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This page is part of the Da Vinci Clinical Documentation Exchange (v2.0.0: STU2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Requesting Attachments Using Questionnaires

Page standards status: Draft

This page documents an optional solicited attachments transaction for requesting additional claims or prior authorization data from a Provider using FHIR Questionnaire.* The Payer uses the Task-based CDex Task Attachment Request Profile to request a Provider to complete a questionnaire. The Provider launches Da Vinci DTR to complete the questionnaire and, as documented in the Sending Attachments page, submits the completed questionnaire to the Payer using the $submit-attachment operation. In contrast to Requesting Attachments Using Attachment Codes, a HIPAA-based request model using LOINC attachment codes, it supports using Questionnaire to define in more detail what data is missing. As a result, it avoids unnecessary documents. In addition, it leverages Da Vinci DTR functionality to fill out the Questionnaire reducing the time involved in reviewing documentation requirements.

* See the Conforming to CDex Attachments page for how systems declare what they support for the various actors and roles in CDex Attachments.

Request Attachments Data Using a FHIR Questionnaire

The Task Based Approach page documents why a Data Consumer should use Task for requesting attachments. For more background on Task-based transactions, see the Requesting Exchange using Task section of the Da Vinci HRex Implementation Guide. For CDex attachment requests transactions, the Payer SHALL use the CDex Task Attachment Request Profile to solicit information from a Provider. For a detailed description of all the mandatory, must support, and optional elements, as well as formal definitions and profile views, see the CDex Task Data Request Profile page.

In contrast to Requesting Attachments Using Attachment Codes, when a Payer references a FHIR Questionnaire as an input parameter, the Task represents a request for the Provider to complete the questionnaire (form). The CDex Task Attachment Request Profile defines a specific Task.code that directs the Provider to launch a Da Vinci - Coverage Requirements Discovery (DTR) application to use the Payer provided Questionnaire and results from any CQL execution to generate and complete a QuestionnaireResponse. Figure 17 below summarizes the steps for requesting and completing a questionnaire using CDex Attachments and DTR, and the sequence diagram in the following section illustrates these transactions in more detail:

Figure 17
attachments-task-Q-summary.svg

Step 1: The Payer POSTs a Task directly to the Provider. The Task is a request to complete a questionnaire.

Step 2: if the Task.code is “attachment-request-questionnaire”, the Provider launches DTR and shares the Task as a launch parameter (i.e., DTR has access to read and update the Task and access to other resources to complete the QuestionnaireResponse in Step 3)

Step 3: DTR fetches the Task, which contains the link to the Questionnaire. Then fetches the Questionnaire (and any CQL rules defined within it) and proceeds to complete the QuestionnaireResponse. Refer to the Da Vinci DTR Implementation Guide for more information on how it generates a QuestionnaireResponse.

Step 4: After completing the QuestionnaireResponse, DTR POSTs it directly to the Provider’s FHIR Server, updates Task.output to reference the QuestionnaireResponse it created, and updates Task.status to “completed”.

Step 5: The Provider “pushes” the QuestionnaireResponse directly to the Payer-defined endpoint using the $submit-attachments operation. See the Sending Attachments page for Implementation Guide for more information on this transaction.

Using Da Vinci DTR to Complete the Questionnaire

The sequence diagram in the Figure 18 below depicts the the FHIR RESTful transactions and processes involved between the Payer, Provider, and DTR application application needed to request, fill, and return a questionnaire using using CDex Attachments. It references a “DTR Launch”. If the DTR is a native EHR application, the launch is implementation specific. If DTR is a SMART on FHIR Application, the next (DTR SMART App Launch) section documents the launch sequence and parameters.

Figure 18
attachments-task-Q-sequencediagram.svg

DTR SMART App Launch

The sequence diagram in Figure 19 below depicts the transactions between the DTR Client, FHIR Server, and DTR application needed to launch a DTR SMART App.

Preconditions and Assumptions:

  • The DTR Client, and FHIR Server are Provider (Data Source) roles.
  • If the DTR is a native EHR application, the launch is implementation specific, and this diagram does not apply.
  • A User kicks off Smart Version 2.0.0 EHR launch flow.
Figure 19
dtr-launch.svg

Step 1 (Optional): The DTR App registers with DTR Client (may be out of band)

Step 2,3: If the Task.code is “attachment-request-questionnaire” (or “data-request-questionnaire” for a Task-based approach), a User initiates Smart Version 2.0.0 EHR launch flow to launch DTR (for example, clicks a button to launch DTR) and DTR Client sends a launch request to the DTR App

Step 4: DTR App retrieves the .well-known/smart-configuration from FHIR Server.

Step 5: DTR App request authorization code requesting the following scopes:

  • “launch”
  • “launch/patient”
  • “launch/task”
  • “patient/*.rs”
  • “patient/Task.u”
  • “patient/QuestionnaireResponse.cu”

Step 6,7: Assuming the authorization is granted, The DTR app requests an access token

Step 8: DTR App obtains an access token and the launch contexts in the “fhirContext” array, including a local reference to the Task in step 2.

Step 9: The DTR App uses the Task reference obtained in step 8 to fetch it, the Questionnaire, and other resources to fill out a QuestionnaireResponse. See the previous section (or this section on the Task Based Approach page) for more detailed transactions.

