverage_xxx",    "ecm_enrollment": false,    "external_id": "cs-referral-123",    "patient_id": "patient_xxx",    "service_type": "COMMUNITY_SUPPORTS",    "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"      }    ],    "supporting_documents": [      {        "document_id": "image_xxx",        "document_type": "OFFICE_NOTES_DX"      }    ]  }'

{  "billing_provider_npi": "string",  "clinical_information": {    "accident_date": "2019-08-24",    "accident_state": "string",    "accident_type": "AUTO",    "body_regions": [      "string"    ],    "clinical_summary": "string",    "comorbidities": [      "string"    ],    "cva_date": "2019-08-24",    "functional_limitations": [      "string"    ],    "home_exercise_program": "string",    "laterality": "LEFT",    "medical_necessity_rationale": "string",    "objective_findings": "string",    "onset_date": "2019-08-24",    "prior_treatments_and_response": "string",    "prognosis": "string",    "progress_summary": "string",    "standardized_tests": [      {        "date": "2019-08-24",        "name": "string",        "result": "string"      }    ],    "surgery_date": "2019-08-24",    "surgery_procedure": "string",    "treatment_goals": [      "string"    ]  },  "clinical_notes": "string",  "contact": {    "email": "user@example.com",    "fax": "string",    "name": "string",    "phone": "string"  },  "coverage_id": "string",  "diagnosis_codes": [    "string"  ],  "external_id": "string",  "ordering_provider": {    "contact_name": "string",    "fax": "string",    "name": "string",    "npi": "string",    "phone": "string"  },  "patient_id": "string",  "payer_specific_fields": {},  "place_of_service_code": "string",  "plan_of_care": {    "end_date": "2019-08-24",    "evaluation_date": "2019-08-24",    "frequency": {      "count": 1,      "period": "WEEK"    },    "frequency_notes": "string",    "requested_visits": 1,    "start_date": "2019-08-24"  },  "previous_authorization": {    "approved_visits": 1,    "effective_date": "2019-08-24",    "expiration_date": "2019-08-24",    "prior_authorization_number": "string",    "used_visits": 0  },  "referring_provider": {    "contact_name": "string",    "fax": "string",    "name": "string",    "npi": "string",    "phone": "string"  },  "rendering_provider_npi": "string",  "request_type": "INITIAL",  "requesting_provider_npi": "string",  "service_facility_id": "string",  "service_lines": [    {      "end_date": "2019-08-24",      "frequency": "string",      "modifiers": [],      "place_of_service_code": "string",      "procedure_code": "string",      "requested_units": 1,      "start_date": "2019-08-24",      "unit_type": "VISITS"    }  ],  "service_type": "PHYSICAL_THERAPY",  "supporting_documents": [],  "test_mode": true,  "therapy_attestations": {},  "urgency": "ROUTINE",  "urgency_reason": "string",  "approved_unit_type": "string",  "approved_units": 0,  "authorized_service_lines": [    {      "approved_units": 1,      "effective_date": "2019-08-24",      "expiration_date": "2019-08-24",      "modifiers": [        "string"      ],      "procedure_code": "string",      "unit_type": "VISITS"    }  ],  "created_at": "2019-08-24T14:15:22Z",  "determined_at": "2019-08-24T14:15:22Z",  "effective_date": "2019-08-24",  "expiration_date": "2019-08-24",  "id": "string",  "last_status_at": "2019-08-24T14:15:22Z",  "payer_id": "string",  "payer_name": "string",  "plan_name": "string",  "plan_type": "string",  "portal_reference_number": "string",  "prior_authorization_number": "string",  "requirements_checked_at": "2019-08-24T14:15:22Z",  "status": "RECEIVED",  "status_message": "string",  "submission_channel": "PORTAL",  "submission_destination": "string",  "submitted_at": "2019-08-24T14:15:22Z",  "updated_at": "2019-08-24T14:15:22Z"}

Authorization

Request Body

Response Body

200application/json

202application/json

400application/json

401application/json

404application/json

409application/json

503application/json

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`