> ## Documentation Index > Fetch the complete documentation index at: https://docs.clinikehr.com/llms.txt > Use this file to discover all available pages before exploring further. # Decide a pre-authorization request > **Permission:** `insurance.pa:decide` Approve or deny a pre-authorization request. For the insurer the clinic linked to your organization. Only a request that is `sent_for_authorization` can be decided, once; a decided request answers 409 `invalid_status_transition`. Answers 200 with the request. A clinic-owned key and an organization with no insurer link are refused (`hmo_not_linked`). The `Idempotency-Key` header is REQUIRED. ## OpenAPI ````yaml /openapi/ehr-api.v1.yaml post /v1/clinics/{clinic_id}/insurance/pre-authorizations/{pa_id}/decision openapi: 3.1.0 info: title: ClinikEHR API version: 1.0.0 description: >- Server-to-server REST API for a clinic's own data, reached with a key the clinic (or a developer workspace) creates in the developer portal. Authenticate every request with `Authorization: Bearer `. Test keys reach only your workspace's own synthetic sandbox; live keys reach the clinic that created them. Lists wrap their rows as `{ data, has_more, next_cursor }`; single resources are returned directly. Errors are `application/problem+json` (RFC 9457) with a stable `code`. Write requests accept an `Idempotency-Key` header so a retry never repeats a change. See the guides for authentication, permissions, pagination, rate limits and retries. servers: - url: https://api.clinikehr.com security: - ApiKey: [] paths: /v1/clinics/{clinic_id}/insurance/pre-authorizations/{pa_id}/decision: post: tags: - HMO insurance summary: Decide a pre-authorization request description: >- **Permission:** `insurance.pa:decide` Approve or deny a pre-authorization request. For the insurer the clinic linked to your organization. Only a request that is `sent_for_authorization` can be decided, once; a decided request answers 409 `invalid_status_transition`. Answers 200 with the request. A clinic-owned key and an organization with no insurer link are refused (`hmo_not_linked`). The `Idempotency-Key` header is REQUIRED. operationId: decideInsurancePreAuthorization parameters: - $ref: '#/components/parameters/IdempotencyKeyRequired' - name: clinic_id in: path required: true schema: type: string format: uuid - name: pa_id in: path required: true schema: type: string format: uuid requestBody: required: true content: application/json: schema: $ref: '#/components/schemas/InsurancePreAuthorizationDecision' responses: '200': description: OK. content: application/json: schema: type: object required: - data properties: data: $ref: '#/components/schemas/InsurancePreAuthorization' idempotent_replay: type: boolean description: >- Present and true when this Idempotency-Key was already used and the original answer is returned. '400': $ref: '#/components/responses/BadRequest' '401': $ref: '#/components/responses/Unauthorized' '403': $ref: '#/components/responses/Forbidden' '404': $ref: '#/components/responses/NotFound' '409': $ref: '#/components/responses/Conflict' '429': $ref: '#/components/responses/TooManyRequests' security: - ApiKey: [] components: parameters: IdempotencyKeyRequired: name: Idempotency-Key in: header required: true description: >- A unique value you choose for this request, such as a UUID. Sending the same key again returns the first answer instead of doing the work twice, so a timed-out request is safe to retry. Reusing a key for a different request is refused with `409 idempotency_key_conflict`, and retrying while the first request is still running with `409 idempotency_key_reused`. See Retries and idempotency. schema: type: string minLength: 1 schemas: InsurancePreAuthorizationDecision: type: object additionalProperties: false description: >- Decide a request that is `sent_for_authorization`. An approval needs `pa_code`; a denial needs `reason`. `approved_amount` (approval only) defaults to the estimated cost and may not exceed it. Lines you do not list follow the decision. A decided request cannot be decided again. required: - decision properties: decision: type: string enum: - approved - denied pa_code: type: string maxLength: 100 approved_amount: type: number minimum: 0 reason: type: string maxLength: 1000 items: type: array maxItems: 500 items: $ref: '#/components/schemas/InsurancePreAuthorizationLineDecision' InsurancePreAuthorization: type: object description: >- A pre-authorization request the clinic sent to an insurer. `status` is `sent_for_authorization` until the insurer decides, then `approved` or `denied` (with `pa_code` on approval). `items` and `diagnoses` are on the single read only. required: - id - request_number - insurance_company_id - status properties: id: type: string format: uuid request_number: type: string insurance_company_id: type: string format: uuid insurance_plan_id: type: - string - 'null' format: uuid enrollee_id: type: - string - 'null' format: uuid patient_id: type: string format: uuid encounter_id: type: - string - 'null' format: uuid request_type: type: - string - 'null' enum: - service - procedure - medication - equipment - hospitalization - consultation - lab_test - null priority_level: type: - string - 'null' enum: - routine - urgent - emergency - null status: type: string enum: - draft - ai_reviewed - reviewed - sent_for_authorization - approved - denied - expired - cancelled estimated_cost: type: - number - 'null' approved_amount: type: - number - 'null' pa_code: type: - string - 'null' pr_code: type: - string - 'null' is_approved: type: - boolean - 'null' is_handled: type: - boolean - 'null' handled_at: type: - string - 'null' format: date-time rejection_reason: type: - string - 'null' encounter_date: type: - string - 'null' format: date-time admission_start: type: - string - 'null' format: date-time admission_end: type: - string - 'null' format: date-time is_floating: type: - boolean - 'null' submitted_at: type: - string - 'null' format: date-time created_at: type: - string - 'null' format: date-time updated_at: type: - string - 'null' format: date-time items: type: array items: $ref: '#/components/schemas/InsurancePreAuthorizationItem' diagnoses: type: array items: $ref: '#/components/schemas/InsuranceDiagnosis' InsurancePreAuthorizationLineDecision: type: object additionalProperties: false required: - item_id - approved properties: item_id: type: string format: uuid approved: type: boolean reason: type: string maxLength: 1000 InsurancePreAuthorizationItem: type: object properties: id: type: string format: uuid item_type: type: - string - 'null' description: type: - string - 'null' tariff_code: type: - string - 'null' quantity: type: - number - 'null' unit_cost: type: - number - 'null' total_cost: type: - number - 'null' diagnosis: type: - string - 'null' icd_cpt_code: type: - string - 'null' medical_necessity: type: - string - 'null' approval_status: type: - string - 'null' is_approved: type: - boolean - 'null' reject_reason: type: - string - 'null' InsuranceDiagnosis: type: object required: - icd_code properties: icd_code: type: string name: type: - string - 'null' is_primary: type: - boolean - 'null' Problem: type: object description: RFC 9457 application/problem+json. required: - type - title - status - code - request_id properties: type: type: string format: uri title: type: string status: type: integer detail: type: string code: type: string request_id: type: string errors: type: array items: type: object required: - pointer - message properties: pointer: type: string message: type: string responses: BadRequest: description: >- The request failed validation (unknown query parameter, limit out of range, malformed body, or a write-off sent without its reason — `reason_required`). content: application/problem+json: schema: $ref: '#/components/schemas/Problem' Unauthorized: description: >- Missing, malformed, unknown, revoked or expired key, or the wrong secret. content: application/problem+json: schema: $ref: '#/components/schemas/Problem' Forbidden: description: >- The key or connection lacks the required scope, the plan does not include this resource, the request came from an address this key's IP allow-list does not permit, a TEST-environment workspace key asked for a clinic_id other than its own workspace's sandbox (`sandbox_only`), or a LIVE workspace key asked for a real clinic while its workspace's verification has lapsed (`not_verified`) — the response never names which addresses ARE allowed, nor which clinic actually is the sandbox. content: application/problem+json: schema: $ref: '#/components/schemas/Problem' NotFound: description: The record is absent, or out of the key's scope — one message for both. content: application/problem+json: schema: $ref: '#/components/schemas/Problem' Conflict: description: >- The request is well-formed but conflicts with the CURRENT STATE of the record — a double-booked slot (`slot_taken`), a clinician's calendar blocked at that time (`out_of_office`), nobody eligible free (`no_provider_available`), an item that still has stock (`item_has_stock`), an item that has been used and so cannot be deleted (`item_has_history`), a ledger movement that cannot be covered (`insufficient_stock`, `expired_stock_not_transferable`), a note already signed or clinician-touched (`note_not_editable`), an Idempotency-Key already used for a different request or still in flight (`idempotency_key_conflict`, `idempotency_key_reused`), or an external-stock batch rejected as structurally invalid or a suspicious shrink versus the clinic's last accepted batch (`batch_rejected`), or an outside record that conflicts with what was already submitted or decided: the same `client_reference` sent again with different content (`client_reference_conflict`), or a submission a clinician has already decided (`submission_not_pending`), or an insurance write that conflicts with the clinic's setup or the coverage's state: the patient already has a coverage for that payer (`coverage_exists`, the existing coverage's id is in `detail` when the caller can see that patient), a payer the clinic has not enabled in Settings → Insurance (`payer_not_enabled`), or `coverage_active: true` sent through the API (`activation_requires_staff` — only clinic staff activate a coverage), or a change to an outside care provider the clinic added rather than an app (`care_provider_clinic_managed` — only the clinic can change or remove it). content: application/problem+json: schema: $ref: '#/components/schemas/Problem' TooManyRequests: description: Rate limited. See the Retry-After header. content: application/problem+json: schema: $ref: '#/components/schemas/Problem' securitySchemes: ApiKey: type: http scheme: bearer bearerFormat: ehr_live__ or ehr_test__ ```` This documentation is built and hosted on [Mintlify](https://mintlify.com), a developer documentation platform.