Data Elements for Requesting Attachments

The Requesting Attachments Using Attachment Codes page documents the data elements needed to associate an attachment to a claim or prior authorization. However, there is no “LOINC Attachment Code” Data element when using Questionnaires to collect attachments-related data.

Step-by-Step Solicited Attachment Transaction

In the following sections, A detailed look at an example Solicited attachment transaction illustrates how:

  • The Payer uses a FHIR Questionnaire to communicate to the Provider what additional attachments-related data is needed.
  • The Payer uses the CDex Task Attachment Request Profile to communicate to the Provider to complete the Questionniare.
  • The Provider launches DTR to fill out the FHIR Questionnaire using QuestionnaireResponse.
  • The DTR completes the QuestionaireResponse and updates the Task.
  • The Provider uses the $submit-attachment operation to communicate the completed QuestionnaireResponse to the Payer.

In this scenario, a Provider creates a prior authorization and sends it to the Payer. The Payer reviews the prior authorization and responds with a request to fill out a questionnaire for attachments-related data using the CDex Attachment Request Profile. After receiving the attachment request, the Provider launches DTR, which completes a QuestionnaireResponse. The Provider returns the QuestionnaireResponse using the $submit-attachment operation, posting it to the endpoint supplied in the request. The flow diagram in figure 20 below illustrates the scenario.

Figure 20: CDex Request Attachment for Prior-Auth Using Questionnaires
cdex-request-questionnaire-priorauth-flow.svg

In addition to the information needed to submit and associate the attachments to the claim successfully, the Payer supplies the following details about what information is necessary to complete the adjudication of the claim:

  • link to the Questionnaire
  • What line numbers on the claim the requested attachment(s) are for
  • The specific purpose of use (POU) for the request

The table below summarizes the mapping between the CDex Request Attachment Profile elements and the $submit-attachment parameters:

Data Element CDex $submit-attachment Parameter CDex Request Attachment Task Profile Element
Tracking ID TrackingId Task.identifier
Use AttachTo Task.reasonCode
Payer ID PayerId Task.requester.identifier
Payer URL (operation endpoint) “payer-url” Task.input
Organization ID OrganizationId PractitionerRole.practitioner.identifier
Provider ID ProviderId PractitionerRole.organization.identifier
Line Item(s) Attachment.LineItem “code” Task.input.extension
LOINC Attachment Code Attachment.Code “code” Task.input
Date of Service ServiceDate “service-date” Task.input
Member ID MemberId Patient.identifier
Questionnaire - “questionnaire” Task.input 
QuestionnaireResponse Attachment.Content -

The data element mapping table is available as a CSV and Excel file.

Payer Requests Attachments for Prior Authorization

In the first FHIR transaction, the Payer POSTs the CDex Task Attachment Request Profile to the Provider endpoint.

POST [base]/Task

Request Body

Task Resource

The optional profile declaration shown below asserts that the resource conforms to the profile and contains all the necessary data elements listed above.

0  {
1      "resourceType": "Task",
2      "meta": {
3          "profile": [
4              "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"
5          ]
6      },

Verifying Patient Identity

The following data elements are used to verify the patient’s identity. (This guide does not cover how the Provider system verifies the patient’s identity.) They are communicated in a contained Patient resource using the CDex Patient Demographics Profile. The contained Patient is referenced in Task.for.reference using a fixed reference value of “#patient”.

Data HRex Patient Demographics Profile.
Member ID or Patient Account No.* Patient.identifier
Patient Name Patient.name
Patient DOB (optional) Patient.birthDate

* Patient Account Number is a Provider assigned identifier

7      "contained": [
8          {
9              "resourceType": "Patient",
10              "id": "patient",
11              "meta": {
12                  "profile": [
13                      "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"
14                  ]
15              },
16              "identifier": [
17                  {
18                      "use": "usual",
19                      "type": {
20                          "coding": [
21                              {
22                                  "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
23                                  "code": "UMB",
24                                  "display": "Member Number"
25                              }
26                          ],
27                          "text": "Member Number"
28                      },
29                      "system": "http://example.org/cdex/payer/member-ids",
30                      "value": "Member123"
31                  },
32                  {
33                      "use": "usual",
34                      "type": {
35                          "coding": [
36                              {
37                                  "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
38                                  "code": "pat",
39                                  "display": "Patient Account Number"
40                              }
41                          ],
42                          "text": "Patient Account Number"
43                      },
44                      "system": "http://example.org/cdex/provider/patient-ids",
45                      "value": "PA-123"
46                  }
47              ],
48              "name": [
49                  {
50                      "family": "Shaw",
51                      "given": [
52                          "Amy"
53                      ]
54                  }
55              ],
56              "birthDate": "1987-02-20"
57          },

Supplying the Provider ID(s)

The Payer communicates the provider ID as either a unique organization/location identifier (e.g., Type 2 NPI) or unique provider identifier (e.g., Type 1 NPI) or both in a contained PractitionerRole resource using the CDex PractitionerRole Profile. This contained PractitionerRole is referenced in Task.owner.reference using a fixed reference value of “#practitionerrole”.

