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. 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: 2.1.0
Standards status: Trial-use Maturity Level: 3 Computable Name: ItemAuthorizedDetail
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.19

The details of what has been authorized for this item.

Context of Use

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

  • Element ID ExplanationOfBenefit
  • 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.

  • productOrServiceCode: CodeableConcept: An Extension
  • modifier: CodeableConcept: An Extension
  • unitPrice: Money: An Extension
  • quantity: Quantity: 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
.... extension:productOrServiceCode 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "productOrServiceCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Type (required)
.... productOrServiceCodeEnd 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... extension:modifier 0..* Extension Extension
..... extension 0..0
..... url 1..1 uri "modifier"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension:unitPrice 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "unitPrice"
..... value[x] 0..1 Money Value of extension
.... extension:quantity 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "quantity"
..... value[x] 0..1 PASQuantity A fixed quantity (no comparator)
.... epsdtIndicator 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
.... nursingHomeLevelOfCare 0..1 CodeableConcept Extension
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.

.... revenue 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode
Binding: AHA NUBC Revenue Value Set (required)
.... revenueUnitRateLimit 0..1 decimal Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
.... authorizedService 0..1 Reference(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..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
... 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
.... extension:productOrServiceCode 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "productOrServiceCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Type (required)
.... productOrServiceCodeEnd 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... extension:modifier 0..* Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "modifier"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension:unitPrice 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "unitPrice"
..... value[x] 0..1 Money Value of extension
.... extension:quantity 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "quantity"
..... value[x] C 0..1 PASQuantity A fixed quantity (no comparator)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
.... epsdtIndicator 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
.... nursingHomeLevelOfCare 0..1 CodeableConcept Extension
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.


.... revenue 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode
Binding: AHA NUBC Revenue Value Set (required)
.... revenueUnitRateLimit 0..1 decimal Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
.... authorizedService 0..1 Reference(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..1 uri "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.

  • productOrServiceCode: CodeableConcept: An Extension
  • modifier: CodeableConcept: An Extension
  • unitPrice: Money: An Extension
  • quantity: Quantity: 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
.... extension:productOrServiceCode 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "productOrServiceCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Type (required)
.... productOrServiceCodeEnd 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... extension:modifier 0..* Extension Extension
..... extension 0..0
..... url 1..1 uri "modifier"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension:unitPrice 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "unitPrice"
..... value[x] 0..1 Money Value of extension
.... extension:quantity 0..1 Extension Extension
..... extension 0..0
..... url 1..1 uri "quantity"
..... value[x] 0..1 PASQuantity A fixed quantity (no comparator)
.... epsdtIndicator 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
.... nursingHomeLevelOfCare 0..1 CodeableConcept Extension
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.

.... revenue 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode
Binding: AHA NUBC Revenue Value Set (required)
.... revenueUnitRateLimit 0..1 decimal Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
.... authorizedService 0..1 Reference(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..1 uri "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..* 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
.... extension:productOrServiceCode 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "productOrServiceCode"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Type (required)
.... productOrServiceCodeEnd 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... extension:modifier 0..* Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "modifier"
..... value[x] 0..1 CodeableConcept Value of extension
Binding: X12 278 Requested Service Modifier Type (required)
.... extension:unitPrice 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "unitPrice"
..... value[x] 0..1 Money Value of extension
.... extension:quantity 0..1 Extension Extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "quantity"
..... value[x] C 0..1 PASQuantity A fixed quantity (no comparator)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
.... epsdtIndicator 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
.... nursingHomeLevelOfCare 0..1 CodeableConcept Extension
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.


.... revenue 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode
Binding: AHA NUBC Revenue Value Set (required)
.... revenueUnitRateLimit 0..1 decimal Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
.... authorizedService 0..1 Reference(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..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSetURI
Extension.extension:productOrServiceCode.value[x]requiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
Extension.extension:modifier.value[x]requiredX12278RequestedServiceModifierType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType
from this IG