CMS-0057-F Test Workflow.

6-step integration test for CRD, DTR, PAS $submit/$inquire, and X12 278 conversion. Two clinical scenarios with complete test data.

Looking for the full compliance suite? CMS-0057-F Compliance Suite →

CMS-PAS Docs: Product Overview Architecture Test Workflow Compatibility Matrix API Reference

Quick Start

REST API Demo (Swagger) https://demo.redix.com/docs
Auth Header X-API-Key: demo-key-12345
Open Swagger UI View API Docs

Demo uses de-identified sample data only (no PHI). Demo key is public and rate-limited; production is customer-managed on customer infrastructure.

Choose Your Scenario

Two clinical scenarios with complete test data

Home Oxygen Therapy

HCPCS E0424 | Sample Patient A

Total Knee Replacement

CPT 27447 | Sample Patient B

Home Oxygen Therapy Test Data

Patient: Sample Patient A (Patient/sample-patient-a)
Procedure: HCPCS E0424 — Stationary Oxygen
Provider: Sample Provider (NPI: 9999999999)
Payer: Sample Payer (Commercial)
Diagnosis: J44.1 — COPD with acute exacerbation
Duration: 6 months rental

Total Knee Replacement Test Data

Patient: Sample Patient B (Patient/sample-patient-b)
Procedure: CPT 27447 — Total Knee Arthroplasty
Provider: Sample Provider (NPI: 9999999998)
Payer: Sample Payer (MA Plan)
Diagnosis: M17.11 — Primary osteoarthritis, right knee
Facility: Sample Facility

Workflow Steps

CRD check, DTR forms, PAS submission, status polling, format conversion, and billing integration

1
CRD — Check If PA Required
POST /cds-services/order-sign-crd

Input

CDS Hook request with ServiceRequest context (procedure code, patient, coverage)

Output

  • info-needed — PA required, proceed to DTR
  • no-pa-needed — Skip to submission
Note: If CRD service is unavailable, you may skip to Step 3 (Submit) but PA may be rejected for missing documentation.
2
DTR — Get Required Forms
GET /fhir/dtr/Questionnaire/{id}

Input

Coverage + procedure context from CRD response

Output

FHIR Questionnaire resource with required documentation fields

Note: Some procedures don't require additional forms. Proceed to Step 3 with a standard PA bundle.
3
Submit PA Request
POST /api/pas/Claim/$submit

Input

  • FHIR Bundle (Claim + supporting resources)
  • Or: X12 278 (auto-converted)
  • Or: RMap 278 (simplified format)

Output

  • ClaimResponse with status
  • Provenance audit record
  • Status: pended / approved / denied

Key Resources

Claim, Patient, Practitioner, Organization, Coverage, ServiceRequest

Validation error? Check OperationOutcome for missing required fields. Common issues: missing NPI, invalid procedure code, coverage not found.
4
Poll PA Status
POST /api/pas/Claim/$inquire

Input

Request identifier returned by $submit (see Swagger for exact field)

Output

  • Updated ClaimResponse
  • preAuthRef if approved
  • Denial reason if rejected
Polling: Use exponential backoff (5s → 15s → 30s → 60s) and respect Retry-After headers. Demo returns quickly; production may take minutes to hours.
5
Convert Response
POST /api/v2/fhir-to-hipaa

Input

FHIR ClaimResponse from Step 4

Output

  • X12 278 Response (for legacy PA systems)
  • Or: RMap format
  • Provenance tracking maintained
Format note: FHIR ClaimResponse → X12 278 conversion for integration with legacy claims and PA systems.
6
(Your System) Link to Billing
Your billing/claims system

What You Do

Use the preAuthRef from Step 4 in your billing system when submitting claims. This links the claim to the approved PA.

Scope: This step is outside Redix PAS — it is your responsibility to integrate with your billing workflow.

Common Errors & Fixes

Error Code Cause Fix
401 Unauthorized Missing or invalid API key Add required auth header (demo key shown above; production is customer-managed)
400 Bad Request Invalid FHIR Bundle structure Validate against PAS IG profile
422 Unprocessable Missing required fields Check OperationOutcome for details
404 Not Found Claim ID does not exist Verify ID from $submit response
500 Server Error Conversion engine issue Contact support with request ID

All ten tools available here. Interactive ePA workflow demo here. Swagger API explorer here.

Live Sandbox Tools

Test the CMS-PAS workflow with these sandbox tools

Interactive workflow demo: Walk through the full ePA process (CRD → DTR → PAS submit → auto-approval → payment) in a single guided page. Launch the demo.

CMS PAS 278

Submit & inquire prior auth requests

X12 to FHIR

Convert HIPAA X12 to FHIR R4 bundles

FHIR to RMap

Convert FHIR PAS bundles to tabular RMap

Related Documentation

Overview → Architecture → Compatibility Matrix → API Reference → Product Page →