HL7 Da Vinci · CRD · DTR · PAS

A payer to test
against._

Synthetic CRD, DTR, and PAS endpoints that approve, pend, deny, and request more info like a real payer, before your Jan 1, 2027 CMS‑0057 deadline. Instant tenant, OAuth creds, scriptable behaviors. Synthetic data only, no BAA.

Start free sandbox Read the scenarios →

submit → A4 pended → $inquire ×2 → A1 certified // scenario: pend-then-approve

POSTClaim/$submit

curl -sX POST https://mockpayer.dev/api/demo/Claim/\$submit \
  -H "Authorization: Bearer sk_demo_mockpayer" \
  -H "Content-Type: application/fhir+json" \
  --data-binary @referral-auth-bundle.json

Runs live against the shared demo tenant. No signup.

200 · application/fhir+json A4 · Pending

{
  "resourceType": "Bundle",
  "type": "collection",
  "timestamp": "2027-01-04T15:22:11Z",
  "entry": [
    {
      "resource": {
        "resourceType": "ClaimResponse",
        "status": "active",
        "use": "preauthorization",
        "patient": { "reference": "Patient/SUBSCRIBER-8891" },
        "insurer": { "reference": "Organization/mockpayer" },
        "request": { "reference": "Claim/REF-AUTH-111099" },
        "outcome": "complete",
        "disposition": "Pended for clinical review.",
        "preAuthRef": "PA-2027-000412",
        "item": [{
          "itemSequence": 1,
          "adjudication": [{
            "category": { "coding": [{ "code": "submitted" }] },
            "extension": [{
              "url": ".../extension-reviewAction",
              "extension": [{
                "url": "code",
                "valueCodeableConcept": { "coding": [{
                  "system": "https://codesystem.x12.org/005010/306",
                  "code": "A4", "display": "Pending" }] }
              }]
            }]
          }]
        }]
      }
    }
    // … Organization, Patient, Coverage (3 more entries)
  ]
}

outcome is complete; the approve/pend/deny signal rides in item.adjudication reviewAction (X12 306). Poll $inquire twice → A4 becomes A1.

demo

Real request / response pairs for each Da Vinci interaction. Payloads adapted from the published PAS, CRD, and DTR implementation guides; trimmed for reading, shapes unchanged.

Coverage Requirements Discovery. A CDS Hooks service the EHR calls at order time. MockPayer answers order-select / order-sign with coverage cards and decorates the draft order with a coverage-information extension.

POST/cds-services/mockpayer-crd

{
  "hook": "order-select",
  "hookInstance": "d1577c69-dfbe-44ad-ba6d-3e05e953b2ea",
  "fhirServer": "https://ehr.example.org/r4",
  "context": {
    "userId": "PractitionerRole/pr-114",
    "patientId": "SUBSCRIBER-8891",
    "encounterId": "enc-9920",
    "selections": ["ServiceRequest/sr-mri-lumbar"],
    "draftOrders": {
      "resourceType": "Bundle",
      "entry": [{
        "resource": {
          "resourceType": "ServiceRequest",
          "id": "sr-mri-lumbar",
          "status": "draft",
          "intent": "order",
          "code": { "coding": [{
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "72148",
            "display": "MRI lumbar spine wo contrast" }] },
          "subject": { "reference": "Patient/SUBSCRIBER-8891" }
        }
      }]
    }
  }
}

200 · cards[]auth-needed

{
  "cards": [{
    "uuid": "8fce8e2a-4f3b-4b1e-9b6a-2f0c9d7a11e2",
    "summary": "Prior auth required: MRI lumbar (CPT 72148)",
    "indicator": "warning",
    "detail": "Plan requires prior authorization for outpatient advanced imaging. Launch documentation to start the request.",
    "source": { "label": "MockPayer Coverage", "url": "https://mockpayer.dev" },
    "links": [{
      "label": "Complete documentation (DTR)",
      "url": "https://mockpayer.dev/dtr/launch",
      "type": "smart"
    }]
  }],
  "systemActions": [{
    "type": "update",
    "resource": {
      "resourceType": "ServiceRequest",
      "id": "sr-mri-lumbar",
      "extension": [{
        "url": ".../ext-coverage-information",
        "extension": [
          { "url": "coverage", "valueReference": { "reference": "Coverage/INS-334" } },
          { "url": "covered", "valueCode": "conditional" },
          { "url": "pa-needed", "valueCode": "auth-needed" },
          { "url": "doc-needed", "valueCode": "clinical" }
        ]
      }]
    }
  }]
}

Documentation Templates & Rules. Fetch the payer's Questionnaire + CQL, prepopulate it from the record, and return a QuestionnaireResponse. MockPayer serves $questionnaire-package with SDC initialExpression CQL bindings.

