BHM Healthcare Solutions API
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, r
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
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.
API Endpoints
Authentication
/sessionsEstablish 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.
UM Cases
/um/casesRetrieve prior authorization and clinical review cases with member, provider, and service-line details. Use this to track statuses, deadlines, and reviewer assignments.
UM Cases
/um/casesCreate a new prior authorization or review case. Include service lines and attach clinical documentation via signed URLs or file upload.
Case Decisions
/um/cases/{caseId}/decisionRecord or retrieve the determination outcome for a case. Supports authorization numbers, validity dates, partial approvals, and requests for additional information.
Clinical Documents
/um/cases/{caseId}/documentsUpload or link clinical documents to a case. Supergood handles signed URL generation and portal-compatible delivery.
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
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
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
Frequently asked questions
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.
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.
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.