58          {
59              "resourceType": "PractitionerRole",
60              "id": "practitionerrole",
61              "meta": {
62                  "profile": [
63                      "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole"
64                  ]
65              },
66              "practitioner": {
67                  "identifier": {
68                      "system": "http://hl7.org/fhir/sid/us-npi",
69                      "value": "9941339100"
70                  }
71              },
72              "organization": {
73                  "identifier": {
74                      "system": "http://hl7.org/fhir/sid/us-npi",
75                      "value": "1234567893"
76                  }
77              }
78          }
79      ],

Supplying the Tracking ID

The mandatory Task.identifier tracking-id slice element represents the Payer tracking identifier. The tracking-id (also called the “re-association tracking control number”) is an identifier that ties the attachments back to the claim or prior authorization. The Provider will echo it back to the Payer when submitting the attachments.

80      "identifier": [
81          {
82              "type": {
83                  "coding": [
84                      {
85                          "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
86                          "code": "tracking-id",
87                          "display": "Tracking Id"
88                      }
89                  ],
90                  "text": "Re-Association Tracking Control Number"
91              },
92              "system": "http://example.org/payer",
93              "value": "trackingid1012"
94          }
95      ],

Task status and intent Elements

These required Task infrastructure elements:

  • Task.status
  • Task.intent

convey the task status, and the intent of the request. The Task.status value of “request” is typical when POSTing the Task-based attachment request. Note that the status will change as the Task moves through different states in the workflow. Task.intent is fixed to “order”.

96      "status": "requested",
97      "intent": "order",

Task code Element

The Task.code communicates that the Payer is requesting attachments for a claim or prior authorization using a code or data request questionnaire. If the code is “attachment-request-code”, the provider system returns attachment(s) identified by the LOINC attachment code(s) in the “code” input parameter. If the code is “attachment-request-questionnaire”, as it is in this scenario, the provider system uses Documentation Templates and Rules (DTR) to complete the Questionnaire referenced in the “questionnaire” input parameter. When either code is present, the provider system uses the $submit-attachment operation to return the information to the endpoint provided in “payer-url” input parameter.

98      "code": {
99          "coding": [
100              {
101                  "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
102                  "code": "attachment-request-questionnaire"
103              }
104          ],
105          "text": "Attachment Request Questionnaire"
106      },

Identifying the Payer, Provider, and Patient

The attachment request will be directed to the same Provider who submitted the claim or prior authorization. Business identifiers are used to identify the Patient, the Payer, and the Provider who submitted the claim, and these identifiers are echoed back to the Payer when submitting the attachments.

As discussed above, the Patient id is in the contained Patient resource, referenced by the Task.for element, and the Provider id is in the contained PractitionerRole resource referenced by the Task.owner element. The Provider id can be a Practitioner identifier (i,e., a Type1 NPI) or the Practitioner’s Organization identifier (i,e., a Type2 NPI) or both.

(note the various Task dates in the request fragment below)

Actor CDex Request Attachment Task Profile Element
payer ID Task.requester.identifier
provider ID (contained)PractitionerRole.practitioner.identifier and/or PractitionerRole.Organization.identifier
patient member ID or Patient Account No (contained)Patient.identifier
107      "for": {
108          "reference": "#patient"
109      },
110      "authoredOn": "2022-06-17T16:16:06Z",
111      "lastModified": "2022-06-17T16:16:06Z",
112      "requester": {
113          "identifier": {
114              "system": "http://example.org/cdex/payer/payer-ids",
115              "value": "Payer123"
116          }
117      },
118      "owner": {
119          "reference": "#practitionerrole"
120      },

Claim Information

The Task communicates whether the attachments are for a claim or prior authorization, and the Payer identifies the claim or prior authorization with its business Identifier.

Data CDex Request Attachment Task Profile Element
Claim or Prior Authorization Task.reasonCode
Claim or Prior Authorization ID Task.reasonReference.identifier
121      "reasonCode": {
122          "coding": [
123              {
124                  "system": "http://hl7.org/fhir/claim-use",
125                  "code": "preauthorization",
126                  "display": "Preauthorization"
127              }
128          ],
129          "text": "preauthorization"
130      },
131      "reasonReference": {
132          "identifier": {
133              "system": "http://example.org/cdex/payer/claim-ids",
134              "value": "Preauth123"
135          }
136      },

Attachment Due Date

The Payer communicates the due date for submitting the attachment in the Task.restriction.period element. Note that Task.restriction.period.end is the due date representing the time by which the Provider should have submitted the attachments.

137      "restriction": {
138          "period": {
139              "end": "2022-06-21"
140          }
141      },

Using Questionnaire to Communicate What Attachments Data is Needed

In this scenario, the Payer supplies the URL of a questionnaire (FHIR Questionnaire) to communicate what attachments-related data is needed. Line item numbers may also be supplied to match the attachment to a line item in the claim or prior authorization. This information is represented in the “questionnaire” Task input element. The Provider launches the Documentation Templates and Rules (DTR) application to complete the Questionnaire. The code snippet below contains a URL to a Home Oxygen Therapy Questionnaire.

142      "input": [
143          {
144              "type": {
145                  "coding": [
146                      {
147                          "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
148                          "code": "questionnaire"
149                      }
150                  ]
151              },
152              "extension": [
153                  {
154                      "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
155                      "valuePositiveInt": 1
156                  }
157              ],
158              "valueCanonical": "http://example.org/cdex-questionnaire-example1"
159          },

Supplying the $submit-attachment Operation Endpoint

The Payer supplies the URL endpoint as a Task input parameter. The Provider System will use this information as the endpoint for the $submit-attachment Operation to send the completed QuestionnaireResponse. Note that the endpoint is not necessarily a FHIR RESTful server endpoint.

