Supergood | BHM Healthcare Solutions API
Programmatically access prior authorization, utilization management (UM), external peer review, and appeals workflows in BHM Healthcare Solutions with a stable REST API. Supergood builds and operates production-grade, unofficial BHM integrations so your team can automate authorization and review pipelines without heavy custom engineering.
In plain English: BHM Healthcare Solutions is a healthcare services organization focused on medical necessity review, external peer review (IRO), utilization management, and appeals. An unofficial API lets you submit prior auth and review cases, attach clinical documentation, track determinations, retrieve decision letters, and surface authorization numbers for downstream billing—directly from your own systems.
If you're a healthcare tech startup building billing or practice management tools, integrating with BHM means you can push prior auth requests from scheduling workflows, pull real-time case statuses and outcomes, automatically attach required clinical documents, detect authorization numbers and validity windows, and trigger operational workflows (e.g., scheduling, claims submission) when decisions arrive.
If you’re a clinic, provider group, or revenue cycle team, integrating your tech stack with BHM unlocks concrete data flows and features:
- Pull: Case queues (prior auth, concurrent review, retrospective review, external appeals), determination statuses, authorization numbers, decision letters (PDF), reviewer assignments, turnaround SLAs
- Push: New case submissions with diagnoses and service lines, clinical document uploads, provider/facility details, requested service units and dates, appeal requests and additional information
- Build: Authorization-aware scheduling, real-time decision tracking, denial/appeal resolution workflows, automated claim readiness checks using decision outcomes and authorization numbers
What is BHM Healthcare Solutions?
BHM Healthcare Solutions provides payer and provider support services for medical necessity determinations, external peer review (as an Independent Review Organization), utilization management outsourcing, and appeals management. BHM’s workflows span intake and triage, clinical review assignment, structured determinations, decision letter generation, and compliance reporting for payers, provider groups, and health systems.
Core product areas include:
- Utilization Management (prior authorization, concurrent and retrospective review)
- External Peer Review (IRO) for appeals and medical necessity determinations
- Appeals and Denial Management (first-level and external appeals)
- Provider and Facility Data Capture (treating provider, facility NPI, taxonomy)
- Determination Letters, Notifications, and Compliance Artifacts
- Reporting on turnaround times, decision outcomes, and audit trails
Common data entities:
- Members (patients) and eligibility context
- Treating Providers and Facilities (NPI, taxonomy, contact)
- Payers/Plans and program metadata
- Cases (prior auth, concurrent review, retrospective review, external appeal)
- Service Lines (HCPCS/CPT codes, units, place of service, dates)
- Diagnoses (ICD-10 codes)
- Clinical Documents and evidence
- Reviewers (specialty, licensure, credential status)
- Determinations (outcomes, rationale, authorization numbers, validity windows)
- Decision Letters (PDF artifacts)
The BHM Integration Challenge
Organizations rely on BHM daily, but turning portal-based review workflows into automated pipelines is hard:
- Payer- and program-specific policies: Criteria, service codes, documentation requirements, and authorization rules vary widely
- Strong enterprise security: SSO/MFA and hardened portals complicate headless automation
- Portal-first delivery: Intake, case updates, and letter retrieval are often designed for human use—not public APIs
- PHI and audit rigor: Sensitive clinical data, strict access controls, and retention/audit requirements demand careful handling
- Timing windows: Expedited reviews, SLA tracking, and appeal deadlines must be respected programmatically
How Supergood Creates BHM APIs
Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.
- Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
- Maintains session continuity with automated refresh and change detection
- Normalizes case, determination, and authorization objects so you can integrate once across payers/programs
- Aligns with customer entitlements and licensing constraints to ensure compliant access
- Bridges batch imports/exports with signed URL retrieval and delivery for decision letters and artifacts
Use Cases
EHR-to-UM Case Submission
- Push prior authorization cases from scheduling with correct CPT/HCPCS codes and units
- Attach clinical documents (progress notes, labs, imaging) automatically
- Maintain a single source of truth for member demographics and treating provider details
Authorization-Aware Scheduling and Eligibility
- Validate decision outcomes and authorization number before scheduling
- Track validity dates and remaining authorized units to prevent over-utilization
- Surface payer- and program-specific rules to care teams
Appeals and Denial Management
- Submit appeals and additional info requests with complete audit trails
- Pull decision letters and rationale to guide clinical and revenue cycle actions
- Escalate unresolved or approaching-deadline cases with automated routing
Claims Readiness and Reimbursement Automation
- Detect approved decisions and authorization numbers to gate claim creation
- Route artifacts (letters, determinations) into RCM workflows
- Reconcile claim outcomes with review decisions for denial prevention
Available Endpoints
Authentication
POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/sessions \
--header 'Authorization: Basic <Base64 encoded token>' \
--header 'Content-Type: application/json' \
--data '{
"username": "[email protected]",
"password": "<password>",
"mfa": {
"type": "totp",
"code": "123456"
}
}'
Example response
{
"authToken": "eyJhbGciOi...",
"expiresIn": 3600,
"user": {
"id": "u_bhm_29b71a",
"name": "UM Admin",
"entitlements": ["cases", "decisions", "documents"]
}
}
UM Cases
GET /um/cases: Retrieve prior authorization and clinical review cases with member, provider, and service-line details. Use this to track statuses, deadlines, and reviewer assignments.
Query parameters
- memberId: string
- payerId: string
- caseType: string (prior_auth | concurrent_review | retrospective_review | external_appeal)
- status: string (open | pending_review | additional_info_requested | determination_sent | closed)
- submittedOn: ISO 8601 date
- serviceCode: string (CPT/HCPCS)
- treatingProviderNpi: string
Example response
{
"items": [
{
"caseId": "case_7342c1",
"caseNumber": "PA-2026-11872",
"caseType": "prior_auth",
"urgency": "expedited",
"member": {
"memberId": "mem_9b42f0",
"name": "Jordan Patel",
"dob": "1989-03-14"
},
"payerId": "payer_mco_oh",
"treatingProvider": {
"npi": "1457382910",
"name": "BrightCare Family Medicine"
},
"facility": {
"npi": "1689321457",
"name": "BrightCare Outpatient Center"
},
"diagnosisCodes": ["M54.5"],
"serviceLines": [
{"code": "97110", "units": 8, "startDate": "2026-01-20", "endDate": "2026-02-20", "placeOfService": "11"}
],
"status": "pending_review",
"reviewer": {"id": "rev_41cf92", "specialty": "Physical Medicine"},
"submittedOn": "2026-01-19T14:02:33Z",
"slaDue": "2026-01-21T14:02:33Z"
}
],
"page": 1,
"pageSize": 50,
"total": 1
}
POST /um/cases: Create a new prior authorization or review case. Include service lines and attach clinical documentation via signed URLs or file upload.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/um/cases \
--header 'Authorization: Bearer <authToken>' \
--header 'Content-Type: application/json' \
--data '{
"caseType": "prior_auth",
"urgency": "standard",
"member": {
"memberId": "mem_9b42f0",
"name": "Jordan Patel",
"dob": "1989-03-14"
},
"payerId": "payer_mco_oh",
"treatingProvider": {
"npi": "1457382910",
"name": "BrightCare Family Medicine"
},
"facility": {
"npi": "1689321457",
"name": "BrightCare Outpatient Center"
},
"diagnosisCodes": ["M54.5"],
"serviceLines": [
{"code": "97110", "units": 8, "startDate": "2026-01-20", "endDate": "2026-02-20", "placeOfService": "11"}
],
"clinicalDocuments": [
{"type": "progress_note", "url": "https://files.example/signed/abc123", "filename": "note_2026-01-18.pdf"},
