Prior Authorization Overview

Develop Health turns the patient, insurance, prescription, provider, and clinical evidence in a prior authorization request into a payer-ready submission. The public create endpoint is the same for both supported submission models; your implementation is configured as delegated or non-delegated with the Develop Health team.

Delegated and non-delegated workflows

Model	Who reviews before submission	Who submits to the payer or PBM	Key lifecycle handoff
Delegated	Develop Health prepares and validates the request without requiring customer pre-submission review.	Develop Health submits and manages payer or PBM follow-up.	After processing, the request generally proceeds to `awaiting_outcome` or another state that identifies required follow-up.
Non-delegated	Your authorized reviewer checks the prefilled answers and evidence, makes edits, and supplies missing information.	Your reviewer approves the prepared request for submission through the review experience.	The request enters `awaiting_review`; after review and submission, it proceeds to `awaiting_outcome`.

In a delegated workflow, continue monitoring the PA while Develop Health handles submission and follow-up. In a non-delegated workflow, treat awaiting_review as an action state for your team: the PA is prepared but has not yet been submitted to the payer or PBM. Other nonterminal states can appear in either model. For example, awaiting_provider_response means the prescriber or provider must supply or review information, while validating_outcome means a payer response is being checked.

Typical lifecycle by model

Delegated: processing → awaiting_outcome → terminal state
Non-delegated: processing → awaiting_review → awaiting_outcome → terminal state

These are the normal paths, not exhaustive state machines. Always use the current data.status and the response handling guide as the source of truth.

Response handling

A successful create response means the PA was accepted, not that it was submitted to a payer or PBM. See Prior Authorization Response Handling for lifecycle states, request errors, terminal exceptions, and recommended caller behavior.

Getting Started

Benefit Verification