160          {
161              "type": {
162                  "coding": [
163                      {
164                          "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
165                          "code": "payer-url"
166                      }
167                  ]
168              },
169              "valueUrl": "http://example.org/cdex/payer/$submit-attachment"
170          },

Purpose of Use for the Request

This optional Task.input element represents the request’s purpose of use (POU). In this example, it is to support a request for a claim, “CLMATTCH”. When requesting attachments for prior authorization, it would be “COVAUTH”.

171          {
172              "type": {
173                  "coding": [
174                      {
175                          "code": "purpose-of-use",
176                          "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"
177                      }
178                  ]
179              },
180              "valueCodeableConcept": {
181                  "coding": [
182                      {
183                          "code": "COVAUTH",
184                          "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
185                          "display": "coverage authorization"
186                      }
187                  ]
188              }
189          }
190      ]
191  }

Provider Launches DTR

The Payer used a Questionnaire to ask for specific attachments-related data. They indicated it with a Task code “attachment-request-questionnaire” and supplied the URL of the questionnaire (FHIR Questionnaire) as an input parameter. Becasue these conditions are met, the Payer launches Da Vinci DTR, a SMART on FHIR App or native EHR application. If the Provider launches a DTR within an EHR native application, skip to the step DTR App Updates Task below. If the Provider Launches DTR as a SMART on FHIR Application, it follows the Smart Version 2.0.0 EHR launch flow with the Task as the launch content. The next several steps describe the DTR SMART App functionality.

DTR SMART App Fetches Task

As part of the DTR launch, the local reference to the Task is passed to the DTR App. The DTR App fetches the Task and inspects it for the Questionnaire URL.

Request

GET [base]/Task/cdex-task-example22

Response Body

1      "resourceType": "Task",
2      "meta": {
...
142      "input": [
143          {
144              "type": {
145                  "coding": [
146                      {
147                          "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
148                          "code": "questionnaire"
149                      }
150                  ]
151              },
152              "extension": [
153                  {
154                      "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
155                      "valuePositiveInt": 1
156                  }
157              ],
158              "valueCanonical": "http://example.org/cdex-questionnaire-example1"
159          },
....
DTR SMART App Fetches Questionnaire

Upon discovery of the Questionnaire URL, the DTR App fetches the Questionnaire.

Request

GET http://example.org/FHIR/Questionnare/cdex-questionnaire-example1

Response Body

0  {
1      "resourceType": "Questionnaire",
2      "name": "HomeOxygenTherapyQuestionnaire",
3      "title": "Home Oxygen Therapy Questionnaire",
4      "url": "http://example.org/cdex-questionnaire-example1",
5      "status": "draft",
6      "subjectType": [
7          "Patient"
8      ],
9      "date": "2022-01-17",
10      "item": [
11          {
12              "linkId": "1",
13              "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
14              "type": "text",
15              "required": true
16          },
17          {
18              "linkId": "2",
19              "text": "Order Reason",
20              "type": "choice",
21              "required": true,
22              "answerOption": [
23                  {
24                      "valueCoding": {
25                          "system": "http://example.org",
26                          "code": "1",
27                          "display": "Initial or original order for certification"
28                      }
29                  },
30                  {
31                      "valueCoding": {
32                          "system": "http://example.org",
33                          "code": "2",
34                          "display": "Change in status"
35                      }
36                  },
37                  {
38                      "valueCoding": {
39                          "system": "http://example.org",
40                          "code": "3",
41                          "display": "Revision or change in equipment"
42                      }
43                  },
44                  {
45                      "valueCoding": {
46                          "system": "http://example.org",
47                          "code": "4",
48                          "display": "Replacement"
49                      }
50                  }
51              ]
52          }
53      ]
54  }

DTR App Fills QuestionnaireResponse

To complete the Questionnaire, the DTR App retrieves FHIR resources from EHRs, runs rules (CQL), and completes a QuestionnaireResponse. See the Da Vinci DTR Implementation Guide for more information.

fill-form-icon.svg

DTR App POSTs QuestionnaireResponse to Provider FHIR Server

The completed QuestionnaireResponse is saved in the Provider’s FHIR Server.

Request

POST [base]/$QuestionnaireResponse

Request Body

0  {
1      "resourceType": "QuestionnaireResponse",
2      "questionnaire": "http://example.org/cdex-questionnaire-example1",
3      "status": "completed",
4      "subject": {
5          "identifier": {
6              "use": "usual",
7              "type": {
8                  "coding": [
9                      {
10                          "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
11                          "code": "UMB",
12                          "display": "Member Number"
13                      }
14                  ],
15                  "text": "Member Number"
16              },
17              "system": "http://example.org/cdex/payer/member-ids",
18              "value": "Member123"
19          },
20          "display": "Amy Shaw"
21      },
22      "authored": "2022-06-17",
23      "author": {
24          "identifier": {
25              "system": "http://hl7.org/fhir/sid/us-npi",
26              "value": "9941339100"
27          }
28      },
29      "item": [
30          {
31              "linkId": "1",
32              "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
33              "answer": [
34                  {
35                      "valueString": "Examplitis"
36                  }
37              ]
38          },
39          {
40              "linkId": "2",
41              "text": "Order Reason",
42              "answer": [
43                  {
44                      "valueCoding": {
45                          "system": "http://example.org",
46                          "code": "4",
47                          "display": "Replacement"
48                      }
49                  }
50              ]
51          }
52      ]
53  }

