Build Integrations with the Health Cloud Business APIs

Use the Health Cloud Business APIs for building integrations with Health Cloud. The APIs wrap complex business logic by executing multiple tasks within a single API call. Most of the APIs are RESTful APIs, but a few are also available through Apex classes and methods. With the new ANSI 278 friendly Authorization APIs, payer organizations can receive prior authorization requests and a variety of other care services requests electronically. The care program enrollment API simplifies enrollments of multiple patients to any care program.

Who: The Health Cloud add-on or Health Cloud Platform licenses are required to access the Business APIs. The user must have the Health Cloud Utilization Management Permission Set, which includes the Health Cloud Platform licenses.

Note

Health Cloud Business APIs follow the same conventions as Chatter REST APIs for authentication, rate limits, and so on.

ANSI 278 Friendly Authorization APIs

Three functionally rich RESTful APIs provide a simplified interface to ANSI 278 transaction data, also known as Health Care Services Review and Response. These business level APIs help payer organizations electronically receive requests for care services, including prior-authorization and referral requests. Senders could be providers, payers, plan sponsors, or other entities involved in healthcare services review, such as clearinghouses.

The APIs facilitate communication between two parties for the following cases:

Appeals
Drug requests
Admissions
Healthcare service requests
Referrals
Complaints
Grievances

Create or update one or more care services review requests: Make a POST or PATCH request to /services/data/vXX.X/connect/health/care-services with a list of care services requests. Each care service request can contain details such as diagnoses, care requests, drugs, care request items, case, patient, subscriber, and transport locations.
Get the status of multiple care services review requests: Make a GET request to /services/data/vXX.X/connect/health/care-services/{ids} to return details about care requests, drugs, diagnoses, subscribers, case, patient, and transport locations.

Care Program Enrollment API

Enroll multiple patients in a single care program. The API creates the patient enrollment cards and enrollee products for the specified patients.

Enroll multiple patients into a single care program: Make a POST request to /services/data/vXX.X/connect/health/care-programs/enrollments with the care program and a list of patients to enroll.