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

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

: Submit a Claim resource for adjudication - XML Representation

Page standards status: Trial-use Maturity Level: 3

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