DSTU2 Ballot Source

This page is part of the FHIR Specification (v0.5.0: DSTU 2 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R3 R2

5.8 Resource ProcessRequest - Content

This resource maintained by the Financial Management Work Group

This resource provides the target, request and response, and action details for an action to be performed by the target on or about existing resources.

5.8.1 Scope and Usage

The ProcessRequest resource allows for the specification of an action to be performed on an existing resporce or resources and the provides the additional supporting information to support that action. The actions currently defined are: cancel, poll, reprocess, and status.

Cancel indicates the resource which is to be reversed and provides both supporting information for the reversal and whether the receiving system is permitted to retain a copy of the reversed resource.

The Cancel is the formal request to cease processing an incomplete prior request or to reverse and/or nullify a complete prior request or information submission. When nullify=true then all copies of the original submission are to be purged, although audit logs may be retained. When Nullify=false a copy of the original request may be retained. A ProcessResponse may be craeted or returned to indicate whether the requestion action was accepted and scucessful.

Poll provides supporting information for the poll request. The response to this is a previously undelivered response or a StatusResponse (or other acknowledgement stype resource 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 Poll request, 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'

Reprocess indicates the resource which is to be reprocessed, for example a claim to be readjudicated or a specemin or diagnostic image to be re-examined, and provides both supporting information for the reprocessing and the line items which are to be reprocessed.

This is necessary for the limited supporters who require the ability to formally request the reprocessing of specified service sub-trees from an already processed resource such as a previously adjudicated Claim.

Status indicates the resource for which the processing status is requested and provides supporting information for the status request.

This is a formal request for Payors which require such and/or transports which don't support a 'Get Operation', for the processing status of a previously submitted processing request.

This resource is referenced by CarePlan, ClinicalImpression and PaymentReconciliation

5.8.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ProcessRequest DomainResourceProcess request
... action 1..1codecancel | poll | reprocess | status
ActionList (Required)
... identifier 0..*IdentifierBusiness Identifier
... ruleset 0..1CodingResource version
Ruleset (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset (Example)
... created 0..1dateTimeCreation date
... target 0..1OrganizationTarget of the request
... provider 0..1PractitionerResponsible practitioner
... organization 0..1OrganizationResponsible organization
... request 0..1AnyRequest reference
... response 0..1AnyResponse reference
... nullify 0..1booleanNullify
... reference 0..1stringReference number/string
... item 0..*ElementItems to re-adjudicate
.... sequenceLinkId 1..1integerService instance
... include 0..*stringResource type(s) to include
... exclude 0..*stringResource type(s) to exclude
... period 0..1PeriodPeriod

UML Diagram

ProcessRequest (DomainResource)The type of procesing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequestaction : code 1..1 « List of allowable action which this resource can requestActionList »The ProcessRequest Business Identifieridentifier : Identifier 0..*The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding 0..1 « (The static and dynamic model to which contents conform, may be business version or standard and version.Ruleset) »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding 0..1 « (The static and dynamic model to which contents conform, may be business version or standard and version.Ruleset) »The date when this resource was createdcreated : dateTime 0..1The organization which is target of the requesttarget : Reference(Organization) 0..1The practitioner who is responsible for the action specified in thise requestprovider : Reference(Practitioner) 0..1The organization which is responsible for the action speccified in thise requestorganization : Reference(Organization) 0..1Reference of resource which is the target or subject of this actionrequest : Reference(Any) 0..1Reference of a prior response to resource which is the target or subject of this actionresponse : Reference(Any) 0..1If true remove all history excluding auditnullify : boolean 0..1A reference to supply which authenticates the processreference : string 0..1Names of resource types to includeinclude : string 0..*Names of resource types to excludeexclude : string 0..*A period of time during which the fulfilling resources would have been createdperiod : Period 0..1ItemsA service line numbersequenceLinkId : integer 1..1List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicateditem0..*

XML Template

<ProcessRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <action value="[code]"/><!-- 1..1 cancel | poll | reprocess | status -->
 <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) Target of the request --></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>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <nullify value="[boolean]"/><!-- 0..1 Nullify -->
 <reference value="[string]"/><!-- 0..1 Reference number/string -->
 <item>  <!-- 0..* Items to re-adjudicate -->
  <sequenceLinkId value="[integer]"/><!-- 1..1 Service instance -->
 </item>
 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->
 <period><!-- 0..1 Period Period --></period>
</ProcessRequest>

