Generated Narrative: ImplementationGuide hl7.fhir.us.davinci-pas

Language: en

DaVinciPriorAuthorizationSupport

The official URL for this implementation guide is: 

http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas

Guidelines for conveying coverage requirements to clinicians when planning treatment.

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value="An example of a ClaimResponse where the requestor is a Practitioner."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ClaimResponse"/> </extension> <reference> <reference value="ClaimResponse/PractitionerRequestorResponseExample"/> </reference> <name value="Authorization Response with Practitioner Requestor Example"/> <description value="An example of a ClaimResponse where the requestor is a Practitioner."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-authorizedProviderType"/> </reference> <name value="Authorized Provider Type"/> <description value="The type of provider who has been authorized to provide this item."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-timingcalendarpattern"/> </reference> <name value="Calendar Pattern"/> <description value="A code representing the specific days when a service is being requested"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-careTeamClaimScope"/> </reference> <name value="Care Team Claim Scope"/> <description value="A flag that indicates whether the care team applies to the entire claim or a single item."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemCertificationEffectiveDate"/> </reference> <name value="Certification Effective Date"/> <description value="The specific date or period within which this item's preauthorization became effective."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemCertificationExpirationDate"/> </reference> <name value="Certification Expiration Date"/> <description value="The specific date or period within which this item's preauthorization expires."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemCertificationIssueDate"/> </reference> <name value="Certification Issue Date"/> <description value="The specific date or period within which this item's preauthorization was issued."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-certificationType"/> </reference> <name value="Certification Type"/> <description value="A code representing the type of certification being requested (UM02)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemCategory"/> </reference> <name value="Claim Response Item Category"/> <description value="The claim item category being responded to."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/ClaimResponseOutcome"/> </reference> <name value="Claim Response Outcome"/> <description value="This set of codes restricts the outcome of a claim response."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-claimResponseReviewer"/> </reference> <name value="Claim Response Reviewer"/> <description value="The responsible practitioner who reviewed to the request."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/ClaimTypes"/> </reference> <name value="Claim Types"/> <description value="This set of codes restricts the claim type."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-communicatedDiagnosis"/> </reference> <name value="Communicated Diagnosis"/> <description value="A code representing the diagnosis that is the subject of the communication"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CommunicationRequest"/> </extension> <reference> <reference value="CommunicationRequest/CommunicationRequestExample"/> </reference> <name value="Communication Request Example"/> <description value="A sample communication request asking for more information about a specific diagnosis."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-conditionCode"/> </reference> <name value="Condition Code"/> <description value="Information to supply various patient conditions."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-contentModifier"/> </reference> <name value="Content Modifier"/> <description value="A code representing a modifier of the content being requested"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-timingdeliverypattern"/> </reference> <name value="Delivery Pattern"/> <description value="A code representing the specific delivery of a service being requested"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="DeviceRequest"/> </extension> <reference> <reference value="DeviceRequest/DeviceRequestExample"/> </reference> <name value="Device Request Example"/> <description value="A sample device request for a wheelchair."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-diagnosisRecordedDate"/> </reference> <name value="Diagnosis Recorded Date"/> <description value="The date that a diagnosis was recorded. (HIxx-4)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-dischargeDate"/> </reference> <name value="Discharge Date"/> <description value="The authorized discharge date for inpatient services."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-documentInformation"/> </reference> <name value="Document Information"/> <description value="Information about the document being included such as the type, transmission method, and identifier."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CapabilityStatement"/> </extension> <reference> <reference value="CapabilityStatement/EHRCapabilities"/> </reference> <name value="EHR PAS Capabilities"/> <description value="Capabilities required for an EHR participating in a PAS Exchange."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Encounter"/> </extension> <reference> <reference value="Encounter/SurgicalEncounterExample"/> </reference> <name value="Encounter Example"/> <description value="An example of encounter details for a surgical admission request."