DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 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

Financial Management Work GroupMaturity Level: 0Compartments: Practitioner

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 ΣDomainResourceProcess request
... action Σ1..1codecancel | poll | reprocess | status
ActionList (Required)
... identifier Σ0..*IdentifierBusiness Identifier
... ruleset Σ0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset Σ0..1CodingOriginal version
Ruleset Codes (Example)
... created Σ0..1dateTimeCreation date
... target Σ0..1Reference(Organization)Target of the request
... provider Σ0..1Reference(Practitioner)Responsible practitioner
... organization Σ0..1Reference(Organization)Responsible organization
... request Σ0..1Reference(Any)Request reference
... response Σ0..1Reference(Any)Response reference
... nullify Σ0..1booleanNullify
... reference Σ0..1stringReference number/string
... item Σ0..*BackboneElementItems to re-adjudicate
.... sequenceLinkId Σ1..1integerService instance
... include Σ0..*stringResource type(s) to include
... exclude Σ0..*stringResource type(s) to exclude
... period Σ0..1PeriodPeriod

doco Documentation for this format

UML Diagram

ProcessRequest (DomainResource)The type of processing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequestaction : code [1..1] « List of allowable action which this resource can request. (Strength=Required)ActionList! »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, which may be business version or standard/version. (Strength=Example)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, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when this resource was createdcreated : dateTime [0..1]The organization which is the target of the requesttarget : Reference [0..1] « Organization »The practitioner who is responsible for the action specified in thise requestprovider : Reference [0..1] « Practitioner »The organization which is responsible for the action speccified in thise requestorganization : Reference [0..1] « Organization »Reference of resource which is the target or subject of this actionrequest : Reference [0..1] « Any »Reference of a prior response to resource which is the target or subject of this actionresponse : Reference [0..1] « Any »If true remove all history excluding auditnullify : boolean [0..1]A reference to supply which authenticates the processreference : string [0..1]Names 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..1]ItemsA service line numbersequenceLinkId : integer [1..1]List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicateditem[0..*]

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>

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ProcessRequest ΣDomainResourceProcess request
... action Σ1..1codecancel | poll | reprocess | status
ActionList (Required)
... identifier Σ0..*IdentifierBusiness Identifier
... ruleset Σ0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset Σ0..1CodingOriginal version
Ruleset Codes (Example)
... created Σ0..1dateTimeCreation date
... target Σ0..1Reference(Organization)Target of the request
... provider Σ0..1Reference(Practitioner)Responsible practitioner
... organization Σ0..1Reference(Organization)Responsible organization
... request Σ0..1Reference(Any)Request reference
... response Σ0..1Reference(Any)Response reference
... nullify Σ0..1booleanNullify
... reference Σ0..1stringReference number/string
... item Σ0..*BackboneElementItems to re-adjudicate
.... sequenceLinkId Σ1..1integerService instance
... include Σ0..*stringResource type(s) to include
... exclude Σ0..*stringResource type(s) to exclude
... period Σ0..1PeriodPeriod

doco Documentation for this format

UML Diagram

ProcessRequest (DomainResource)The type of processing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequestaction : code [1..1] « List of allowable action which this resource can request. (Strength=Required)ActionList! »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, which may be business version or standard/version. (Strength=Example)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, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when this resource was createdcreated : dateTime [0..1]The organization which is the target of the requesttarget : Reference [0..1] « Organization »The practitioner who is responsible for the action specified in thise requestprovider : Reference [0..1] « Practitioner »The organization which is responsible for the action speccified in thise requestorganization : Reference [0..1] « Organization »Reference of resource which is the target or subject of this actionrequest : Reference [0..1] « Any »Reference of a prior response to resource which is the target or subject of this actionresponse : Reference [0..1] « Any »If true remove all history excluding auditnullify : boolean [0..1]A reference to supply which authenticates the processreference : string [0..1]Names 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..1]ItemsA service line numbersequenceLinkId : integer [1..1]List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicateditem[0..*]

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>

 

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

5.8.2.1 Terminology Bindings

PathDefinitionTypeReference
ProcessRequest.action List of allowable action which this resource can request.RequiredActionList
ProcessRequest.ruleset
ProcessRequest.originalRuleset
The static and dynamic model to which contents conform, which may be business version or standard/version.ExampleRuleset Codes

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 regenerated this requestProcessRequest.provider
(Practitioner)