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

Extension: ItemAuthorizedDetail

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail Version: 2.0.1
Standards status: Trial-use Maturity Level: 3 Computable Name: ItemAuthorizedDetail

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

Context of Use

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

  • Element ID ClaimResponse.item

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

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

Maturity: 3

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... extension:productOrServiceCode 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"productOrServiceCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Type (required)
... productOrServiceCodeEnd 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... extension:modifier 0..*ExtensionExtension
.... extension 0..0
.... url 1..1uri"modifier"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension 0..0
.... url 1..1uri"unitPrice"
.... value[x] 0..1MoneyValue of extension
... extension:quantity 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"quantity"
.... value[x] 0..1SimpleQuantityA fixed quantity (no comparator)
... epsdtIndicator 0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
... nursingHomeLevelOfCare 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... extension:revenue 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"revenue"
.... value[x] 0..1CodeableConceptValue of extension
Binding: AHA NUBC Revenue Value Set (required)
... revenueUnitRateLimit 0..1decimalExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
... authorizedService 0..1Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order)Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
... url 1..1uri"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... extension:productOrServiceCode 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"productOrServiceCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Type (required)
... extension:modifier 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"modifier"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Modifier Type (required)
... extension:unitPrice 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"unitPrice"
.... value[x] 0..1MoneyValue of extension
... extension:quantity 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"quantity"
.... value[x] C0..1SimpleQuantityA fixed quantity (no comparator)
... epsdtIndicator 0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
... nursingHomeLevelOfCare 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... extension:revenue 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"revenue"
.... value[x] 0..1CodeableConceptValue of extension
Binding: AHA NUBC Revenue Value Set (required)
... revenueUnitRateLimit 0..1decimalExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
... authorizedService 0..1Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order)Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
... url 1..1uri"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"

doco Documentation for this format

This structure is derived from Extension

Summary

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

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

Maturity: 3

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... extension:productOrServiceCode 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"productOrServiceCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Type (required)
... productOrServiceCodeEnd 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
... extension:modifier 0..*ExtensionExtension
.... extension 0..0
.... url 1..1uri"modifier"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension 0..0
.... url 1..1uri"unitPrice"
.... value[x] 0..1MoneyValue of extension
... extension:quantity 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"quantity"
.... value[x] 0..1SimpleQuantityA fixed quantity (no comparator)
... epsdtIndicator 0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
... nursingHomeLevelOfCare 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... extension:revenue 0..1ExtensionExtension
.... extension 0..0
.... url 1..1uri"revenue"
.... value[x] 0..1CodeableConceptValue of extension
Binding: AHA NUBC Revenue Value Set (required)
... revenueUnitRateLimit 0..1decimalExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
... authorizedService 0..1Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order)Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
... url 1..1uri"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... extension:productOrServiceCode 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"productOrServiceCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Type (required)
... extension:modifier 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"modifier"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Requested Service Modifier Type (required)
... extension:unitPrice 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"unitPrice"
.... value[x] 0..1MoneyValue of extension
... extension:quantity 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"quantity"
.... value[x] C0..1SimpleQuantityA fixed quantity (no comparator)
... epsdtIndicator 0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
... nursingHomeLevelOfCare 0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... extension:revenue 0..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"revenue"
.... value[x] 0..1CodeableConceptValue of extension
Binding: AHA NUBC Revenue Value Set (required)
... revenueUnitRateLimit 0..1decimalExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
... authorizedService 0..1Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order)Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
... url 1..1uri"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Extension.extension:productOrServiceCode.value[x]requiredX12278RequestedServiceType
Extension.extension:modifier.value[x]requiredX12278RequestedServiceModifierType
Extension.extension:revenue.value[x]requiredAHANUBCRevenueCodes (a valid code from https://www.nubc.org/revenue-code)