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-epsdtIndicator"/> </reference> <name value="EPSDT Indicator"/> <description value="An indicator of whether early and periodic screen for diagnosis and treatment of children is involved."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-errorElement"/> </reference> <name value="Error Element"/> <description value="The specific loop, segment, or element that this error information is about. The string will follow the X12 format for specifying elements and is returned from the Payer. Example: 2010A-NM103"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-errorFollowupAction"/> </reference> <name value="Error Follow-up Action"/> <description value="A code representing what action must occur to resolve this error."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-errorPath"/> </reference> <name value="Error Path"/> <description value="The [FHIRPath](https://www.hl7.org/fhirpath/) expression that indicates which FHIR element that this error information is about. The expression will start with the Bundle and can be followed to determine the specific element. STU NOTE: We would like feedback during the STU period on whether this extension is sufficient for implementers to determine and display the errored element. Examples: Bundle.entry[1].resource.name, Bundle.entry[0].resource.identifier[0].value"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/ErrorResponseBundleExample"/> </reference> <name value="Error Response Bundle Example"/> <description value="An example of a ClaimResponse bundle with errors."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ClaimResponse"/> </extension> <reference> <reference value="ClaimResponse/ErrorResponseExample"/> </reference> <name value="Error Response Example"/> <description value="An example of a ClaimResponse with errors."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-homeHealthCareInformation"/> </reference> <name value="Home Health Care Information"/> <description value="Information needed for home health care requests."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/HomecareAuthorizationBundleExample"/> </reference> <name value="Homecare Authorization Bundle Example"/> <description value="An example of a Claim bundle requesting prior authorization of a home healthcare service."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/HomecareAuthorizationExample"/> </reference> <name value="Homecare Authorization Example"/> <description value="An example of a Claim resource requesting prior authorization of a home healthcare service."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/HomecareAuthorizationUpdateBundleExample"/> </reference> <name value="Homecare Authorization Update Bundle Example"/> <description value="An example of a Claim bundle updating a previously sent prior authorization request."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/HomecareAuthorizationUpdateExample"/> </reference> <name value="Homecare Authorization Update Example"/> <description value="An example of a Claim resource updating a prior authorization."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-identifierJurisdiction"/> </reference> <name value="Identifier Jurisdiction"/> <description value="An additional element that provides the assigning jurisdiction of the identifier (i.e. provider state license number or state driver's license) so that it does not need to be mapped from the identifier system."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-identifierSubDepartment"/> </reference> <name value="Identifier Sub-Department"/> <description value="An additional element that provides a further subdivision within the organization granting the identifier."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/modifierextension-infoCancelled"/> </reference> <name value="Information Cancelled Flag"/> <description value="A flag indicating whether the piece of information was cancelled."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-infoChanged"/> </reference> <name value="Information Change Mode"/> <description value="A code indicating how the piece of information has changed."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CapabilityStatement"/> </extension> <reference> <reference value="CapabilityStatement/IntermediaryCapabilities"/> </reference> <name value="Intermediary PAS Capabilities"/> <description value="Capabilities required for an Intermediary participating in a PAS Exchange."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="OperationOutcome"/> </extension> <reference> <reference value="OperationOutcome/InvalidRequestResponse"/> </reference> <name value="Invalid Request Response"/> <description value="An instance of an operation outcome showing how an invalid request would be handled."/> <exampleBoolean value="true"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemAuthorizedDetail"/> </reference> <name value="Item Authorized Detail"/> <description value="The details of what has been authorized for this item."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemAuthorizedProvider"/> </reference> <name value="Item Authorized Provider"/> <description value="The specific provider who has been authorized to provide this item."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemPreAuthIssueDate"/> </reference> <name value="Item Preauthorization Issue Date"/> <description value="The date when this item's preauthorization was issued."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemPreAuthPeriod"/> </reference> <name value="Item Preauthorization Period"/> <description value="The date/period when this item's preauthorization is valid."