Da Vinci Payer Data Exchange
2.1.0 - STU 2.1
Da Vinci Payer Data Exchange
2.1.0 - STU 2.1
This page is part of the Da Vinci Payer Data Exchange (v2.1.0: STU2.1) 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
| Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction | Version: 2.1.0 | |||
| Standards status: Informative | Computable Name: ReviewAction | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
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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)
ExplanationOfBenefit.item.adjudication
ExplanationOfBenefit.adjudication
ExplanationOfBenefit.addItem.adjudication
Usage info
Usages:
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Extension |
0..* | Extension | Extension | |
  Slices for extension |
Content/Rules for all slices | |||
   extension:code |
0..1 | CodeableConcept | Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pdex/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 | Explanation of the pending, review denial or partial approval | |
| 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-pdex/StructureDefinition/extension-reviewAction" | |
 value[x] |
0..0 | |||
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| 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:code |
0..1 | CodeableConcept | Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pdex/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 | Explanation of the pending, review denial or partial approval | |
| 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-pdex/StructureDefinition/extension-reviewAction" | |
| Documentation for this format | ||||
This structure is derived from Extension
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Extension | |
| Slices for extension |
Content/Rules for all slices | |||
| extension:code |
0..1 | CodeableConcept | Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pdex/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 | Explanation of the pending, review denial or partial approval | |
| 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-pdex/StructureDefinition/extension-reviewAction" | |
| value[x] |
0..0 | |||
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| 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:code |
0..1 | CodeableConcept | Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pdex/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 | Explanation of the pending, review denial or partial approval | |
| 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-pdex/StructureDefinition/extension-reviewAction" | |
| Documentation for this format | ||||
This structure is derived from Extension
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet | URI |
| Extension.extension:reasonCode.value[x] | required | X12278ReviewDecisionReasonCode(a valid code from https://codesystem.x12.org/external/886)http://hl7.org/fhir/us/davinci-pdex/ValueSet/X12278ReviewDecisionReasonCodeFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.0 based on FHIR 4.0.1. Generated 2025-06-18
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