POST/Questionnaire/$questionnaire-package

{
  "resourceType": "Parameters",
  "parameter": [
    { "name": "coverage",
      "valueReference": { "reference": "Coverage/INS-334" } },
    { "name": "order",
      "valueReference": { "reference": "ServiceRequest/sr-mri-lumbar" } }
  ]
}

200 · BundleQuestionnaire

{
  "resourceType": "Bundle",
  "type": "collection",
  "entry": [{
    "resource": {
      "resourceType": "Questionnaire",
      "id": "mri-lumbar-pa",
      "url": "https://mockpayer.dev/Questionnaire/mri-lumbar-pa",
      "version": "1.0.0",
      "status": "active",
      "item": [
        {
          "linkId": "1",
          "text": "Weeks of conservative therapy completed",
          "type": "integer",
          "required": true,
          "extension": [{
            "url": ".../sdc-questionnaire-initialExpression",
            "valueExpression": {
              "language": "text/cql",
              "expression": "ConservativeTherapyWeeks"
            }
          }]
        },
        { "linkId": "2",
          "text": "Progressive neurologic deficit?",
          "type": "boolean", "required": true }
      ]
    }
  }
    // … Library/mri-lumbar-cql (1 more entry: CQL for prepopulation)
  ]
}

Prior Authorization Support. Submit the FHIR Claim bundle to $submit, poll $inquire for async decisions. MockPayer returns approved / pended / denied / more-info driven by your tenant's scenario.

POSTClaim/$submit · PASRequestBundle

{
  "resourceType": "Bundle",
  "type": "collection",
  "identifier": { "value": "A12345" },
  "timestamp": "2027-01-04T15:21:40Z",
  "entry": [{
    "fullUrl": "urn:uuid:claim-1",
    "resource": {
      "resourceType": "Claim",
      "status": "active",
      "type": { "coding": [{ "code": "professional" }] },
      "use": "preauthorization",
      "patient": { "reference": "Patient/SUBSCRIBER-8891" },
      "insurer": { "reference": "Organization/mockpayer" },
      "provider": { "reference": "Organization/UMO-114" },
      "priority": { "coding": [{ "code": "normal" }] },
      "insurance": [{ "sequence": 1, "focal": true,
        "coverage": { "reference": "Coverage/INS-334" } }],
      "item": [{
        "sequence": 1,
        "productOrService": { "coding": [{
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "72148" }] },
        "extension": [{
          "url": ".../extension-requestType",
          "valueCodeableConcept": { "coding": [{
            "system": "https://codesystem.x12.org/005010/1525",
            "code": "HS", "display": "Health Services Review" }] }
        }]
      }]
    }
  }
    // … Organization, Coverage, Patient (3 more entries)
  ]
}

200 · PASResponseBundleA1 · Certified

{
  "resourceType": "Bundle",
  "type": "collection",
  "entry": [{
    "resource": {
      "resourceType": "ClaimResponse",
      "status": "active",
      "use": "preauthorization",
      "outcome": "complete",
      "disposition": "Certified in total.",
      "patient": { "reference": "Patient/SUBSCRIBER-8891" },
      "request": { "reference": "Claim/REF-AUTH-111099" },
      "preAuthRef": "PA-2027-000412",
      "item": [{
        "itemSequence": 1,
        "extension": [{
          "url": ".../extension-itemPreAuthPeriod",
          "valuePeriod": { "start": "2027-01-05", "end": "2027-04-05" }
        }],
        "adjudication": [{
          "category": { "coding": [{ "code": "submitted" }] },
          "extension": [{
            "url": ".../extension-reviewAction",
            "extension": [
              { "url": "number", "valueString": "AUTH0001" },
              { "url": "code", "valueCodeableConcept": { "coding": [{
                "system": "https://codesystem.x12.org/005010/306",
                "code": "A1", "display": "Certified in total" }] } }
            ]
          }]
        }]
      }]
    }
  }]
}

scenarios

Set a tenant to any behavior with one call. Deterministic in CI mode: same request, same bytes, every run. Every response stays profile-valid; only the outcome changes.