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemRequestedServiceDate"/> </reference> <name value="Item Requested Service Date"/> <description value="The original date/period that was requested by the submitter for this item."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-itemTraceNumber"/> </reference> <name value="Item Trace Number"/> <description value="Uniquely identifies this claim item. (2000F-TRN)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-levelOfServiceCode"/> </reference> <name value="Level of Service Code"/> <description value="A code specifying the level of service being requested (UM06)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/MedicalServicesAuthorizationBundleExample"/> </reference> <name value="Medical Services Authorization Bundle Example"/> <description value="An example of a Claim bundle requesting Medical Services Reservation."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/MedicalServicesAuthorizationExample"/> </reference> <name value="Medical Services Authorization Example"/> <description value="An example of a Claim resource requesting prior authorization of Medical Services Reservation."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="MedicationRequest"/> </extension> <reference> <reference value="MedicationRequest/MedicationRequestExample"/> </reference> <name value="Medication Request Example"/> <description value="A sample medication request to prescribe a specific drug."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-medicationrequest|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/MetricDataSource"/> </reference> <name value="Metric Data Source"/> <description value="A list of codes indicating the perspective from which metric data was captured"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-militaryStatus"/> </reference> <name value="Military Status"/> <description value="A patient's military status."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Requirements"/> </extension> <reference> <reference value="Requirements/fromNarrative"/> </reference> <name value="Narrative Conformance Statements"/> <description value="Conformance statements found throughout the narrative of the IG consolidated into this computable resource for traceability purposes"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-nursingHomeLevelOfCare"/> </reference> <name value="Nursing Home Level of Care"/> <description value="A code specifying the level of care provided by a nursing home facility. (SV120, SV210)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-nursingHomeResidentialStatus"/> </reference> <name value="Nursing Home Residential Status"/> <description value="A code specifying the status of a nursing home resident at the time of service. (SV209)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="NutritionOrder"/> </extension> <reference> <reference value="NutritionOrder/NutritionOrderExample"/> </reference> <name value="Nutrition Order Example"/> <description value="A sample nutrition order."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-nutritionorder|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-beneficiary"/> </reference> <name value="PAS Beneficiary Patient"/> <description value="A patient who is the beneficiary of an insurance plan."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-claim"/> </reference> <name value="PAS Claim"/> <description value="PAS constraints on Claim resource mandating support for elements relevant to the prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource:abstract"/> </extension> <reference> <reference value="StructureDefinition/profile-claim-base"/> </reference> <name value="PAS Claim Base"/> <description value="PAS constraints on Claim resource that are common to both the request and the inquiry."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-claim-inquiry"/> </reference> <name value="PAS Claim Inquiry"/> <description value="PAS constraints on Claim resource when submitting an inquiry for existing authorizations."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/PASClaimInquiryExample"/> </reference> <name value="PAS Claim Inquiry Example"/> <description value="An example of a Claim resource used to search for prior authorizations that match the example."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-claiminquiryresponse"/> </reference> <name value="PAS Claim Inquiry Response"/> <description value="PAS constraints on Claim resource mandating support for elements relevant to the response of an inquiry for details of previous authorizations."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ClaimResponse"/> </extension> <reference> <reference value="ClaimResponse/PASClaimInquiryResponseExample"/> </reference> <name value="PAS Claim Inquiry ResponseExample"/> <description value="An example of a ClaimResponse resource that is a response to a claims inquiry."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-claimresponse"/> </reference> <name value="PAS Claim Response"/> <description value="PAS constraints on Claim resource mandating support for elements relevant to the response of a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource:abstract"/> </extension> <reference> <reference value="StructureDefinition/profile-claimresponse-base"/> </reference> <name value="PAS Claim Response Base"/> <description value="PAS constraints on ClaimResponse resource that are common to both the request and the inquiry."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-claim-update"/> </reference> <name value="PAS Claim Update"/> <description value="This profile defines constraints and extensions used when updating a previously submitted Claim instance."