Reference architecture
How Authora fits into your stack
The wiring diagram, the API contracts, and what changes for your providers and your UM team.
Figure 1 · Authora reference architecture · provider EHR ↔ Authora ↔ payer UM
API contracts
Three sides of the wire
EHR side
- Epic Hyperdrive App Orchard / SMART on FHIR launch
- FHIR R4 · Patient · Coverage · Encounter · Condition · MedicationRequest · DocumentReference
- CDS Hooks v2.0 · order-sign · order-select
- Read-only by default · scoped tokens per launch
example bundle ▾
{
"resourceType": "Bundle",
"type": "collection",
"entry": [
{ "resource": { "resourceType": "Patient", "id": "pt-park" }},
{ "resource": { "resourceType": "Coverage", "status": "active",
"payor": [{"display":"Anthem"}] }},
{ "resource": { "resourceType": "ServiceRequest",
"code": {"coding":[{"system":"http://www.ama-assn.org/cpt",
"code":"72148"}]} }},
{ "resource": { "resourceType": "Encounter", "class": "AMB" }},
{ "resource": { "resourceType": "DocumentReference",
"type": {"text":"Progress note"} }}
]
}Payer side
- Da Vinci PAS 2.1 · $submit · $inquire
- X12 278 005010X217 (request) + 005010X216 (response)
- OAuth 2.0 client_credentials + mutual TLS
- FHIR-PAS Bundle profile validation before transmit
example PAS submit ▾
POST /Claim/$submit
Content-Type: application/fhir+json
Authorization: Bearer eyJhbGciOiJSUzI1...
{
"resourceType": "Bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
]
},
"type": "collection",
"entry": [ ... Claim, Patient, Coverage, ServiceRequest ... ]
}
→ HTTP/1.1 200 OK
ClaimResponse / outcome=complete / hcr01=A1Internal
- Audit log · immutable · 7-year retention · WORM
- Decision engine · deterministic match + LLM-evidenced reasoning
- Policy index · auto-refreshed weekly · diff-tracked
- OpenTelemetry traces · per-agent · per-tool-call
example run trace ▾
{
"runId": "run_aut-2026-00187_82041",
"caseId": "case-001",
"agents": [
{ "role": "patient_context", "ms": 642, "tokens": 720 },
{ "role": "policy_match", "ms": 286, "tokens": 500 },
{ "role": "evidence_extraction", "ms": 2410, "tokens": 4180 },
{ "role": "compliance", "ms": 176, "tokens": 520 },
{ "role": "submission", "ms": 1380, "tokens": 1080 },
{ "role": "notification", "ms": 398, "tokens": 590 }
],
"decision": "auto_approve",
"conformsTo": ["DaVinci-PAS-2.1","CMS-0057-F","X12-005010X217"]
}Workflow impact
What changes for the people who do the work
| Persona | What changes |
|---|---|
| Ordering physician | Sees a CDS Hooks card at order-sign with PA requirements pre-checked. No portals. |
| PA coordinator | Inbox in Authora replaces 11 payer portals + 4 fax queues. Worklist shows SLA pressure. |
| UM nurse · payer-side | Cases arrive pre-mapped to criteria with quoted chart evidence. One keystroke to approve. |
| Medical director | Replays the full agent trace + chart citations on every escalation. |
| CISO · compliance | HIPAA + 21st Century Cures + CMS-0057-F controls inventoried, with audit log and conformance receipts. |
| Patient | SMS at every state transition. Plain-language denial explanations + appeal path. |
Deployment
Three ways to run Authora
Embedded payer module
Runs inside the payer's UM environment (Optum, Carelon, eviCore). Cases arrive already evidence-mapped; reviewers approve in their existing tooling.
Topology
Private VPC · BAA in place · zero-trust mesh
Latency target
< 800ms p95 review-render
Regulatory profile
HITRUST i1 · SOC 2 Type II · NCQA-aligned
Provider-side gateway
Deployed at the IDN or hospital. SMART on FHIR launches from Epic / Cerner; submits to all contracted payers from a single inbox.
Topology
On-prem appliance or single-tenant cloud
Latency target
< 90s end-to-end determination (auto-approve path)
Regulatory profile
HIPAA · 21st Century Cures · TEFCA-ready
Multi-tenant SaaS
Hosted Authora platform. Best for ambulatory groups, ASCs, and specialty practices submitting across multiple payers and EHRs.
Topology
Edge runtime · Postgres · Anthropic API
Latency target
< 120s end-to-end · 99.95% uptime
Regulatory profile
HIPAA · SOC 2 · row-level isolation per tenant
Quick links