import { ParmanaClient, ParmanaApiError } from "@parmanasystems/sdk-client";
import type { ExecutionAttestation } from "@parmanasystems/sdk-client";
const client = new ParmanaClient({
baseUrl: process.env.PARMANA_URL ?? "http://localhost:3000",
apiKey: process.env.PARMANA_API_KEY,
});
// Signals use clinical codes and plan/network identifiers — no PHI
interface PriorAuthSignals {
procedureCode: string; // CPT code
diagnosisCode: string; // ICD-10 code
memberPlanTier: string; // "basic" | "standard" | "premium"
providerNetwork: string; // "in_network" | "out_of_network"
estimatedCost: number; // USD
urgency: string; // "routine" | "urgent" | "emergency"
priorAuthCount: number; // prior auths for this member+procedure in last 12 months
treatmentDuration: number; // days
}
interface PriorAuthResult {
authorizationId: string;
approved: boolean;
pendingClinicalReview: boolean;
action: string;
reason: string;
attestation: ExecutionAttestation;
}
async function requestPriorAuth(
authorizationId: string,
signals: PriorAuthSignals
): Promise<PriorAuthResult> {
const attestation = await client.execute({
executionId: authorizationId,
policyId: "prior-auth",
policyVersion: "1.0.0",
signals,
});
// Verify before returning — attestation must be valid before any clinical action
const verification = await client.verify(attestation);
if (!verification.valid) {
throw new Error(
`Attestation verification failed for authorization ${authorizationId}. ` +
`Authorization cannot be granted.`
);
}
return {
authorizationId,
approved:
attestation.execution_state === "completed" &&
attestation.decision.action === "approve",
pendingClinicalReview:
attestation.execution_state === "pending_override",
action: attestation.decision.action,
reason: attestation.decision.reason,
attestation,
};
}
async function clinicalReviewApprove(
authorizationId: string,
reviewerId: string,
reviewerRole: string,
clinicalReason: string
) {
return client._request<{
status: string;
overrideId: string;
resolution: { status: string; execution_fingerprint: string; signature: string };
}>("/override", {
method: "POST",
body: JSON.stringify({
executionId: authorizationId,
approved: true,
approvedBy: reviewerId,
approverRole: reviewerRole,
reason: clinicalReason,
}),
});
}
async function clinicalReviewDeny(
authorizationId: string,
reviewerId: string,
reviewerRole: string,
denialReason: string
) {
return client._request<{
status: string;
executionId: string;
}>("/override", {
method: "POST",
body: JSON.stringify({
executionId: authorizationId,
approved: false,
approvedBy: reviewerId,
approverRole: reviewerRole,
reason: denialReason,
}),
});
}
// Example usage
async function main() {
// Auto-approved: emergency
const emergency = await requestPriorAuth("PA-2024-00341", {
procedureCode: "27447", // total knee replacement
diagnosisCode: "M17.11", // primary osteoarthritis, right knee
memberPlanTier: "standard",
providerNetwork: "in_network",
estimatedCost: 30000,
urgency: "emergency",
priorAuthCount: 0,
treatmentDuration: 3,
});
console.log(emergency.action); // "approve" — emergency overrides cost threshold
console.log(emergency.approved); // true
// Auto-approved: routine, in-network, low cost
const routine = await requestPriorAuth("PA-2024-00342", {
procedureCode: "71046", // chest X-ray
diagnosisCode: "J18.9", // pneumonia
memberPlanTier: "premium",
providerNetwork: "in_network",
estimatedCost: 450,
urgency: "routine",
priorAuthCount: 1,
treatmentDuration: 1,
});
console.log(routine.action); // "approve"
console.log(routine.approved); // true
// Clinical review: out-of-network
const outOfNetwork = await requestPriorAuth("PA-2024-00343", {
procedureCode: "27447",
diagnosisCode: "M17.11",
memberPlanTier: "standard",
providerNetwork: "out_of_network",
estimatedCost: 35000,
urgency: "routine",
priorAuthCount: 0,
treatmentDuration: 3,
});
console.log(outOfNetwork.action); // "clinical_review"
console.log(outOfNetwork.pendingClinicalReview); // true
// Medical director approves out-of-network case
if (outOfNetwork.pendingClinicalReview) {
const approved = await clinicalReviewApprove(
"PA-2024-00343",
"md-dr-patricia-osei",
"medical_director",
"No in-network specialist available within 50 miles. " +
"Out-of-network approved at in-network benefit level."
);
console.log(approved.status); // "approved"
console.log(approved.overrideId); // override record ID
}
}
main().catch(console.error);