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ActorDefinition"/> </extension> <reference> <reference value="ActorDefinition/client"/> </reference> <name value="PAS Client"/> <description value="Any system (or collection of systems) that is responsible for requesting prior authorizations."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/PASCommunicationRequestMedium"/> </reference> <name value="PAS Communication Medium Value Set"/> <description value="Types of channels that a communication request can be made"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-communicationrequest"/> </reference> <name value="PAS CommunicationRequest"/> <description value="PAS constraints on CommunicationRequest resource mandating support for elements relevant to the prior authorization response. For DTR submit-attachment use, the identifer will always be present since the medium will not be VOICE and thus the identifiers can be used as the tracking control number."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/cs-categories"/> </reference> <name value="PAS Conformance Statement Categories"/> <description value="Categories for conformance statements found in the PAS IG"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-coverage"/> </reference> <name value="PAS Coverage"/> <description value="PAS constraints on Coverage resource mandating support for insurance elements relevant to the prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-devicerequest"/> </reference> <name value="PAS Device Request"/> <description value="PAS constraints on DeviceRequest resource mandating support for elements relevant to the devices being requested on a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-documentreference"/> </reference> <name value="PAS Document Reference"/> <description value="PAS constraints on US Core DocumentReference to require the document content to be included and not referenced externally."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="DocumentReference"/> </extension> <reference> <reference value="DocumentReference/DocumentReferenceExample"/> </reference> <name value="PAS Document Reference Example"/> <description value="An example of a DocumentReference conveying a procedure note."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-documentreference"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-encounter"/> </reference> <name value="PAS Encounter"/> <description value="PAS constraints on the Encounter resource mandating support for elements relevant to details of a requested institutional stay on the prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:complex-type"/> </extension> <reference> <reference value="StructureDefinition/profile-identifier"/> </reference> <name value="PAS Identifier"/> <description value="Constraints and extensions on Identifier allowing for a common datatype across all resource profiles."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/PASInformationChangeMode"/> </reference> <name value="PAS Information Change Mode Value Set"/> <description value="The mode by which a piece of information has changed."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Parameters"/> </extension> <reference> <reference value="Parameters/PASClaimInquiryOperationResponseExample"/> </reference> <name value="PAS Inquiry Operation Response Example"/> <description value="An example of a claims inquiry operation response."/> <exampleBoolean value="true"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-pas-inquiry-request-bundle"/> </reference> <name value="PAS Inquiry Request Bundle"/> <description value="PAS constraints on Bundle resource ensuring that a claim inquiry resource is present and that non-supported elements are not."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/PASClaimInquiryBundleExample"/> </reference> <name value="PAS Inquiry Request Bundle Example"/> <description value="An example of a Claim bundle inquiring about prior authorizations."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-pas-inquiry-response-bundle"/> </reference> <name value="PAS Inquiry Response Bundle"/> <description value="PAS constraints on Bundle resource ensuring that a claim inquiry response resource is present and that non-supported elements are not."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/PASClaimInquiryResponseBundleExample"/> </reference> <name value="PAS Inquiry Response Bundle Example"/> <description value="An example of a ClaimResponse bundle returning a response to a claims inquiry."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-insurer"/> </reference> <name value="PAS Insurer Organization"/> <description value="An organization who provides insurance and is the receiver of a prior authorization request."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-location"/> </reference> <name value="PAS Location Profile"/> <description value="A profile on US-Core location to allow for specifying where a practitioner is working at."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/pas-loinc-attachment-codes"/> </reference> <name value="PAS LOINC Attachment Codes Value Set"/> <description value="This value set includes LOINC terms that can be sent by a payer as part of an HL7 attachment request for additional information. It has been curated by the HL7 Payer/Provider Information Exchange (PIE) Work Group. More information about using LOINC in HIPAA attachments and the source of this value set can be found at [LOINC Attahments](https://loinc.org/attachments/)."