DTR App Updates Task

The DTR SMART App or EHR native application Updates Task.output to Reference the completed QuestionnaireResponse and Task.status to “completed”

PUT [base]/Task/cdex-task-example-22

Request Body

0  {
1      "resourceType": "Task",
2      "id": "cdex-task-example22",
...
96              {
...
189              "type": {
190                  "coding": [
191                      {
192                          "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
193                          "code": "questionnaire-response"
194                      }
195                  ]
196              },
197              "valueReference": {
198                  "reference": "QuestionnaireResponse/cdex-questionnaireresponse-example1"
199              }
200          }
201      ]
202  }

Provider Submits Solicited Attachments

When the Task is completed, the Provider POSTs the $submit-attachment operation and its payload to the Payer’s endpoint. As stated above, the Payer communicates the operation endpoint to the Payer in the CDex Task Attachment Request Profile. The operation payload contains the completed QuestionnaireResponse and echoes many data elements sent in the request. The table in the introduction to this section summarizes the mapping between the CDex Request Attachment Profile elements and the $submit-attachment parameters. The documentation below describes and demonstrates the $submit-attachment parameters.

Data Element CDex Request Attachment Task Profile Element CDex #submit-attachment Parameter
Payer URL “payer-url”Task.input (operation endpoint)

Request

POST [base]/$submit-attachment

Request Body

The Submit Attachment Operation Payload

The QuestionnaireResponse along with the metadata needed to associate it to the claim or prior authorization are in the $submit-attachments payload, a Parameters resource.

0  {
1      "resourceType": "Parameters",
2      "parameter": [

Tracking ID and Indicating a Claim or Prior Authorization

The TrackingId parameter represents the identifier that ties the attachments to the claim or prior authorization. It is often referred to as the “re-association tracking control number”. The operation must indicate whether the attachments are for claim or prior authorization. These data elements are taken from the CDex request as follows:

Data Element CDex Request Attachment Task Profile Element CDex #submit-attachment Parameter
TrackingID Task.identifier TrackingId
Use Task.reasonCode AttachTo
3          {
4              "name": "TrackingId",
5              "valueIdentifier": {
6                  "system": "http://example.org/payer",
7                  "value": "trackingid1012"
8              }
9          },
10          {
11              "name": "AttachTo",
12              "valueCode": "preauthorization"
13          },

Identifying the Payer, Provider, Organization, and Patient

As documented above, The Payer uses business identifiers to identify itself, the Patient, and Provider (i.e., the practitioner) and Organization (i.e., the provider organization) who submitted the claim or prior authorization. The Provider uses these same identifiers when submitting the attachments.

Data Element CDex Request Attachment Task Profile Element CDex #submit-attachment Parameter
Payer ID Task.requester.identifier PayerId
Organization ID PractitionerRole.organization.identifier OrganizationId
Provider ID PractitionerRole.practitioner.identifier ProviderId
Member ID Patient.identifier MemberId
14          {
15              "name": "PayerId",
16              "valueIdentifier": {
17                  "system": "http://example.org/cdex/payer/payer-ids",
18                  "value": "payer123"
19              }
20          },
21          {
22              "name": "OrganizationId",
23              "valueIdentifier": {
24                  "system": "http://hl7.org/fhir/sid/us-npi",
25                  "value": "1234567893"
26              }
27          },
28          {
29              "name": "ProviderId",
30              "valueIdentifier": {
31                  "system": "http://hl7.org/fhir/sid/us-npi",
32                  "value": "9941339100"
33              }
34          },
35          {
36              "name": "MemberId",
37              "valueIdentifier": {
38                  "system": "http://example.org/cdex/payer/member-ids",
39                  "value": "Member123"
40              }
41          },

Supply the QuestionnaireResponse

The completed QuestionnaireResponse and the corresponding line item numbers are communicated as named parts of the multi-part Attachment parameter. The Attachment.content parameter represents the QuestionnaireResponse as an inline FHIR resource. The Attachment.LineItem parameter lists the line item numbers associated with it.

Data Element CDex Request Attachment Task Profile Element CDex #submit-attachment Parameter
line item(s) “code”Task.input.extension Attachment.LineItem
QuestionnaireResponse - Attachment.content
42          {
43              "name": "Attachment",
44              "part": [
45                  {
46                      "name": "LineItem",
47                      "valueString": "1"
48                  },
49                  {
50                      "name": "Content",
51                      "resource": {
52                          "resourceType": "QuestionnaireResponse",
53                          "id": "cdex-questionnaireresponse-example1",
54                          "questionnaire": "http://example.org/cdex-questionnaire-example1",
55                          "status": "completed",
56                          "subject": {
57                              "identifier": {
58                                  "use": "usual",
59                                  "type": {
60                                      "coding": [
61                                          {
62                                              "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
63                                              "code": "UMB",
64                                              "display": "Member Number"
65                                          }
66                                      ],
67                                      "text": "Member Number"
68                                  },
69                                  "system": "http://example.org/cdex/payer/member-ids",
70                                  "value": "Member123"
71                              },
72                              "display": "Amy Shaw"
73                          },
74                          "authored": "2022-06-17",
75                          "author": {
76                              "identifier": {
77                                  "system": "http://hl7.org/fhir/sid/us-npi",
78                                  "value": "9941339100"
79                              }
80                          },
81                          "item": [
82                              {
83                                  "linkId": "1",
84                                  "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
85                                  "answer": [
86                                      {
87                                          "valueString": "Examplitis"
88                                      }
89                                  ]
90                              },
91                              {
92                                  "linkId": "2",
93                                  "text": "Order Reason",
94                                  "answer": [
95                                      {
96                                          "valueCoding": {
97                                              "system": "http://example.org",
98                                              "code": "4",
99                                              "display": "Replacement"
100                                          }
101                                      }
102                                  ]
103                              }
104                          ]
105                      }
106                  }
107              ]
108          }
109      ]
110  }

