Prior Auth API

Fill Prior Authorization

Fill a prior authorization fax form. Provide the patient’s plan identifiers (bin, pcn, group, member_id, state), a drug_slug (from /search_drugs), the icd10_diagnosis, plus patient, prescriber, and clinical-question data; the backend looks up the full drug profile (medication_strength, qty, day_supply, directions, route, etc.) from its internal drug catalog, resolves the correct PA form, and fills it. Returns a form ID and a signed URL to preview the filled PDF. Call Submit Prior Authorization with the ID to transmit the fax to the payer.

Python

import requests
import json

url = 'https://api.simplex.sh/fill_pa'
headers = {
    'X-API-Key': 'your_api_key_here'
}

patient = {
    'name': 'Michael Chen',
    'dob': '1985-03-14',
    'id': 'WLR482913057',
    'address': '4200 Cedar Springs Rd',
    'city': 'Dallas',
    'state': 'TX',
    'zip': '75201',
    'home_phone': '214-555-0173',
    'gender': 'M'
}
prescriber = {
    'name': 'Ravi Patel',
    'npi': '1528074691',
    'address': '8700 Beverly Blvd Ste 310',
    'city': 'Los Angeles',
    'state': 'CA',
    'zip': '90048',
    'office_phone': '310-555-0142',
    'fax': '310-555-0143',
    'contact_person': 'Lisa Nguyen'
}
clinical_questions = [
    {'question_id': 'cont_therapy_q1', 'answer': 'Yes'},
    {'question_id': 'cont_therapy_q3', 'answer': '4 months'},
    {'question_id': 'fda_approved_indication', 'answer': 'Yes'}
]

data = {
    'bin': '003858',
    'pcn': 'A4',
    'group': 'RXINN01',
    'member_id': '4XS00000523646',
    'state': 'CA',
    'drug_slug': 'ozempic_1_mg_dose_4mg_3ml_pen_injectors',
    'icd10_diagnosis': 'E11.9',
    'patient': json.dumps(patient),
    'prescriber': json.dumps(prescriber),
    'clinical_questions': json.dumps(clinical_questions)
}
files = [
    ('documents', ('chart_notes.pdf', open('chart_notes.pdf', 'rb'), 'application/pdf')),
    ('documents', ('labs.pdf', open('labs.pdf', 'rb'), 'application/pdf'))
]

response = requests.post(url, headers=headers, data=data, files=files)
result = response.json()
print(f"Form ID: {result['form_id']}")
print(f"Preview PDF: {result['signed_url']}")

{
  "succeeded": true,
  "form_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
  "signed_url": "<string>",
  "expires_at": "2023-11-07T05:31:56Z"
}

Authorizations

X-API-Key

string

header

required

Simplex API Key

Body

multipart/form-data

bin

string

required

pcn

string

required

member_id

string

required

state

string

required

drug_slug

string

required

Drug catalog slug (e.g. ozempic_1_mg_dose_4mg_3ml_pen_injectors). Use Search Drugs to resolve a free-text query to a slug. The backend loads the drug's medication_strength, qty, quantity_qualifier, day_supply, directions_frequency, expected_length_therapy, and route_of_administration from the catalog so you don't assemble them yourself.

icd10_diagnosis

string

required

ICD-10 diagnosis code (e.g. E11.9, E66.3).

patient

object

required

Show child attributes

prescriber

object

required

Show child attributes

group

string

form_specific_questions

object

Show child attributes

clinical_questions

object[]

Show child attributes

documents

file[]

Response

200 - application/json

succeeded

boolean

required

form_id

string<uuid>

required

signed_url

string<url>

required

expires_at

string<date-time>

Submit Prior AuthorizationTransmit a previously filled fax form to the payer. Accepts the form UUID returned by Fill Prior Authorization.

⌘I

Python

import requests
import json

url = 'https://api.simplex.sh/fill_pa'
headers = {
    'X-API-Key': 'your_api_key_here'
}

patient = {
    'name': 'Michael Chen',
    'dob': '1985-03-14',
    'id': 'WLR482913057',
    'address': '4200 Cedar Springs Rd',
    'city': 'Dallas',
    'state': 'TX',
    'zip': '75201',
    'home_phone': '214-555-0173',
    'gender': 'M'
}
prescriber = {
    'name': 'Ravi Patel',
    'npi': '1528074691',
    'address': '8700 Beverly Blvd Ste 310',
    'city': 'Los Angeles',
    'state': 'CA',
    'zip': '90048',
    'office_phone': '310-555-0142',
    'fax': '310-555-0143',
    'contact_person': 'Lisa Nguyen'
}
clinical_questions = [
    {'question_id': 'cont_therapy_q1', 'answer': 'Yes'},
    {'question_id': 'cont_therapy_q3', 'answer': '4 months'},
    {'question_id': 'fda_approved_indication', 'answer': 'Yes'}
]

data = {
    'bin': '003858',
    'pcn': 'A4',
    'group': 'RXINN01',
    'member_id': '4XS00000523646',
    'state': 'CA',
    'drug_slug': 'ozempic_1_mg_dose_4mg_3ml_pen_injectors',
    'icd10_diagnosis': 'E11.9',
    'patient': json.dumps(patient),
    'prescriber': json.dumps(prescriber),
    'clinical_questions': json.dumps(clinical_questions)
}
files = [
    ('documents', ('chart_notes.pdf', open('chart_notes.pdf', 'rb'), 'application/pdf')),
    ('documents', ('labs.pdf', open('labs.pdf', 'rb'), 'application/pdf'))
]

response = requests.post(url, headers=headers, data=data, files=files)
result = response.json()
print(f"Form ID: {result['form_id']}")
print(f"Preview PDF: {result['signed_url']}")

{
  "succeeded": true,
  "form_id": "3c90c3cc-0d44-4b50-8888-8dd25736052a",
  "signed_url": "<string>",
  "expires_at": "2023-11-07T05:31:56Z"
}