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-medicationrequest"/> </reference> <name value="PAS Medication Request"/> <description value="PAS constraints on MedicationRequest resource mandating support for elements relevant to the prescriptions being requested on a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:logical"/> </extension> <reference> <reference value="StructureDefinition/PASMetricData"/> </reference> <name value="PAS Metric Data"/> <description value="A logical model describing the information that ought to be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-nutritionorder"/> </reference> <name value="PAS Nutrition Order"/> <description value="PAS constraint on Nutrition Order resource for elements relevant to the ordering of nutrition on a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource:abstract"/> </extension> <reference> <reference value="StructureDefinition/profile-organization"/> </reference> <name value="PAS Organization Base Profile"/> <description value="A base profile for organizations in PAS"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ActorDefinition"/> </extension> <reference> <reference value="ActorDefinition/payer"/> </reference> <name value="PAS Payer"/> <description value="Any system (or collection of systems) that is responsible for responding to prior authorization requests."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-practitioner"/> </reference> <name value="PAS Practitioner"/> <description value="PAS constraints on Practitioner resource mandating support for elements relevant to the care team involved in a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-practitionerrole"/> </reference> <name value="PAS PractitionerRole"/> <description value="PAS constraints on PractitionerRole resource mandating support for elements relevant to the care team involved in a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/pas-pwk01-attachment-report-type-code"/> </reference> <name value="PAS PWK01 Attachment Report Type Code Value Set"/> <description value="In addition to using LOINC attachment codes, a payer may request for additional information from the provider to support a prior authorization request using X12's PWK01 Attachment Report Type Code. Note that the PWK01 codes will not be published in due to X12 IP restrictions."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:complex-type"/> </extension> <reference> <reference value="StructureDefinition/profile-quantity"/> </reference> <name value="PAS Quantity"/> <description value="Constraints and extensions on SimpleQuantity which restricts the units."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-pas-request-bundle"/> </reference> <name value="PAS Request Bundle"/> <description value="PAS constraints on Bundle resource ensuring that a claim/claim update resource is present and that non-supported elements are not."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-requestor"/> </reference> <name value="PAS Requestor Organization"/> <description value="The organization who is making a prior authorization request."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-pas-response-bundle"/> </reference> <name value="PAS Response Bundle"/> <description value="PAS constraints on Bundle resource ensuring that a claim response resource is present and that non-supported elements are not."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-servicerequest"/> </reference> <name value="PAS Service Request"/> <description value="PAS constraints on ServiceRequest resource mandating support for elements relevant to the generic services being requested on a prior authorization request"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-subscriber"/> </reference> <name value="PAS Subscriber Patient"/> <description value="A patient who is the subscriber of an insurance plan."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-subscription"/> </reference> <name value="PAS Subscription"/> <description value="The profile for PAS subscription."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Subscription"/> </extension> <reference> <reference value="Subscription/PASSubscriptionExample"/> </reference> <name value="PAS Subscription example for a specific provider"/> <description value="An example of a PAS Subscription submission for a specific provider."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscription|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/PASSubscriptionNotification"/> </reference> <name value="PAS Subscription Notification example"/> <description value="An example of a PAS Subscription Notification"/> <exampleBoolean value="true"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Parameters"/> </extension> <reference> <reference value="Parameters/SubscriptionNotificationParameters"/> </reference> <name value="PAS Subscription Notification Parameters"/> <description value="An example of the parameters going back for a PAS subscription notification"/> <exampleBoolean value="true"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SubscriptionTopic"/> </extension> <reference> <reference value="SubscriptionTopic/PASSubscriptionTopic"/> </reference> <name value="PAS Subscription Topic"/> <description value="This is the subscription topic used for retrieving results from pended authorization requests."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/PASSupportingInfoType"/> </reference> <name value="PAS Supporting Info Type Value Set"/> <description value="Types of supporting information for a Prior Authorization Claim."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/profile-task"/> </reference> <name value="PAS Task"/> <description value="PAS constraints on Task resource that is used to request additional documentation for prior authorizations."