ProcessRequest - FHIR v3.2.0

R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

12.19.8 Resource ProcessRequest - Operations

Financial Management

Work Group

Maturity Level: 2

Trial Use

Compartments: Practitioner

This resource has 1 operation associated with it:

$submit

Submit an ProcessRequest resource for assessment

For more information about operations, including how they are invoked, see Operations.

12.19.8.1 Submit an ProcessRequest resource for assessment

This operation is used to submit an ProcessRequest for assessment either as a single ProcessRequest resource instance or as a Bundle containing the ProcessRequest and other referenced resources, or Bundle containing a batch of ProcessRequest resources, either as single ProcessRequests resources or Bundle resources, for processing. The only input parameter is the single ProcessRequest or Bundle resource and the only output is a single ProcessResponse or other single resource, Bundle of resources or Bundles or an OperationOutcome resource.

The official URL for this operation definition is

 http://hl7.org/fhir/OperationDefinition/ProcessRequest-submit

Formal Definition (as a OperationDefinition).

URL: [base]/ProcessRequest/$submit

This is not an idempotent operation

In Parameters:

Name

Cardinality

Type

Binding

Profile

Documentation

resource

1..1

Resource

An ProcessRequest resource or Bundle of ProcessRequests, either as individual ProcessRequest resources or as Bundles each containing a single ProcessRequest plus referenced resources.

Out Parameters:

Name

Cardinality

Type

Binding

Profile

Documentation

return

1..1

Resource

A resource or Bundle of responses, either as individual resources or as Bundles each containing a single focal resource plus referenced resources.

12.19.8.1.1 Examples

Request:

POST [baseurl]/ProcessRequest/$submit
[headers]

<?xml version="1.0" encoding="UTF-8"?>
<ProcessRequest xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
 <id value="1115"/>

 <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Poll ProcessRequest</div>
  </text>

  <identifier>
    <system value="http://www.phr.com/patient/12345/processrequest"/>
    <value value="115"/>
  </identifier>
  
  <status value="active"/>
  
  <action value="poll"/>
 
  <created value="2014-08-16"/>

  <include value="ExplanationOfBenefit"/>
  
 </ProcessRequest>

Response:

HTTP/1.1 200 OK
[headers]

<?xml version="1.0" encoding="UTF-8"?>
<ExplanationOfBenefit xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" >
	<id value="EB3500"/>

	<text>
		<status value="generated"/>
		<div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the ExplanationOfBenefit</div>
	</text>

	<identifier>
		<system value="http://www.BenefitsInc.com/fhir/explanationofbenefit"/>
		<value value="987654321"/>
	</identifier>

	<status value="active"/>

	<type>
		<coding>
			<system value="http://hl7.org/fhir/ex-claimtype"/>
			<code value="oral"/>
		</coding>
	</type>

	<patient>
		<reference value="Patient/pat1"/>
	</patient>

	<created value="2014-08-16"/>

	<enterer>
		<reference value="Practitioner/1"/>
	</enterer>

	<provider>
		<reference value="Practitioner/1"/>
	</provider>

	<organization>
		<reference value="Organization/2"/>
	</organization>

	<facility>
		<reference value="Location/1"/>
	</facility>

	<claim>
		<reference value="Claim/100150"/>
	</claim>

	<claimResponse>
		<reference value="ClaimResponse/R3500"/>
	</claimResponse> 

	<outcome value="complete" />

	<disposition value="Claim settled as per contract."/>

	<payee>
		<type>
			<coding>
				<system value="http://hl7.org/fhir/payeetype"/>
				<code value="provider"/>
			</coding>
		</type>
		<resource>
			<system value="http://hl7.org/fhir/resource-type-link"/>
			<code value="organization"/>
		</resource>
		<party>
			<reference value="Organization/2"/>
		</party>
	</payee>

	<careTeam>
		<sequence value="1"/>
		<provider>
			<reference value="Practitioner/example"/>
		</provider>
	</careTeam>

	<insurance>
		<coverage>
			<reference value="Coverage/9876B1"/>
		</coverage>
	</insurance>

	<item>
		<sequence value="1"/>
		<careTeamSequence value="1"/>
		<service>
			<coding>
				<system value="http://hl7.org/fhir/service-uscls"/>
				<code value="1200"/>
			</coding>
		</service>
		<servicedDate value="2014-08-16"/>
		<unitPrice>
			<value value="135.57"/>
			<system value="urn:iso:std:iso:4217"/>
			<code value="USD"/> 
		</unitPrice> 
		<net>
			<value value="135.57"/>
			<system value="urn:iso:std:iso:4217"/>
			<code value="USD"/> 
		</net> 
		<encounter>
			<reference value="Encounter/example"/>
		</encounter>
		<adjudication>
			<category>
				<coding>
					<code value="eligible"/>
				</coding>
			</category>
			<amount>
				<value value="120.00"/>
				<system value="urn:iso:std:iso:4217"/>
				<code value="USD"/> 
			</amount> 
		</adjudication>
		<adjudication>
			<category>
				<coding>
					<code value="eligpercent"/>
				</coding>
			</category>
			<value value="0.80"/>
		</adjudication>
		<adjudication>
			<category>
				<coding>
					<code value="benefit"/>
				</coding>
			</category>
			<amount>
				<value value="96.00"/>
				<system value="urn:iso:std:iso:4217"/>
				<code value="USD"/> 
			</amount> 
		</adjudication>
	</item>

	<totalCost>
		<value value="135.57"/>
		<system value="urn:iso:std:iso:4217"/>
		<code value="USD"/> 
	</totalCost>

	<totalBenefit>
		<value value="96.00"/>
		<system value="urn:iso:std:iso:4217"/>
		<code value="USD"/> 
	</totalBenefit>

</ExplanationOfBenefit>