What is Predictive Document Intelligence?
Predictive Document Intelligence evaluates clinical documentation before a prior authorization is submitted to a payor. It analyzes uploaded documents against validation rules to catch issues - missing signatures, outdated assessments, mismatched diagnosis codes - before they cause denials. Validation does not prevent submission as you can always proceed with creating and submitting a prior authorization, regardless of whether all rules pass.
Rules come from two sources:
- Payor rules - Managed by Silna based on each payor’s specific requirements for a given specialty and document type.
- Provider rules - Self-configured by providers in the Automation tab of the Provider Overview in the Silna portal. These let providers enforce their own documentation standards on top of payor requirements.
How It Works
Predictive Document Intelligence validates documents automatically when you upload them during a PATCH (Update) Prior Authorization request. Validation typically completes in 30 to 45 seconds.
Validation Flow
Validation failures do not prevent you from moving forward with creating a prior authorization. If you choose to proceed despite failures, you can either disable validation for specific document types or set skip_document_intelligence: true on your next PATCH request. The prior authorization will then advance to ALL_REQUIRED_DATA_RECEIVED as normal. Integration Steps
- Upload documents - Call PATCH Prior Authorization with clinical documents attached to the appropriate document types.
- Poll for results - Call GET Prior Authorization with
with_requirements=true. Once the status moves to DATA_REQUESTED or ALL_REQUIRED_DATA_RECEIVED, validation results are available in required_data.documents[].document_validation_batch.
- Handle failures - If
document_validation_batch.result is "FAILED", use the batch ID to get detailed rule results. You can fix documents and re-upload, or choose to proceed despite the failures (see Overriding Validations).
- Complete the request - Once the status is
ALL_REQUIRED_DATA_RECEIVED (either because all validations passed or because you chose to proceed), call POST Complete Prior Authorization.
Rule Types
Predictive Document Intelligence evaluates documents across seven rule categories. Both payor rules and provider-configured rules use the same rule types:
| Rule Type | What It Validates | Example Checks |
|---|
| CLINICIAN | Clinician credentials and identity | Valid signature present, matching NPI/credential, correct taxonomy code |
| TIME_FRAME | Document dates and expiration | Document not expired, evaluation within required window, dates align with auth period |
| DIAGNOSIS | Diagnosis codes and dates | Required ICD codes present, diagnosis date documented |
| TREATMENT | Treatment and referral information | Referred specialties match requirements, CPT codes present |
| PATIENT | Patient demographics and history | Age verification, clinical history present, patient identity confirmed |
| ASSESSMENT | Diagnostic tools and clinical criteria | Required assessment instruments used, diagnostic criteria met, severity documented |
| DOCUMENT | Document type and completeness | Document matches the required type |
Reading Validation Results
From the Prior Authorization
When you call GET Prior Authorization with with_requirements=true, each document in required_data.documents[] includes:
{
"document_type": "DIAGNOSIS_REPORT",
"required": true,
"requirement_satisfied": false,
"document_validation_batch": {
"id": "0194a4ed-130d-775b-81fd-ca2b4eb618ce",
"result": "FAILED"
}
}
document_validation_batch.result - "PASSED" or "FAILED"document_validation_batch.id - Use this ID to fetch detailed rule results via the Get Document Validation Batch endpointrequirement_satisfied - Set to false when validation fails. The prior authorization will stay in DATA_REQUESTED until the documents are fixed or validation is overridden
The document_validation field on the GET Prior Authorization response is deprecated. It only returns a single document validation and does not reflect the full batch. Use document_validation_batch instead, which provides the batch ID and aggregate result.
Detailed Rule Results
Use the Get Document Validation Batch endpoint to retrieve the full breakdown of which rules passed and failed:
{
"id": "batch-uuid",
"document_type": "DIAGNOSIS_REPORT",
"result": "FAILED",
"document_validations": [
{
"id": "validation-uuid",
"result": "FAILED",
"passed_rules": [
{
"rule": "DIAGNOSIS_CODES",
"result": "PASSED",
"reason": "Required ICD-10 codes F84.0 found in document"
}
],
"failed_rules": [
{
"rule": "DOCUMENT_EXPIRED",
"result": "FAILED",
"reason": "Document date (2024-01-15) exceeds the 90-day validity window"
}
],
"rule_results": [...]
}
]
}
reason explaining why it passed or failed.
Use document_validation_batch.id from the GET Prior Authorization response to retrieve detailed results via the batch endpoints. The document_validation field on the PA response is deprecated — it only returns a single document validation. You can still use the individual document validation endpoint to look up a specific validation by ID. Overriding Validations
Validation is designed to help catch issues before submission, but it never prevents you from creating a prior authorization. If you want to proceed despite failures, there are two options:
Option 1: Disable validation for specific document types
Set document_intelligence_configurations[].document_validation.enabled to false in your PATCH request to skip validation for individual document types while still validating others:
{
"documents": [
{
"document_type": "REFERRAL",
"file_id": "your-file-id"
}
],
"document_intelligence_configurations": [
{
"document_type": "REFERRAL",
"document_validation": {
"enabled": false
}
}
]
}
Option 2: Skip all validation
Set skip_document_intelligence to true in your PATCH request to bypass validation entirely for that update:
{
"skip_document_intelligence": true,
"documents": [
{
"document_type": "REFERRAL",
"file_id": "your-file-id"
}
]
}
ALL_REQUIRED_DATA_RECEIVED once all other requirements are met, regardless of any previous validation failures.
Prior Authorization Lifecycle
Validation runs automatically after you upload documents and before the authorization can be completed. When rules fail, the response includes details about which rules failed and why. You can fix and re-upload, or skip validation and proceed.
API Endpoints
| Endpoint | Description |
|---|
| Get Document Validation Batch | Returns a batch with all document validations and rule results |
| Get Document Validations in a Batch | Returns paginated document validations within a batch |
| Get Document Validation | Returns a single document validation by ID |