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/PASTaskCodes"/> </reference> <name value="PAS Task Codes"/> <description value="The code for the task that is request additional information."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/PASTempCodes"/> </reference> <name value="PAS Temporary Codes"/> <description value="Codes temporarily defined as part of the PAS implementation guide. These will eventually migrate into an officially maintained terminology (likely either SNOMED CT or HL7's UTG code systems)."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:complex-type"/> </extension> <reference> <reference value="StructureDefinition/profile-datatype-timing"/> </reference> <name value="PAS Timing"/> <description value="PAS constraints on the Timing datatype used in the various service requests."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-patientStatus"/> </reference> <name value="Patient Status"/> <description value="A code representing the status of the patient when being admitted"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ClaimResponse"/> </extension> <reference> <reference value="ClaimResponse/PractitionerRequestorPendingResponseExample"/> </reference> <name value="Pending Authorization Response with Practitioner Requestor Example"/> <description value="An example of a ClaimResponse where the requestor is a Practitioner and the response is pended."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-productOrServiceCodeEnd"/> </reference> <name value="Product or Service Code End"/> <description value="Used to provide the last code in a series of codes for the service being requested."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/ReferralAuthorizationBundleExample"/> </reference> <name value="Referral Authorization Bundle Example"/> <description value="An example of a Claim bundle requesting prior authorization of a referral."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/ReferralAuthorizationExample"/> </reference> <name value="Referral Authorization Example"/> <description value="An example of a Claim resource requesting prior authorization of a referral."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/ReferralAuthorizationResponseBundleExample"/> </reference> <name value="Referral Authorization Response Bundle Example"/> <description value="An example of a ClaimResponse bundle approving the authorization of a referral."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/ReferralPendingAuthorizationResponseBundleExample"/> </reference> <name value="Referral Pending Authorization Response Bundle Example"/> <description value="An example of a ClaimResponse bundle with a pending authorization of a referral."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/RejectionResponseBundleExample"/> </reference> <name value="Rejection Response Bundle Example"/> <description value="An example of a ClaimResponse bundle showing the rejection of a request."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ClaimResponse"/> </extension> <reference> <reference value="ClaimResponse/RejectionResponseExample"/> </reference> <name value="Rejection Response Example"/> <description value="An example of a ClaimResponse that is rejected."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-requestedService"/> </reference> <name value="Requested Service"/> <description value="The details of the service being requested."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-revenueCode"/> </reference> <name value="Revenue Code"/> <description value="A revenue code that expresses what was approved which maps to X12 SV201"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-revenueUnitRateLimit"/> </reference> <name value="Revenue Unit Rate Limit"/> <description value="The limit on the rate per unit of revenue for hospital accomodation. (SV206)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-reviewAction"/> </reference> <name value="Review Action"/> <description value="The details of the review action that is necessary for the authorization."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-reviewActionCode"/> </reference> <name value="Review Action Code"/> <description value="The code describing the result of the review."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="OperationDefinition"/> </extension> <reference> <reference value="OperationDefinition/Claim-inquiry"/> </reference> <name value="Search for a Prior Authorization Response by example"/> <description value="This operation is used to make a search for a Prior Authorization Response by example for a previously-submitted PreAuthorization. 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 output is a Parameters object with 0..* Claim Inquiry Response Bundles included as the query results."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-serviceItemRequestType"/> </reference> <name value="Service Item Request Type"/> <description value="A code that identifies the type of service being requested."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-serviceLineNumber"/> </reference> <name value="Service Line Number"/> <description value="A number that links the content being requested with the claim item number."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="OperationDefinition"/> </extension> <reference> <reference value="OperationDefinition/Claim-submit"/> </reference> <name value="Submit a Prior Authorization Request for adjudication"/> <description value="This operation is used to submit a PreAuthorization Claim Request for adjudication as a Bundle containing the PASClaimRequest and other referenced resources for processing. The only input parameter is the single Bundle resource with a PASClaimRequest instance (along with other referenced resources) and the only output is a single Bundle with a PASClaimResponse (and other referenced resources) or an OperationOutcome resource. This is a variant of the FHIR Core Claim $submit operation."