JSON Template

{doco
  "resourceType" : "ProcessRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "action" : "<code>", // R!  cancel | poll | reprocess | status
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Target of the request
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "request" : { Reference(Any) }, // Request reference
  "response" : { Reference(Any) }, // Response reference
  "nullify" : <boolean>, // Nullify
  "reference" : "<string>", // Reference number/string
  "item" : [{ // Items to re-adjudicate
    "sequenceLinkId" : <integer> // R!  Service instance
  }],
  "include" : ["<string>"], // Resource type(s) to include
  "exclude" : ["<string>"], // Resource type(s) to exclude
  "period" : { Period } // Period
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ProcessRequest DomainResourceProcess request
... action 1..1codecancel | poll | reprocess | status
ActionList (Required)
... identifier 0..*IdentifierBusiness Identifier
... ruleset 0..1CodingResource version
Ruleset (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset (Example)
... created 0..1dateTimeCreation date
... target 0..1OrganizationTarget of the request
... provider 0..1PractitionerResponsible practitioner
... organization 0..1OrganizationResponsible organization
... request 0..1AnyRequest reference
... response 0..1AnyResponse reference
... nullify 0..1booleanNullify
... reference 0..1stringReference number/string
... item 0..*ElementItems to re-adjudicate
.... sequenceLinkId 1..1integerService instance
... include 0..*stringResource type(s) to include
... exclude 0..*stringResource type(s) to exclude
... period 0..1PeriodPeriod

UML Diagram

ProcessRequest (DomainResource)The type of procesing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequestaction : code 1..1 « List of allowable action which this resource can requestActionList »The ProcessRequest Business Identifieridentifier : Identifier 0..*The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding 0..1 « (The static and dynamic model to which contents conform, may be business version or standard and version.Ruleset) »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding 0..1 « (The static and dynamic model to which contents conform, may be business version or standard and version.Ruleset) »The date when this resource was createdcreated : dateTime 0..1The organization which is target of the requesttarget : Reference(Organization) 0..1The practitioner who is responsible for the action specified in thise requestprovider : Reference(Practitioner) 0..1The organization which is responsible for the action speccified in thise requestorganization : Reference(Organization) 0..1Reference of resource which is the target or subject of this actionrequest : Reference(Any) 0..1Reference of a prior response to resource which is the target or subject of this actionresponse : Reference(Any) 0..1If true remove all history excluding auditnullify : boolean 0..1A reference to supply which authenticates the processreference : string 0..1Names of resource types to includeinclude : string 0..*Names of resource types to excludeexclude : string 0..*A period of time during which the fulfilling resources would have been createdperiod : Period 0..1ItemsA service line numbersequenceLinkId : integer 1..1List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicateditem0..*

XML Template

<ProcessRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <action value="[code]"/><!-- 1..1 cancel | poll | reprocess | status -->
 <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) Target of the request --></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>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <nullify value="[boolean]"/><!-- 0..1 Nullify -->
 <reference value="[string]"/><!-- 0..1 Reference number/string -->
 <item>  <!-- 0..* Items to re-adjudicate -->
  <sequenceLinkId value="[integer]"/><!-- 1..1 Service instance -->
 </item>
 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->
 <period><!-- 0..1 Period Period --></period>
</ProcessRequest>

JSON Template

{doco
  "resourceType" : "ProcessRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "action" : "<code>", // R!  cancel | poll | reprocess | status
  "identifier" : [{ Identifier }], // Business Identifier
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "target" : { Reference(Organization) }, // Target of the request
  "provider" : { Reference(Practitioner) }, // Responsible practitioner
  "organization" : { Reference(Organization) }, // Responsible organization
  "request" : { Reference(Any) }, // Request reference
  "response" : { Reference(Any) }, // Response reference
  "nullify" : <boolean>, // Nullify
  "reference" : "<string>", // Reference number/string
  "item" : [{ // Items to re-adjudicate
    "sequenceLinkId" : <integer> // R!  Service instance
  }],
  "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)

5.8.2.1 Terminology Bindings

PathDefinitionTypeReference
ProcessRequest.action List of allowable action which this resource can requestRequiredhttp://hl7.org/fhir/actionlist
ProcessRequest.ruleset
ProcessRequest.originalRuleset 		The static and dynamic model to which contents conform, may be business version or standard and version.Examplehttp://hl7.org/fhir/vs/ruleset

5.8.3 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
actiontokenThe action requested by this resourceProcessRequest.action
identifiertokenThe business identifier of the ProcessRequestProcessRequest.identifier
organizationreferenceThe organization who generated this requestProcessRequest.organization
(Organization)
providerreferenceThe provider who renerated this requestProcessRequest.provider
(Practitioner)