ItemAuthorizedDetail - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.1.0-preview

Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2 United States of America flag

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

Extension: ItemAuthorizedDetail

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail				Version: 2.1.0-preview
Standards status: Trial-use			Maturity Level: 3	Computable Name: ItemAuthorizedDetail

The details of what has been authorized for this item if different from what was requested.

Context of Use

This extension may be used on the following element(s):

Element ID ExplanationOfBenefit
Element ID ClaimResponse.item

Usage info

Usage:

Use this Extension: PAS Claim Response Base
Examples for this Extension: Bundle/ReferralAuthorizationResponseBundleExample and ClaimResponse/PractitionerRequestorResponseExample

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

Text Summary
Differential Table
Snapshot Table
All

This structure is derived from Extension

Summary

Complex Extension: The details of what has been authorized for this item if different from what was requested.

productOrServiceCode: CodeableConcept: An Extension
modifier: CodeableConcept: An Extension
unitPrice: Money: An Extension
quantity: Quantity: An Extension
revenue: CodeableConcept: An Extension

Maturity: 3

This structure is derived from Extension

Name	Card.	Type	Description & Constraints
Extension	0..*	Extension	Extension
Slices for extension			Content/Rules for all slices
extension:productOrServiceCode	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"productOrServiceCode"
value[x]	0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Type (required)
productOrServiceCodeEnd	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier	0..*	Extension	Extension
extension	0..0
url	1..1	uri	"modifier"
value[x]	0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"unitPrice"
value[x]	0..1	Money	Value of extension
extension:quantity	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"quantity"
value[x]	0..1	SimpleQuantity	A fixed quantity (no comparator)
epsdtIndicator	0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
nursingHomeLevelOfCare	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"revenue"
value[x]	0..1	CodeableConcept	Value of extension Binding: AHA NUBC Revenue Value Set (required)
revenueUnitRateLimit	0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
authorizedService	0..1	Reference(PAS Medication Request \| PAS Service Request \| PAS Device Request \| PAS Nutrition Order)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url	1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x]	0..0
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Extension		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Type (required)
productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"unitPrice"
value[x]		0..1	Money	Value of extension
extension:quantity		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"quantity"
value[x]	C	0..1	SimpleQuantity	A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present
epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
nursingHomeLevelOfCare		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"revenue"
value[x]		0..1	CodeableConcept	Value of extension Binding: AHA NUBC Revenue Value Set (required)
revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
authorizedService		0..1	Reference(PAS Medication Request \| PAS Service Request \| PAS Device Request \| PAS Nutrition Order)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The details of what has been authorized for this item if different from what was requested.

productOrServiceCode: CodeableConcept: An Extension
modifier: CodeableConcept: An Extension
unitPrice: Money: An Extension
quantity: Quantity: An Extension
revenue: CodeableConcept: An Extension

Maturity: 3

Differential View

This structure is derived from Extension

Name	Card.	Type	Description & Constraints
Extension	0..*	Extension	Extension
Slices for extension			Content/Rules for all slices
extension:productOrServiceCode	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"productOrServiceCode"
value[x]	0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Type (required)
productOrServiceCodeEnd	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier	0..*	Extension	Extension
extension	0..0
url	1..1	uri	"modifier"
value[x]	0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"unitPrice"
value[x]	0..1	Money	Value of extension
extension:quantity	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"quantity"
value[x]	0..1	SimpleQuantity	A fixed quantity (no comparator)
epsdtIndicator	0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
nursingHomeLevelOfCare	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue	0..1	Extension	Extension
extension	0..0
url	1..1	uri	"revenue"
value[x]	0..1	CodeableConcept	Value of extension Binding: AHA NUBC Revenue Value Set (required)
revenueUnitRateLimit	0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
authorizedService	0..1	Reference(PAS Medication Request \| PAS Service Request \| PAS Device Request \| PAS Nutrition Order)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url	1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x]	0..0
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Extension		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Type (required)
productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"unitPrice"
value[x]		0..1	Money	Value of extension
extension:quantity		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"quantity"
value[x]	C	0..1	SimpleQuantity	A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present
epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
nursingHomeLevelOfCare		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"revenue"
value[x]		0..1	CodeableConcept	Value of extension Binding: AHA NUBC Revenue Value Set (required)
revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
authorizedService		0..1	Reference(PAS Medication Request \| PAS Service Request \| PAS Device Request \| PAS Nutrition Order)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Conformance	ValueSet	URI
Extension.extension:productOrServiceCode.value[x]	required	X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` from this IG
Extension.extension:modifier.value[x]	required	X12278RequestedServiceModifierType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType` from this IG
Extension.extension:revenue.value[x]	required	AHANUBCRevenueCodes (a valid code from `https://www.nubc.org/revenue-code`) `http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes` from this IG

IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.1.0-preview based on FHIR 4.0.1. Generated 2024-09-26
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