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Patient"/> </extension> <reference> <reference value="Patient/BeneficiaryExample"/> </reference> <name value="Submit Claim Beneficiary Example"/> <description value="Sample patient who is a beneficiary of an insurance plan."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Coverage"/> </extension> <reference> <reference value="Coverage/InsuranceExample"/> </reference> <name value="Submit Claim Insurance Example"/> <description value="Sample insurance for a prior authorization."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/InsurerExample"/> </reference> <name value="Submit Claim Insurer Example"/> <description value="A sample payor organization."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Location"/> </extension> <reference> <reference value="Location/ReferralLocationExample"/> </reference> <name value="Submit Claim Referral Location Example"/> <description value="A sample location."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/ReferralPractitionerExample"/> </reference> <name value="Submit Claim Referral Practitioner Example"/> <description value="A sample practitioner who is being referred to."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="PractitionerRole"/> </extension> <reference> <reference value="PractitionerRole/ReferralPractitionerRoleExample"/> </reference> <name value="Submit Claim Referral Practitioner Role Example"/> <description value="A sample practitioner role instance."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ServiceRequest"/> </extension> <reference> <reference value="ServiceRequest/ReferralRequestExample"/> </reference> <name value="Submit Claim Referral Request Example"/> <description value="A sample referral request that is the subject of a prior authorization."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/UMOExample"/> </reference> <name value="Submit Claim Requestor Example"/> <description value="A sample organization that is requesting a prior authorization."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Patient"/> </extension> <reference> <reference value="Patient/SubscriberExample"/> </reference> <name value="Submit Claim Subscriber Example"/> <description value="Sample patient who is a subscriber of an insurance plan."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Location"/> </extension> <reference> <reference value="Location/SurgicalLocationExample"/> </reference> <name value="Submit Claim Surgical Location Example"/> <description value="A sample location."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/SurgicalPractitionerExample"/> </reference> <name value="Submit Claim Surgical Practitioner Example"/> <description value="A sample practitioner who is being referred to."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="PractitionerRole"/> </extension> <reference> <reference value="PractitionerRole/SurgicalPractitionerRoleExample"/> </reference> <name value="Submit Claim Surgical Practitioner Role Example"/> <description value="A sample practitioner role instance."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Bundle"/> </extension> <reference> <reference value="Bundle/SurgicalRequestBundleExample"/> </reference> <name value="Surgical Admission Request Bundle Example"/> <description value="An example of a Claim bundle requesting prior authorization of a surgical service."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Claim"/> </extension> <reference> <reference value="Claim/SurgicalAuthorizationRequestExample"/> </reference> <name value="Surgical Request Authorization Example"/> <description value="An example of a Claim resource requesting prior authorization of a surgical service."/> <exampleCanonical value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.2.1"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:extension"/> </extension> <reference> <reference value="StructureDefinition/extension-TransmissionIdentifiers"/> </reference> <name value="Transmission Identifiers"/> <description value="Identifiers used for transmission tracking. Used in the X12 GS and ISA header segments."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278ConditionCategory"/> </reference> <name value="X12 278 CRC Condition Category"/> <description value="This set of codes identifies the category of a patient's condition."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278ConditionCode"/> </reference> <name value="X12 278 CRC Condition Code"/> <description value="This set of codes identifies a patient's conditions."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278DiagnosisCodes"/> </reference> <name value="X12 278 Diagnosis Code Value Set"/> <description value="The complete set of codes that can be used to convey a patient diagnosis. This includes codes from ICD-10-CM, ICD-9-CM and Diagnosis Related Group codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278DiagnosisInformationType"/> </reference> <name value="X12 278 Diagnosis Information Type"/> <description value="LOINC codes that convey the type of information that is being requested about the diagnosis."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278DiagnosisType"/> </reference> <name value="X12 278 Diagnosis Type Value Set"/> <description value="This set of codes is used to identify the type of diagnosis that is being conveyed in the prior authorization."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278FollowUpActionCodes"/> </reference> <name value="X12 278 Follow Up Action Value Set"/> <description value="The complete set of codes that are used to indicate any follow-up actions that are allowed for a reject reason."