This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions
Page standards status: Trial-use | Maturity Level: 3 |
<OperationDefinition xmlns="http://hl7.org/fhir">
<id value="Claim-inquiry"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: OperationDefinition Claim-inquiry</b></p><a name="Claim-inquiry"> </a><a name="hcClaim-inquiry"> </a><a name="Claim-inquiry-en-US"> </a><p>URL: [base]/Claim/$inquire</p><p>Input parameters Profile:<a href="StructureDefinition-profile-pas-inquiry-request-bundle.html">PAS Inquiry Request Bundle</a></p><p>Output parameters Profile:<a href="StructureDefinition-profile-pas-inquiry-response-bundle.html">PAS Inquiry Response Bundle</a></p><h3>Parameters</h3><table class="grid"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>resource</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/bundle.html">Bundle</a></td><td/><td><div><p>A Bundle containing a single ClaimInquiry plus referenced resources.</p>
</div></td></tr><tr><td>OUT</td><td>return</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/bundle.html">Bundle</a></td><td/><td><div><p>A Bundle containing a single ClaimInquiryResponse plus referenced resources.</p>
</div></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="3">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"/>
</extension>
</valueInteger>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"/>
</extension>
</valueCode>
</extension>
<url
value="http://hl7.org/fhir/us/davinci-pas/OperationDefinition/Claim-inquiry"/>
<version value="2.1.0-preview"/>
<name value="ClaimInquiry"/>
<title value="Search for a Prior Authorization Response by example"/>
<status value="draft"/>
<kind value="operation"/>
<date value="2024-09-26T18:54:51-04:00"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://hl7.org/Special/committees/fm"/>
</telecom>
<telecom>
<system value="email"/>
<value value="fmlists@lists.hl7.org"/>
</telecom>
</contact>
<contact>
<name value="Jean Duteau"/>
<telecom>
<system value="email"/>
<value value="mailto:jean@duteaudesign.com"/>
</telecom>
</contact>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
</telecom>
</contact>
<description
value="This operation is used to make a search for a Prior Authorization Response by example. This Prior Authorization $inquire operation is a query-by-example that follows the X12 278 Inquiry rules. The only input parameter is the single Bundle resource with a PASClaimInquiry instance (along with other referenced resources) and the only output is a single Bundle with zero-to-many PASClaimInquiryResponses (and other referenced resources) or an OperationOutcome resource."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<code value="inquire"/>
<base value="http://hl7.org/fhir/OperationDefinition/Claim-submit"/>
<resource value="Claim"/>
<system value="false"/>
<type value="true"/>
<instance value="false"/>
<inputProfile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle"/>
<outputProfile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"/>
<parameter>
<name value="resource"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation
value="A Bundle containing a single ClaimInquiry plus referenced resources."/>
<type value="Bundle"/>
</parameter>
<parameter>
<name value="return"/>
<use value="out"/>
<min value="1"/>
<max value="1"/>
<documentation
value="A Bundle containing a single ClaimInquiryResponse plus referenced resources."/>
<type value="Bundle"/>
</parameter>
</OperationDefinition>