Aetna

Aetna Prior Authorization FHIR API

Da Vinci prior-authorization surface built for CMS-0057-F: Coverage Requirements Discovery (STU 2.1) at /coveragerequirementsdiscovery/v1/cds-services/{id} supporting the order-sign, order-dispatch and appointment-book CDS Hooks; Prior Authorization Support (STU 2.1) at /priorauthorizationsupport/v1/Claim/$submit and /$inquire; and Clinical Data Exchange (CDex STU 2.1.0) at /clinicaldataexchange/v1/$submit-attachment. Aetna states that Meritain members, Medicaid members, pharmacy prior authorization and SNOMED procedure codes are not supported. Production traffic for these products moved to the apix.cvshealth.com host on 2026-03-04. Every spec document for this API returned HTTP 403 when this repo was harvested, so no machine-readable contract for it is held here.

GitHub

Documentation

📖
Documentation
https://developerportal.aetna.com/
📖
APIReference
https://developerportal.aetna.com/assets/Data/Fhir.json

Other Resources

🔗
DeveloperPortal
https://developerportal.aetna.com/

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API entry from apis.yml

apis.yml Raw ↑ 
aid: aetna-prior-authorization-fhir-api
name: Aetna Prior Authorization FHIR API
description: 'Da Vinci prior-authorization surface built for CMS-0057-F: Coverage Requirements Discovery
  (STU 2.1) at /coveragerequirementsdiscovery/v1/cds-services/{id} supporting the order-sign, order-dispatch
  and appointment-book CDS Hooks; Prior Authorization Support (STU 2.1) at /priorauthorizationsupport/v1/Claim/$submit
  and /$inquire; and Clinical Data Exchange (CDex STU 2.1.0) at /clinicaldataexchange/v1/$submit-attachment.
  Aetna states that Meritain members, Medicaid members, pharmacy prior authorization and SNOMED procedure
  codes are not supported. Production traffic for these products moved to the apix.cvshealth.com host
  on 2026-03-04. Every spec document for this API returned HTTP 403 when this repo was harvested, so no
  machine-readable contract for it is held here.'
humanURL: https://developerportal.aetna.com/
baseURL: https://apix.cvshealth.com
tags:
- FHIR
- Prior Authorization
- Da Vinci
- CDS Hooks
- CRD
- PAS
- CDex
- CMS-0057-F
properties:
- type: Documentation
  url: https://developerportal.aetna.com/
- type: DeveloperPortal
  url: https://developerportal.aetna.com/
- type: APIReference
  url: https://developerportal.aetna.com/assets/Data/Fhir.json