Guided Intake
Guided Intake is Medecision’s advanced digital solution that streamlines the Prior Authorization (PA) intake process for providers. It provides a seamless and intelligent experience, guiding users through assessment-driven workflows that leverage FHIR-based standards to capture the right data and automate decision-making wherever possible.
Considerations
Guided Intake integrates into the Provider Portal to enable real-time PA request creation, assessment completion, and submission.
All assessments (questionnaires) are dynamically presented based on service codes, healthcare types, and policies.
Guided Intake supports automated decision-making where possible and stores assessment data within Medecision’s utilization management engine.
Workflow Breakdown
Step 1: Provider Initiates PA Request
Provider accesses the Provider Portal.
Provider initiates a new Prior Authorization.
The portal checks for eligibility to use Guided Intake for the request via the Medecision PAS API.
Step 2: Create Draft Request
The request is created in Draft status using Medecision’s PAS API.
A Request ID is returned and stored.
Step 3: Redirect to Assessment Page
The provider is redirected to the Assessment Page (FHIR Questionnaire).
This page is hosted via Medecision’s assessment widget, embedded in the Provider Portal.
Step 4: Load and Display Questionnaires
The PAS API retrieves assessment templates based on the request’s configuration.
The assessment widget calls the DTR API to display appropriate questionnaires.
Step 5: Assessment Completion
Provider completes the assessments.
All responses are stored and linked to the Request ID in the request database.
Step 6: Submit the Request
Once completed, the provider submits the request.
Submission is asynchronous – the client polls the Claim resource for final status.
Step 7: Results and Response
After processing, request results are returned via the Provider Portal.
Medecision sends the final request result to the client endpoint.
Assessment Lifecycle and Use Cases
Template Authoring
Users author templates via the Assessment Constructor tool.
Assessment metadata includes request type, category, healthcare type, and scoring logic.
Draft Request Creation and Update
APIs support dynamic draft creation.
Encoded request identifiers are used for redirection and stage tracking.
Assessment Availability
Templates are dynamically matched based on request details.
Fallback to policy mapping (via ACI) ensures completeness.
Assessment Instance Management
Instances are created for each service needing an assessment.
Instance IDs are stored and linked to the originating request.
Auto-Approval Decision-Making
Completed assessments trigger rules engine (ACI) for automatic decision-making.
Services may be approved or moved to manual review based on logic.
Supplemental API Support
Assessment answers can be consumed downstream (e.g., for manual review).
Discharge and Concurrent Review Support
Supports multiple workflows such as discharge, concurrent extensions, or edits.
Technology Stack
FHIR-based APIs: PAS, DTR, CRD
UM Core Services: Request DB, Assessment DB
Widget-Based UI: Embedded within Provider Portal
External Integration: PAS API provides integration to external systems
Benefits
Reduces time to submit PAs
Improves accuracy of submissions
Enables real-time guidance and decision-making
Scales across service types (behavioral health, physical health, inpatient, outpatient)
Ensures consistent intake quality with AI-enhanced authoring
Terminology
Term | Definition |
PAS API | Medecision Prior Authorization Services API |
DTR API | Data Triggered Response API for assessments |
ASMT | Assessment (Questionnaire) |
CRD API | Coverage Requirements Discovery API |
ACI | Automation and Clinical Intelligence rules engine |
Request ID | Unique identifier for a PA request |
Stage ID | Identifier for a specific request stage (e.g., extension) |
Additional Resources
Medecision Dev Portal: https://dev.medecision.com
API Reference for Guided Intake (available after onboarding)
Provider Training Materials (access via your Implementation Manager)
For further support, contact your Client Success Manager or Implementation Lead.