scenario	behavior	what it exercises
instant-approve	$submit returns `outcome: complete`, reviewAction A1 Certified in total + preAuthRef	happy path, preAuthRef + preAuthPeriod capture
pend-then-approve	returns A4 Pending; $inquire flips to A1 after N polls	async $inquire polling + status-transition handling
deny-with-reasons	returns A3 Not Certified with reviewAction reasonCode(s)	denial UX + X12 reason-code display
request-more-info	A4 Pending + a `CommunicationRequest` for missing documentation	additional-documentation loop, DTR re-launch
partial-approve	`outcome: partial`; some items A1, some A3	per-item adjudication, mixed-outcome rendering
token-expiry	OAuth access token 401s after 60s	refresh-token flow + silent retry
rate-limit	429 after N req/min with a `Retry-After` header	backoff, jitter, throttling
slow-payer	$submit responds after an 8s delay	client timeouts, async submission patterns

validation

Send a bundle that violates the profile and MockPayer answers with an OperationOutcome that says what's wrong in English, points at the FHIRPath, and shows the corrected shape. No guessing from a schema dump.

request · broken supportingInfoinvalid

{
  "resourceType": "Claim",
  "use": "preauthorization",
  "supportingInfo": [{
    "sequence": 1,
    "valueReference": {
      "reference": "DocumentReference/doc-1"
    }
  }]
}

422 · OperationOutcome

{
  "resourceType": "OperationOutcome",
  "issue": [{
    "severity": "error",
    "code": "required",
    "expression": ["Claim.supportingInfo[0].category"],
    "details": {
      "text": "supportingInfo[0] has no category, so it matches no slice in the PAS Claim profile. To attach a document, set category to PASTempCodes#additionalInformation and add the required documentInformation extension. Corrected shape below."
    }
  }]
}

corrected · supportingInfo[AdditionalInformation]valid

{
  "sequence": 1,
  "category": {
    "coding": [{
      "system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
      "code": "additionalInformation"
    }]
  },
  "extension": [{
    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation",
    "extension": [{
      "url": "reportTypeCode",
      "valueCodeableConcept": { "coding": [{
        "system": "https://codesystem.x12.org/005010/755",
        "code": "PY", "display": "Physician's Report"
      }] }
    }]
  }],
  "valueReference": { "reference": "DocumentReference/doc-1" }
}

Why: the PAS Claim profile slices supportingInfo by category. Without a category coding the payer can't tell an attached document from admission dates or free-form message text, so it's rejected before adjudication rather than silently dropped.

ci

Point a deterministic tenant at a fixed scenario and assert the full submit → poll loop in CI. Responses are byte-stable, so snapshot tests don't flake.

.github/workflows/prior-auth.yml

name: prior-auth-integration
on: [push, pull_request]

jobs:
  pas-contract:
    runs-on: ubuntu-latest
    env:
      MOCKPAYER_TENANT: ci-deterministic
      MOCKPAYER_TOKEN: ${{ secrets.MOCKPAYER_CI_TOKEN }}
    steps:
      - uses: actions/checkout@v4
      - uses: actions/setup-node@v4
        with: { node-version: 20 }
      - run: npm ci

      # Pin the tenant to a fixed scenario so responses are byte-stable
      - name: Select scenario
        run: |
          curl -sf -X POST \
            https://mockpayer.dev/api/tenants/$MOCKPAYER_TENANT/scenario \
            -H "Authorization: Bearer $MOCKPAYER_TOKEN" \
            -d '{ "scenario": "pend-then-approve", "inquiryPollsUntilApproval": 2 }'

      - name: PAS submit + inquire integration test
        run: npm run test:pas   # asserts A4 Pending → A1 Certified after 2 polls

pricing

Start on the free tier with one scenario. Upgrade when you need CI mode and the full scenario set. Cancel anytime.

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Shared demo tenant
Rate-limited endpoints
CRD / DTR / PAS sandbox

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pro

$199/mo

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Deterministic CI mode
Dedicated tenants
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Synthetic cohort generator

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faq

Is there any PHI?

No. Every patient, coverage, and claim is synthetic: generated cohorts, never derived from real records. Nothing you send is retained beyond your tenant's session.

Do I need a BAA?

No. There's no protected health information in the system, so there's nothing to cover. That's the point of testing against a mock payer instead of a real one.

What is CMS-0057-F?

A CMS final rule requiring impacted payers to expose FHIR Prior Authorization APIs built on the Da Vinci guides. The API compliance date is January 1, 2027.

Can I self-host?

Not yet. MockPayer is hosted only today. A self-hosted image for air-gapped CI is on the roadmap; tell us if that's a blocker.

What's on the roadmap after PAS?

The other CMS-0057 APIs: Provider Access and Payer-to-Payer, plus the Prior Authorization metrics reporting endpoints.

Which FHIR version and IG releases?

FHIR R4. Payloads track the published PAS, CRD, and DTR STU releases; the demo tenant pins a version and reports it in the capability statement.