2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

7.12 Resource PendedRequest - Content

This resource maintained by the Financial Management Work Group

This resource provides the request and response details for the resource for which the status is to be checked.

7.12.1 Scope and Usage

The PendedRequest resource provides supporting information for the poll request. The response to this is a previously undelivered response or a StatusResponse (or other acknowledgement which may contain errors).

This is a formal request for Payors or systems which require such and/or transports which don't support a 'Get Operation', for the retrieval of pended, held, resources.

A simple PendedRequest, one which doesn't specify: request, include, exclude or period; would return any pended resource. Specific types of business behaviors may be supported by providing values for the filtering elements, for example:

  • Get any pended resource - no filters specified
  • Get deferred response to a Claim - specify the Claim in the 'request'
  • Get all Supporting Documentation - specify 'SupportingDocumentation' as an 'include'
  • Get an Explanation of Benefit - specify 'ExplanationOfBenefit' as an 'include'
  • Get a payment reconciliation - specify a 'period' which contains the expected reconciliation creation date, and specify 'PaymentReconciliation' as an 'include'

Todo

This resource is referenced by [PaymentReconciliation]

7.12.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PendedRequest DomainResourcePendedRequest request
... identifier 0..*IdentifierBusiness Identifier
... ruleset 0..1CodingResource version
Ruleset (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset (Example)
... created 0..1dateTimeCreation date
... target 0..1OrganizationInsurer
... provider 0..1PractitionerResponsible practitioner
... organization 0..1OrganizationResponsible organization
... request 0..1AnyRequest reference
... include 0..*stringResource type(s) to include
... exclude 0..*stringResource type(s) to exclude
... period 0..1PeriodPeriod

XML Template

<PendedRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <target><!-- 0..1 Reference(Organization) Insurer --></target>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->
 <period><!-- 0..1 Period Period --></period>
</PendedRequest>

JSON Template

{doco
  "resourceType" : "PendedRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Insurer
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "request" : { Reference(Any) }, // Request reference
  "include" : ["<string>"], // Resource type(s) to include
  "exclude" : ["<string>"], // Resource type(s) to exclude
  "period" : { Period } // Period
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PendedRequest DomainResourcePendedRequest request
... identifier 0..*IdentifierBusiness Identifier
... ruleset 0..1CodingResource version
Ruleset (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset (Example)
... created 0..1dateTimeCreation date
... target 0..1OrganizationInsurer
... provider 0..1PractitionerResponsible practitioner
... organization 0..1OrganizationResponsible organization
... request 0..1AnyRequest reference
... include 0..*stringResource type(s) to include
... exclude 0..*stringResource type(s) to exclude
... period 0..1PeriodPeriod

XML Template

<PendedRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <target><!-- 0..1 Reference(Organization) Insurer --></target>
 <provider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></provider>
 <organization><!-- 0..1 Reference(Organization) Responsible organization --></organization>
 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->
 <period><!-- 0..1 Period Period --></period>
</PendedRequest>

JSON Template

{doco
  "resourceType" : "PendedRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Insurer
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "request" : { Reference(Any) }, // Request reference
  "include" : ["<string>"], // Resource type(s) to include
  "exclude" : ["<string>"], // Resource type(s) to exclude
  "period" : { Period } // Period
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

7.12.2.1 Terminology Bindings

PathDefinitionTypeReference
PendedRequest.ruleset
PendedRequest.originalRuleset 		The static and dynamic model to which contents conform, may be business version or standard and version.Examplehttp://hl7.org/fhir/vs/ruleset

7.12.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
identifiertokenThe business identifier of the EligibilityPendedRequest.identifier