Complete Solicited Attachment Transaction

The example below shows the complete solicited attachment transaction. A Payer uses the CDex Task Attachment Request Profile to request the attachment using an attachment code, and the Provider uses the $submit-attachment operation to submit the attachments to the Payer:

Step 1 - POST Task to Provider endpoint

Request


POST [base]/Task

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body


{
    "resourceType": "Task",
    "meta": {
        "profile": [
            "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"
        ]
    },
    "contained": [
        {
            "resourceType": "Patient",
            "id": "patient",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"
                ]
            },
            "identifier": [
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                                "code": "UMB",
                                "display": "Member Number"
                            }
                        ],
                        "text": "Member Number"
                    },
                    "system": "http://example.org/cdex/payer/member-ids",
                    "value": "Member123"
                },
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "pat",
                                "display": "Patient Account Number"
                            }
                        ],
                        "text": "Patient Account Number"
                    },
                    "system": "http://example.org/cdex/provider/patient-ids",
                    "value": "PA-123"
                }
            ],
            "name": [
                {
                    "family": "Shaw",
                    "given": [
                        "Amy"
                    ]
                }
            ],
            "birthDate": "1987-02-20"
        },
        {
            "resourceType": "PractitionerRole",
            "id": "practitionerrole",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole"
                ]
            },
            "practitioner": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "9941339100"
                }
            },
            "organization": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "1234567893"
                }
            }
        }
    ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "tracking-id",
                        "display": "Tracking Id"
                    }
                ],
                "text": "Re-Association Tracking Control Number"
            },
            "system": "http://example.org/payer",
            "value": "trackingid1012"
        }
    ],
    "status": "requested",
    "intent": "order",
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                "code": "attachment-request-questionnaire"
            }
        ],
        "text": "Attachment Request Questionnaire"
    },
    "for": {
        "reference": "#patient"
    },
    "authoredOn": "2022-06-17T16:16:06Z",
    "lastModified": "2022-06-17T16:16:06Z",
    "requester": {
        "identifier": {
            "system": "http://example.org/cdex/payer/payer-ids",
            "value": "Payer123"
        }
    },
    "owner": {
        "reference": "#practitionerrole"
    },
    "reasonCode": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/claim-use",
                "code": "preauthorization",
                "display": "Preauthorization"
            }
        ],
        "text": "preauthorization"
    },
    "reasonReference": {
        "identifier": {
            "system": "http://example.org/cdex/payer/claim-ids",
            "value": "Preauth123"
        }
    },
    "restriction": {
        "period": {
            "end": "2022-06-21"
        }
    },
    "input": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                        "code": "questionnaire"
                    }
                ]
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
                    "valuePositiveInt": 1
                }
            ],
            "valueCanonical": "http://example.org/cdex-questionnaire-example1"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "payer-url"
                    }
                ]
            },
            "valueUrl": "http://example.org/cdex/payer/$submit-attachment"
        },
        {
            "type": {
                "coding": [
                    {
                        "code": "purpose-of-use",
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"
                    }
                ]
            },
            "valueCodeableConcept": {
                "coding": [
                    {
                        "code": "COVAUTH",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                        "display": "coverage authorization"
                    }
                ]
            }
        }
    ]
}

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Provider Server

Location: http://example.org/FHIR/Task/cdex-task-example22/_history/1

...(other headers)

Step 2 - Invoke DTR To Complete Questionnaire

If the Provider Launches DTR as a SMART on FHIR Application in SMART’s EHR launch flow, proceed to step 3 If the Provider launches a DTR within an EHR native application, skip to step 7

Step 3 - DTR App Fetches Task

Request


GET [base]/Task/cdex-task-example22

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Provider Server

Location: http://example.org/FHIR/Task/cdex-task-example22/_history/1

...(other headers)