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278LocationType"/> </reference> <name value="X12 278 Health Care Service Location Type Value Set"/> <description value="This set of codes identifies where services were, or may be, performed. The codes are taken from NUBC Bill Type and from CMS Place of Service codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278NutritionEnteralFormulaType"/> </reference> <name value="X12 278 Nutrition Enteral Formula Type"/> <description value="This set of codes identifies enteral formula codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278NutritionOralDietType"/> </reference> <name value="X12 278 Nutrition Oral Diet Type"/> <description value="This set of codes identifies oral diet codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278RejectReasonCodes"/> </reference> <name value="X12 278 Reject Reason Value Set"/> <description value="The complete set of codes that are used to indicate the reason why something was rejected."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278RequestedServiceModifierType"/> </reference> <name value="X12 278 Requested Service Modifier Type"/> <description value="This set of codes identifies modifiers to the type of service being requested. It is a combination of CPT (HCPCS I) and HCPCS II procedure code modifiers. NOTE: HCPCS Level 1 Codes are the CPT codes so either code system could be used to send the codes. When receiving the codes from an X12 system, the system returned will be HCPCS even if it was initially sent as a CPT code."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278RequestedServiceType"/> </reference> <name value="X12 278 Requested Service Type"/> <description value="This set of codes identifies what service is being requested. For queries, if the query is not searching for a specific service type, the not-applicable data absent reason code can be used. It is a combination of X12 Service Type codes, CPT (HCPCS I) and HCPCS II procedure code modifiers, ICD-9 Procedure codes, ICD-10 Procedure codes, and NDC Drug codes. NOTE: HCPCS Level 1 Codes are the CPT codes so either code system could be used to send the codes. When receiving the codes from an X12 system, the system returned will be HCPCS even if it was initially sent as a CPT code."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12278ReviewDecisionReasonCode"/> </reference> <name value="X12 278 Review Decision Reason Codes"/> <description value="Codes used to identify the reason for the health care service review outcome."/> <exampleBoolean value="false"/> </resource> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="toc.html"/> </extension> <nameUrl value="toc.html"/> <title value="Table of Contents"/> <generation value="html"/> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="index.html"/> </extension> <nameUrl value="index.html"/> <title value="Prior Authorization Implementation Guide Home Page"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="background.html"/> </extension> <nameUrl value="background.html"/> <title value="Reading This IG"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="trial-use"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> 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url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="metrics.html"/> </extension> <nameUrl value="metrics.html"/> <title value="PAS Metrics"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="trial-use"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="conformancedetails.html"/> </extension> <nameUrl value="conformancedetails.html"/> <title value="Conformance Details"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="fhirArtifacts.html"/> </extension> <nameUrl value="fhirArtifacts.html"/> <title value="Artifacts Overview"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="terminology.html"/> </extension> <nameUrl value="terminology.html"/> <title value="PAS Terminology"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="downloads.html"/> </extension> <nameUrl value="downloads.html"/> <title value="Downloads"/> <generation value="markdown"/> </page> <page> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="informative"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name"> <valueUrl value="changelog.html"/> </extension> <nameUrl value="changelog.html"/> <title value="Change Log"/> <generation value="markdown"/> </page> </page> <parameter> <code value="path-resource"/> <value value="input/capabilities"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/examples"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/extensions"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/models"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/operations"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/profiles"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/resources"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/vocabulary"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/maps"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/testing"/> </parameter> <parameter> <code value="path-resource"/> <value value="input/history"/> </parameter> <parameter> <code value="path-resource"/> <value value="fsh-generated/resources"/> </parameter> <parameter> <code value="path-pages"/> <value value="template/config"/> </parameter> <parameter> <code value="path-pages"/> <value value="input/assets"/> </parameter> <parameter> <code value="path-pages"/> <value value="input/images"/> </parameter> <parameter> <code value="path-tx-cache"/> <value value="input-cache/txcache"/> </parameter> </definition> </ImplementationGuide>