Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Extension: ReviewAction

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction Version: 2.1.0
Standards status: Trial-use Maturity Level: 3 Computable Name: ReviewAction
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.38

The details of the review action that is necessary for the authorization.

Context of Use

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

  • Element ID ExplanationOfBenefit
  • Element ID ClaimResponse.adjudication
  • Element ID ClaimResponse.item.adjudication
  • Element ID ClaimResponse.addItem.adjudication

Usage info

Usage:

Formal Views of Extension Content

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

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

  • number: string: An Extension
  • reasonCode: CodeableConcept: An Extension
  • secondSurgicalOpinionFlag: boolean: An Extension

Maturity: 3

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..* Extension Extension
... Slices for extension Content/Rules for all slices
.... code 0..1 CodeableConcept Healthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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:number 0..1 Extension Item Level Review Number
..... extension 0..0
..... url 1..1 uri "number"
..... value[x] 0..1 string Value of extension
.... extension:reasonCode 0..* Extension Certification Action Code: indicates the reason for the approved, denied, or pended services
..... extension 0..0
..... url 1..1 uri "reasonCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension:secondSurgicalOpinionFlag 0..1 Extension Whether a second surgical opinion is need for approval
..... extension 0..0
..... url 1..1 uri "secondSurgicalOpinionFlag"
..... value[x] 0..1 boolean Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... code 0..1 CodeableConcept Healthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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:number 0..1 Extension Item Level Review Number
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "number"
..... value[x] 0..1 string Value of extension
.... extension:reasonCode 0..* Extension Certification Action Code: indicates the reason for the approved, denied, or pended services
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "reasonCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension:secondSurgicalOpinionFlag 0..1 Extension Whether a second surgical opinion is need for approval
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "secondSurgicalOpinionFlag"
..... value[x] 0..1 boolean Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

  • number: string: An Extension
  • reasonCode: CodeableConcept: An Extension
  • secondSurgicalOpinionFlag: boolean: An Extension

Maturity: 3

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..* Extension Extension
... Slices for extension Content/Rules for all slices
.... code 0..1 CodeableConcept Healthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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:number 0..1 Extension Item Level Review Number
..... extension 0..0
..... url 1..1 uri "number"
..... value[x] 0..1 string Value of extension
.... extension:reasonCode 0..* Extension Certification Action Code: indicates the reason for the approved, denied, or pended services
..... extension 0..0
..... url 1..1 uri "reasonCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension:secondSurgicalOpinionFlag 0..1 Extension Whether a second surgical opinion is need for approval
..... extension 0..0
..... url 1..1 uri "secondSurgicalOpinionFlag"
..... value[x] 0..1 boolean Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... code 0..1 CodeableConcept Healthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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:number 0..1 Extension Item Level Review Number
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "number"
..... value[x] 0..1 string Value of extension
.... extension:reasonCode 0..* Extension Certification Action Code: indicates the reason for the approved, denied, or pended services
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "reasonCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension:secondSurgicalOpinionFlag 0..1 Extension Whether a second surgical opinion is need for approval
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "secondSurgicalOpinionFlag"
..... value[x] 0..1 boolean Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSetURI
Extension.extension:reasonCode.value[x]requiredX12278ReviewDecisionReasonCode (a valid code from https://codesystem.x12.org/external/886)
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278ReviewDecisionReasonCode
from this IG