Response Body


{
    "resourceType": "Task",
    "id": "cdex-task-example22",
    "meta": {
        "profile": [
            "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"
        ]
    },
    "contained": [
        {
            "resourceType": "Patient",
            "id": "patient",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"
                ]
            },
            "identifier": [
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                                "code": "UMB",
                                "display": "Member Number"
                            }
                        ],
                        "text": "Member Number"
                    },
                    "system": "http://example.org/cdex/payer/member-ids",
                    "value": "Member123"
                },
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "pat",
                                "display": "Patient Account Number"
                            }
                        ],
                        "text": "Patient Account Number"
                    },
                    "system": "http://example.org/cdex/provider/patient-ids",
                    "value": "PA-123"
                }
            ],
            "name": [
                {
                    "family": "Shaw",
                    "given": [
                        "Amy"
                    ]
                }
            ],
            "birthDate": "1987-02-20"
        },
        {
            "resourceType": "PractitionerRole",
            "id": "practitionerrole",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole"
                ]
            },
            "practitioner": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "9941339100"
                }
            },
            "organization": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "1234567893"
                }
            }
        }
    ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "tracking-id",
                        "display": "Tracking Id"
                    }
                ],
                "text": "Re-Association Tracking Control Number"
            },
            "system": "http://example.org/payer",
            "value": "trackingid1012"
        }
    ],
    "status": "requested",
    "intent": "order",
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                "code": "attachment-request-questionnaire"
            }
        ],
        "text": "Attachment Request Questionnaire"
    },
    "for": {
        "reference": "#patient"
    },
    "authoredOn": "2022-06-17T16:16:06Z",
    "lastModified": "2022-06-17T16:16:06Z",
    "requester": {
        "identifier": {
            "system": "http://example.org/cdex/payer/payer-ids",
            "value": "Payer123"
        }
    },
    "owner": {
        "reference": "#practitionerrole"
    },
    "reasonCode": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/claim-use",
                "code": "preauthorization",
                "display": "Preauthorization"
            }
        ],
        "text": "preauthorization"
    },
    "reasonReference": {
        "identifier": {
            "system": "http://example.org/cdex/payer/claim-ids",
            "value": "Preauth123"
        }
    },
    "restriction": {
        "period": {
            "end": "2022-06-21"
        }
    },
    "input": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                        "code": "questionnaire"
                    }
                ]
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
                    "valuePositiveInt": 1
                }
            ],
            "valueCanonical": "http://example.org/cdex-questionnaire-example1"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "payer-url"
                    }
                ]
            },
            "valueUrl": "http://example.org/cdex/payer/$submit-attachment"
        },
        {
            "type": {
                "coding": [
                    {
                        "code": "purpose-of-use",
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"
                    }
                ]
            },
            "valueCodeableConcept": {
                "coding": [
                    {
                        "code": "COVAUTH",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                        "display": "coverage authorization"
                    }
                ]
            }
        }
    ]
}

Step 4 - DTR App Inspects Task for Questionnaire URL and fetches the “Questionnaire Package”

Request


GET http://example.org/FHIR/Questionnare/cdex-questionnaire-example1

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Provider Server

Location: http://example.org/FHIR/Questionnare/cdex-questionnaire-example1

...(other headers)

Response Body


{
    "resourceType": "Questionnaire",
    "name": "HomeOxygenTherapyQuestionnaire",
    "title": "Home Oxygen Therapy Questionnaire",
    "url": "http://example.org/cdex-questionnaire-example1",
    "status": "draft",
    "subjectType": [
        "Patient"
    ],
    "date": "2022-01-17",
    "item": [
        {
            "linkId": "1",
            "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
            "type": "text",
            "required": true
        },
        {
            "linkId": "2",
            "text": "Order Reason",
            "type": "choice",
            "required": true,
            "answerOption": [
                {
                    "valueCoding": {
                        "system": "http://example.org",
                        "code": "1",
                        "display": "Initial or original order for certification"
                    }
                },
                {
                    "valueCoding": {
                        "system": "http://example.org",
                        "code": "2",
                        "display": "Change in status"
                    }
                },
                {
                    "valueCoding": {
                        "system": "http://example.org",
                        "code": "3",
                        "display": "Revision or change in equipment"
                    }
                },
                {
                    "valueCoding": {
                        "system": "http://example.org",
                        "code": "4",
                        "display": "Replacement"
                    }
                }
            ]
        }
    ]
}

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Step 5 - DTR App Fills QuestionnaireResponse

fill-form-icon.svg

Step 6 - DTR App POSTs QuestionnaireResponse to Provider FHIR Server

Request


POST [base]/QuestionnaireResponse

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body


{
    "resourceType": "QuestionnaireResponse",
    "questionnaire": "http://example.org/cdex-questionnaire-example1",
    "status": "completed",
    "subject": {
        "identifier": {
            "use": "usual",
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                        "code": "UMB",
                        "display": "Member Number"
                    }
                ],
                "text": "Member Number"
            },
            "system": "http://example.org/cdex/payer/member-ids",
            "value": "Member123"
        },
        "display": "Amy Shaw"
    },
    "authored": "2022-06-17",
    "author": {
        "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9941339100"
        }
    },
    "item": [
        {
            "linkId": "1",
            "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
            "answer": [
                {
                    "valueString": "Examplitis"
                }
            ]
        },
        {
            "linkId": "2",
            "text": "Order Reason",
            "answer": [
                {
                    "valueCoding": {
                        "system": "http://example.org",
                        "code": "4",
                        "display": "Replacement"
                    }
                }
            ]
        }
    ]
}

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Provider Server

Location: http://example.org/FHIR/Task/cdex-questionnaireresponse-example1/_history/1

...(other headers)

Step 7 - The DTR SMART App or EHR native application Updates Task.output to Reference QuestionnaireResponse and Task.status to “completed”

