niche · 0.4 marketcapability industryschema

Prior Authorization

Score 17.5 / 100 34 providers +3 via APIs 14 APIs Search apis.io →

Providers using this tag (34)

Ranked by API Evangelist rating — Exemplar and Strong are expanded by default.

Exemplar 1 Complete, well-documented, and agent-ready
AvailityHealthcareClearinghouseHIPAAX12 EDI14 APIs68.4
Strong 5 Solid coverage with minor gaps
Candid HealthMedical BillingRevenue Cycle ManagementHealthcareClaims1 API62.9OptumCompanyHealthcareHealth InsuranceClaims59 APIs62.4DoseSpote-PrescribingeRxHealthcareElectronic Health Records3 APIs60.2AetnaHealth InsuranceHealthcareFHIRPatient Access96 APIs55.6TruepillPharmacyHealthcarePrescription FulfillmentTelehealth1 API54.7
Developing 4 Usable, with meaningful gaps to close
SilnaCompanyAutomationHealthcare1 API49.8SuperDialCompanyHealthcareRevenue Cycle ManagementVoice AI1 API49.0Element5CompanyHealthcareRevenue Cycle ManagementPost-Acute Care1 API43.3SurescriptsHealthcaree-PrescribingHealth Information NetworkNCPDP SCRIPT8 APIs39.9
Thin 4 Limited public surface area
Cohere HealthHealthcareUnited StatesUtilization Management3 APIs30.6GenHealth.aiCompanyHealthHealthcareArtificial Intelligence37.6InfinitusCompanyArtificial IntelligenceHealthcareVoice AI1 API32.6Change HealthcareHealthcareTechnologyAnalyticsEDI1 API28.3
Emerging 14 Early or largely undocumented
SamaCareCompanyHealthcarePatient Access1 API21.0Ruma CareCompanyHealthcareHealth Insurance11.0Beacon HealthCompanyHealthcarePrimary CareValue-Based Care23.7InsurfCompanyHealthcareHealth Insurance22.2NotableCompanyApplicationHealthcareArtificial Intelligence19.3ForusCompanyHealthcareHealth IT17.6House RxCompanyHealthcareSpecialty PharmacyPharmacy17.3Smile Digital HealthHealthcareFHIRHL7Clinical Data Repository11 APIs16.9LatentCompanyHealthcareHealth SystemsPharmacy16.8Parachute HealthCompanyHealthcareDMEe-Prescribing16.7MedmonkCompanyHealthcarePharma Market AccessFHIR16.1TennrCompanyHealthcareArtificial IntelligenceMachine Learning14.2Standard PracticeCompanyVoice AIHealthcareRevenue Cycle Management12.0PlenfulCompanyHealthcarePharmacyArtificial Intelligence11.9
Minimal 6 Almost no public developer surface
Rhyme (fka PriorAuthNow)CompanyHealthcareHealth IT6.8Verata HealthCompanyHealthcareArtificial Intelligence0.0ProfilityHealthcareHealth ITPost-Acute CareArtificial Intelligence9.9Bookend AICompanyHealthcareRevenue Cycle Management5.1ClaimglideCompanyHealthcareDigital Health4.0Olive AIHealthcareHealthcare AutomationRevenue Cycle Management0.0

APIs with this tag (14)

Ranked by the provider's API Evangelist rating — the Kin Score is scored per provider, not per API, so every API of a provider shares its band. How the rating works →

Exemplar 1 Complete, well-documented, and agent-ready
1up Electronic Prior Authorization APICMS-0057-F Electronic Prior Authorization solution automating prior authorization submission and decisionin...72.3
Strong 3 Solid coverage with minor gaps
Optum Real (Medical) APIOptum Real point-of-care APIs on the oihub gateway: pre-service eligibility, claim pre-check, claim actions...62.4Aetna Prior Authorization FHIR APIDa Vinci prior-authorization surface built for CMS-0057-F: Coverage Requirements Discovery (STU 2.1) at /co...55.6Truepill Prior Authorization APIThe Prior Authorization API from Truepill — 2 operation(s) for prior authorization.54.7
Developing 2 Usable, with meaningful gaps to close
Waystar Authorization & Referral APIAutomates prior authorization and referral determination and status, modeled on the X12 278 health care ser...44.3Surescripts Electronic Prior AuthorizationAutomates electronic prior authorization (ePA) between prescribers and PBMs/payers using the NCPDP SCRIPT e...39.9
Thin 6 Limited public surface area
Infinitus Platform APIThe customer-gated Infinitus backend API. Infinitus' own AI Agent Security Guide instructs customers to all...32.6Cohere Health Coverage Requirements Discovery (CRD) APIHL7 Da Vinci Coverage Requirements Discovery (CRD) FHIR API that lets a provider system instantly verify wh...30.6Cohere Health Documentation Templates and Rules (DTR) APIHL7 Da Vinci Documentation Templates and Rules (DTR) FHIR API that intelligently gathers and submits the do...30.6Cohere Health Prior Authorization Support (PAS) APIHL7 Da Vinci Prior Authorization Support (PAS) FHIR API that submits an authorization request and returns t...30.6UnitedHealthcare Prior Authorization APIPrior authorization and referral actions30.4Change Healthcare Medical Network APIJSON-over-REST front end to the HIPAA X12 EDI transaction set — 270/271 eligibility, 276/277 claim status, ...28.3
Emerging 2 Early or largely undocumented
SamaCare Platform APIThe private integration API behind the SamaCare prior authorization platform, used for two-way exchange of ...21.0Smile CDR CMS Interoperability SuitePre-packaged CMS-compliant FHIR APIs for US payers — Patient Access, Provider Directory, Drug Formulary, Pa...16.9

Companies reaching this through an API (3)

These companies publish an API, specification or operation carrying “Prior Authorization” but do not classify their business under it. Listed unranked and kept out of the count above, because one tagged operation is not a statement about what a company does.

1upHealth UnitedHealthcare Waystar

Score breakdown

Frequency
45.9
log-scaled weighted occurrences
Breadth
0.8
spread across providers
Quality lift
29.0
mean composite of providers using it
Cohesion
0.0
strength of nearest seed neighbor

Where this tag sits

Healthcare broader

Related tags

Revenue Cycle Management 14 co-occurrences Clearinghouse 6 co-occurrences Eligibility 11 co-occurrences Patient Access 9 co-occurrences Payers 8 co-occurrences Revenue Cycle 5 co-occurrences Pharmacy 8 co-occurrences SMART on FHIR 5 co-occurrences

Where this tag comes from

Api tag14
Provider tag35
Openapi tag2
Openapi op tag3

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  • cohort_statsPRO — the distribution across this tag: mean, median, band split, adoption rates.
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  • resolveTurn a domain, URL or GitHub org into the provider it belongs to.
  • find_cohortsEvery scored population of providers in the catalog.
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