This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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: Submit a Claim resource for adjudication - JSON Representation

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{
  "resourceType" : "OperationDefinition",
  "id" : "Claim-submit",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>URL: [base]/Claim/$submit</p><p>Input parameters Profile: <a href=\"StructureDefinition-profile-pas-request-bundle.html\">PAS Request Bundle</a></p><p>Output parameters Profile: <a href=\"StructureDefinition-profile-pas-response-bundle.html\">PAS Response Bundle</a></p><p>Parameters</p><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 Claim plus referenced resources.</p>\n</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 ClaimResponse plus referenced resources.</p>\n</div></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 3,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
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            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-pas/OperationDefinition/Claim-submit",
  "version" : "2.0.1",
  "name" : "ClaimSubmit",
  "title" : "Submit a Claim resource for adjudication",
  "status" : "draft",
  "kind" : "operation",
  "date" : "2023-12-01T21:19:45+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "name" : "HL7 International / Financial Management",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org/Special/committees/fm"
        },
        {
          "system" : "email",
          "value" : "fmlists@lists.hl7.org"
        }
      ]
    },
    {
      "name" : "Jean Duteau",
      "telecom" : [
        {
          "system" : "email",
          "value" : "mailto:jean@duteaudesign.com"
        }
      ]
    },
    {
      "name" : "HL7 International / Financial Management",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "This operation is used to submit a Pre-Authorization 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.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "code" : "submit",
  "base" : "http://hl7.org/fhir/OperationDefinition/Claim-submit",
  "resource" : [
    "Claim"
  ],
  "system" : false,
  "type" : true,
  "instance" : false,
  "inputProfile" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle",
  "outputProfile" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle",
  "parameter" : [
    {
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      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "A Bundle containing a single Claim plus referenced resources.",
      "type" : "Bundle"
    },
    {
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      "min" : 1,
      "max" : "1",
      "documentation" : "A Bundle containing a single ClaimResponse plus referenced resources.",
      "type" : "Bundle"
    }
  ]
}