Request


PUT [base]/Task/cdex-task-example-22

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body


{
    "resourceType": "Task",
    "id": "cdex-task-example22",
    "contained": [
        {
            "resourceType": "Patient",
            "id": "patient",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"
                ]
            },
            "identifier": [
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                                "code": "UMB",
                                "display": "Member Number"
                            }
                        ],
                        "text": "Member Number"
                    },
                    "system": "http://example.org/cdex/payer/member-ids",
                    "value": "Member123"
                },
                {
                    "use": "usual",
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "pat",
                                "display": "Patient Account Number"
                            }
                        ],
                        "text": "Patient Account Number"
                    },
                    "system": "http://example.org/cdex/provider/patient-ids",
                    "value": "PA-123"
                }
            ],
            "name": [
                {
                    "family": "Shaw",
                    "given": [
                        "Amy"
                    ]
                }
            ],
            "birthDate": "1987-02-20"
        },
        {
            "resourceType": "PractitionerRole",
            "id": "practitionerrole",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole"
                ]
            },
            "practitioner": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "9941339100"
                }
            },
            "organization": {
                "identifier": {
                    "system": "http://hl7.org/fhir/sid/us-npi",
                    "value": "1234567893"
                }
            }
        }
    ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "tracking-id",
                        "display": "Tracking Id"
                    }
                ],
                "text": "Re-Association Tracking Control Number"
            },
            "system": "http://example.org/payer",
            "value": "trackingid1012"
        }
    ],
    "status": "completed",
    "intent": "order",
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                "code": "attachment-request-questionnaire"
            }
        ],
        "text": "Attachment Request Questionnaire"
    },
    "for": {
        "reference": "#patient"
    },
    "authoredOn": "2022-06-17T16:16:06Z",
    "lastModified": "2022-06-17T16:17:06Z",
    "requester": {
        "identifier": {
            "system": "http://example.org/cdex/payer/payer-ids",
            "value": "Payer123"
        }
    },
    "owner": {
        "reference": "#practitionerrole"
    },
    "reasonCode": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/claim-use",
                "code": "preauthorization",
                "display": "Preauthorization"
            }
        ],
        "text": "preauthorization"
    },
    "reasonReference": {
        "identifier": {
            "system": "http://example.org/cdex/payer/claim-ids",
            "value": "Preauth123"
        }
    },
    "restriction": {
        "period": {
            "end": "2022-06-21"
        }
    },
    "input": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                        "code": "questionnaire"
                    }
                ]
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
                    "valuePositiveInt": 1
                }
            ],
            "valueCanonical": "http://example.org/cdex-questionnaire-example1"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "payer-url"
                    }
                ]
            },
            "valueUrl": "http://example.org/cdex/payer/$submit-attachment"
        },
        {
            "type": {
                "coding": [
                    {
                        "code": "purpose-of-use",
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"
                    }
                ]
            },
            "valueCodeableConcept": {
                "coding": [
                    {
                        "code": "COVAUTH",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                        "display": "coverage authorization"
                    }
                ]
            }
        }
    ],
    "output": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                        "code": "questionnaire-response"
                    }
                ]
            },
            "valueReference": {
                "reference": "QuestionnaireResponse/cdex-questionnaireresponse-example1"
            }
        }
    ]
}

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Provider Server

Location: http://example.org/FHIR/Task/cdex-task-example22/_history/2

...(other headers)

Step 8 - POST $submit-attachment Operation to Payer endpoint

Request


POST [base]/$submit-attachment

Request Headers

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body


{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "TrackingId",
            "valueIdentifier": {
                "system": "http://example.org/payer",
                "value": "trackingid1012"
            }
        },
        {
            "name": "AttachTo",
            "valueCode": "preauthorization"
        },
        {
            "name": "PayerId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer/payer-ids",
                "value": "payer123"
            }
        },
        {
            "name": "OrganizationId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1234567893"
            }
        },
        {
            "name": "ProviderId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339100"
            }
        },
        {
            "name": "MemberId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer/member-ids",
                "value": "Member123"
            }
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "QuestionnaireResponse",
                        "id": "cdex-questionnaireresponse-example1",
                        "questionnaire": "http://example.org/cdex-questionnaire-example1",
                        "status": "completed",
                        "subject": {
                            "identifier": {
                                "use": "usual",
                                "type": {
                                    "coding": [
                                        {
                                            "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                                            "code": "UMB",
                                            "display": "Member Number"
                                        }
                                    ],
                                    "text": "Member Number"
                                },
                                "system": "http://example.org/cdex/payer/member-ids",
                                "value": "Member123"
                            },
                            "display": "Amy Shaw"
                        },
                        "authored": "2022-06-17",
                        "author": {
                            "identifier": {
                                "system": "http://hl7.org/fhir/sid/us-npi",
                                "value": "9941339100"
                            }
                        },
                        "item": [
                            {
                                "linkId": "1",
                                "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
                                "answer": [
                                    {
                                        "valueString": "Examplitis"
                                    }
                                ]
                            },
                            {
                                "linkId": "2",
                                "text": "Order Reason",
                                "answer": [
                                    {
                                        "valueCoding": {
                                            "system": "http://example.org",
                                            "code": "4",
                                            "display": "Replacement"
                                        }
                                    }
                                ]
                            }
                        ]
                    }
                }
            ]
        }
    ]
}

Response Headers


HTTP/1.1 200 OK

Server: CDEX Example Payer Server

Content-Type: application/fhir+json;charset=utf-8

...(other headers)

Rendered QuestionnaireResponse


Signatures

Refer to the Signatures section in the Sending Attachments page.