{"type": "imaging", "url": "https://files.example/signed/def456", "filename": "lumbar_mri.pdf"}
],
"referenceId": "ehr-req-42391"
}'
Example response
{
"caseId": "case_81af2b",
"caseNumber": "PA-2026-11883",
"status": "open",
"submittedOn": "2026-01-19T16:05:42Z",
"reviewer": null,
"referenceId": "ehr-req-42391"
}
Case Decisions
POST /um/cases/{caseId}/decision: Record or retrieve the determination outcome for a case. Supports authorization numbers, validity dates, partial approvals, and requests for additional information.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/um/cases/case_81af2b/decision \
--header 'Authorization: Bearer <authToken>' \
--header 'Content-Type: application/json' \
--data '{
"outcome": "approved",
"authorizationNumber": "AUTH-2026-55421",
"authorizedUnits": 8,
"validFrom": "2026-01-20",
"validTo": "2026-03-20",
"decisionCodes": ["MCN"],
"rationale": "Meets criteria based on clinical documentation and guidelines.",
"reviewerId": "rev_41cf92",
"letter": {"url": "https://files.example/signed/letter_81af2b.pdf", "format": "pdf", "size": 234567}
}'
Example response
{
"caseId": "case_81af2b",
"outcome": "approved",
"authorizationNumber": "AUTH-2026-55421",
"authorizedUnits": 8,
"validFrom": "2026-01-20",
"validTo": "2026-03-20",
"decisionCodes": ["MCN"],
"rationale": "Meets criteria based on clinical documentation and guidelines.",
"reviewerId": "rev_41cf92",
"letter": {"url": "https://files.example/signed/letter_81af2b.pdf"},
"status": "determination_sent",
"updatedAt": "2026-01-20T09:12:33Z"
}
Clinical Documents
POST /um/cases/{caseId}/documents: Upload or link clinical documents to a case. Supergood handles signed URL generation and portal-compatible delivery.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/um/cases/case_81af2b/documents \
--header 'Authorization: Bearer <authToken>' \
--header 'Content-Type: application/json' \
--data '{
"documents": [
{"type": "progress_note", "filename": "note_update_2026-01-20.pdf", "url": "https://files.example/signed/new_abc789"},
{"type": "labs", "filename": "cbc_results.pdf", "url": "https://files.example/signed/new_def321"}
],
"referenceId": "ehr-attach-99817"
}'
Example response
{
"caseId": "case_81af2b",
"accepted": 2,
"rejected": [],
"updatedAt": "2026-01-20T10:05:11Z",
"referenceId": "ehr-attach-99817"
}
Technical Specifications
- Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
- Response format: JSON with consistent resource schemas and pagination
- Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
- Session management: Automatic reauth and cookie/session rotation with health checks
- Data freshness: Near real-time retrieval of cases, determinations, and letter artifacts
- Security: Encrypted transport, scoped tokens, and audit logging; respects BHM entitlements and HIPAA requirements
- Webhooks: Optional asynchronous delivery for decision events, letter availability, and SLA breach alerts
Performance Characteristics
- Latency: Sub-second responses for list/detail queries under normal load
- Throughput: Designed for high-volume prior auth and appeals pipelines
- Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
- Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your BHM product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened BHM adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as BHM evolves.
Frequently Asked Questions
Q: Which BHM workflows can this integration cover?
Supergood supports commonly used BHM portals and agency-facing tools, subject to your licensing and entitlements. We scope coverage (e.g., prior auth intake, clinical review assignment, determinations, decision letter retrieval, appeals submissions) during integration assessment.
Q: How are MFA, SSO, and document handling automated?
We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For documents, we manage signed URL delivery and retrieval, ensure portal-compatible metadata, and maintain audit trails for uploads and letter downloads.
Q: Can I gate claims on authorization outcomes?
Yes. You can pull decision outcomes and authorization numbers, then coordinate scheduling and claim creation. We can route artifacts (letters, determinations) into your RCM/clearinghouse workflows and return statuses for reconciliation.
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