5.8 Resource ProcessRequest - Content

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.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
ProcessRequest	Σ		DomainResource	Process request
action	Σ	1..1	code	cancel | poll | reprocess | status ActionList (Required)
identifier	Σ	0..*	Identifier	Business Identifier
ruleset	Σ	0..1	Coding	Resource version Ruleset Codes (Example)
originalRuleset	Σ	0..1	Coding	Original version Ruleset Codes (Example)
created	Σ	0..1	dateTime	Creation date
target	Σ	0..1	Reference(Organization)	Target of the request
provider	Σ	0..1	Reference(Practitioner)	Responsible practitioner
organization	Σ	0..1	Reference(Organization)	Responsible organization
request	Σ	0..1	Reference(Any)	Request reference
response	Σ	0..1	Reference(Any)	Response reference
nullify	Σ	0..1	boolean	Nullify
reference	Σ	0..1	string	Reference number/string
item	Σ	0..*	BackboneElement	Items to re-adjudicate
sequenceLinkId	Σ	1..1	integer	Service instance
include	Σ	0..*	string	Resource type(s) to include
exclude	Σ	0..*	string	Resource type(s) to exclude
period	Σ	0..1	Period	Period
Documentation for this format

<ProcessRequest xmlns="http://hl7.org/fhir"> 
 <!-- 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>

{
  "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

Name	Flags	Card.	Type	Description & Constraints
ProcessRequest	Σ		DomainResource	Process request
action	Σ	1..1	code	cancel | poll | reprocess | status ActionList (Required)
identifier	Σ	0..*	Identifier	Business Identifier
ruleset	Σ	0..1	Coding	Resource version Ruleset Codes (Example)
originalRuleset	Σ	0..1	Coding	Original version Ruleset Codes (Example)
created	Σ	0..1	dateTime	Creation date
target	Σ	0..1	Reference(Organization)	Target of the request
provider	Σ	0..1	Reference(Practitioner)	Responsible practitioner
organization	Σ	0..1	Reference(Organization)	Responsible organization
request	Σ	0..1	Reference(Any)	Request reference
response	Σ	0..1	Reference(Any)	Response reference
nullify	Σ	0..1	boolean	Nullify
reference	Σ	0..1	string	Reference number/string
item	Σ	0..*	BackboneElement	Items to re-adjudicate
sequenceLinkId	Σ	1..1	integer	Service instance
include	Σ	0..*	string	Resource type(s) to include
exclude	Σ	0..*	string	Resource type(s) to exclude
period	Σ	0..1	Period	Period
Documentation for this format

UML Diagram

XML Template

<ProcessRequest xmlns="http://hl7.org/fhir"> 
 <!-- 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

{
  "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
}