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BFD-4764: Prior Auth Server Implementation - #3201

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aschey-forpeople merged 22 commits into
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BFD-4764
Jul 29, 2026
Merged

BFD-4764: Prior Auth Server Implementation#3201
aschey-forpeople merged 22 commits into
masterfrom
BFD-4764

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@mel1-G

@mel1-G mel1-G commented Jul 7, 2026

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JIRA Ticket:
BFD-4764

What Does This PR Do?

  • Separates prior auth into two tables: idr.prior_auth and idr.prior_auth_item
  • Implements the prior authorization mappings on the server
  • Supports filtering by _source=CWF. Prior Auth eobs will always be returned by default otherwise.

MISC:

  • cleans up ClaimAuditStatusCode since we stopped relying on it to determine the outcome on an EOB in 4593: BFD-4593 Add EOB Outcome Search #3174
  • Implements the missing mappings for ClaimAuditStatusCode and ClaimPaidStatusCode
  • Adds support to collect metrics on our executor
  • renames the samhsa_filter metric to transform so our dashboard uses the correct metric

Notes:

  • The data quality of prior auth is...not great. We still have some open questions and future meetings with IDR. This is why prior auth is behind a feature flag for prod. We'll only be serving synthetic data for now.
  • Searching for prior auth's by id currently is not supported. This is why I short circuit relying on our SourceFilterParam. I left it out since it turns out to have a large blast radius. It can be done but as a future effort.

What Should Reviewers Watch For?

If you're reviewing this PR, please check for these things in particular:

Make sure that I implemented the mappings correctly!

What Security Implications Does This PR Have?

Please indicate if this PR does any of the following:

  • Adds any new software dependencies

  • Modifies any security controls

  • Adds new transmission or storage of data

  • Any other changes that could possibly affect security?

  • I have considered the above security implications as it relates to this PR. (If one or more of the above apply, it cannot be merged without the ISSO or team security engineer's (@sb-benohe) approval.)

  • I have created tests to sufficiently ensure the reliability of my code, if applicable. If this is a modification to an existing piece of code, I have audited the associated tests to ensure everything works as expected.

Validation

Have you fully verified and tested these changes? Is the acceptance criteria met? Please provide reproducible testing instructions, code snippets, or screenshots as applicable.

Integration tests

Comment thread apps/bfd-model-idr/maps/ExplanationOfBenefit-PriorAuth.map Outdated
@mel1-G
mel1-G marked this pull request as ready for review July 7, 2026 21:42
Comment thread apps/bfd-pipeline-idr/model/base_model.py Outdated
Comment thread apps/bfd-pipeline-idr/model/base_model.py
Comment thread apps/bfd-pipeline-idr/pipeline_stages.py Outdated
Comment thread apps/bfd-server-ng/src/main/java/gov/cms/bfd/server/ng/eob/EobHandler.java Outdated
Comment thread apps/bfd-server-ng/src/main/java/gov/cms/bfd/server/ng/claim/ClaimRepository.java Outdated
@mel1-G
mel1-G marked this pull request as draft July 10, 2026 19:25
@mel1-G
mel1-G marked this pull request as ready for review July 20, 2026 23:30
Comment thread apps/bfd-pipeline-idr/model/idr_prior_auth_item.py Outdated
clewellyn-nava
clewellyn-nava previously approved these changes Jul 27, 2026
JFisk42
JFisk42 previously approved these changes Jul 27, 2026
@mel1-G
mel1-G dismissed stale reviews from JFisk42, clewellyn-nava, and aschey-forpeople via 97d152c July 28, 2026 19:14
clewellyn-nava
clewellyn-nava previously approved these changes Jul 29, 2026
alex-dzeda
alex-dzeda previously approved these changes Jul 29, 2026
@mel1-G
mel1-G added this pull request to the merge queue Jul 29, 2026
@github-merge-queue
github-merge-queue Bot removed this pull request from the merge queue due to failed status checks Jul 29, 2026
@mel1-G
mel1-G dismissed stale reviews from alex-dzeda and clewellyn-nava via 579857c July 29, 2026 17:46
@bfd-sast

bfd-sast Bot commented Jul 29, 2026

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@aschey-forpeople
aschey-forpeople added this pull request to the merge queue Jul 29, 2026
Merged via the queue into master with commit 596a3a1 Jul 29, 2026
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@aschey-forpeople
aschey-forpeople deleted the BFD-4764 branch July 29, 2026 18:08
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6 participants