Da Vinci Prior Authorization Support (PAS) FHIR IG
1.0.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PAS CommunicationRequest

Defining URL:http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest
Version:1.0.0
Name:PASCommunicationRequest
Title:PAS CommunicationRequest
Status:Active as of 2020-12-20T19:17:24+00:00
Definition:

PAS constraints on CommunicationRequest resource mandating support for elements relevant to the prior authorization response

Publisher:HL7 International - Financial Management Work Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest

Formal Views of Profile Content

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

This structure is derived from CommunicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. CommunicationRequest 0..*CommunicationRequestA request for information to be sent to a receiver
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-communicatedDiagnosis S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis
Binding: X12 278 Diagnosis Code Value Set (required)
... extension-contentModifier S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier
Binding: X12 278 Diagnosis Information Type (required)
... status 1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Fixed Value: active
... category S0..*CodeableConceptMessage category
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755 (required): Codes indicating the title or contents of a document, report or supporting item. 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.

... medium S0..*CodeableConceptA channel of communication
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756 (required): Codes defining timing, transmission method or format by which reports are to be sent. 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.

... payload S0..*BackboneElementMessage payload
.... content[x] S1..1stringMessage part content
... requester S0..1Reference(PAS Insurer Organization)Who/what is requesting service
... recipient S0..*Reference(PAS Practitioner | US Core Organization Profile)Message recipient
... sender S0..1Reference(PAS Requestor Organization)Message sender

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. CommunicationRequest 0..*CommunicationRequestA request for information to be sent to a receiver
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-communicatedDiagnosis S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis
Binding: X12 278 Diagnosis Code Value Set (required)
... extension-contentModifier S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier
Binding: X12 278 Diagnosis Information Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierUnique identifier
... basedOn Σ0..*Reference(Resource)Fulfills plan or proposal
... replaces Σ0..*Reference(CommunicationRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of the communication request.


Fixed Value: active
... statusReason 0..1CodeableConceptReason for current status
Binding: (unbound) (example): Codes identifying the reason for the current state of a request.

... category S0..*CodeableConceptMessage category
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755 (required): Codes indicating the title or contents of a document, report or supporting item. 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.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Codes indicating the relative importance of a communication request.

... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... medium S0..*CodeableConceptA channel of communication
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756 (required): Codes defining timing, transmission method or format by which reports are to be sent. 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.


... subject 0..1Reference(Patient | Group)Focus of message
... about 0..*Reference(Resource)Resources that pertain to this communication request
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... payload S0..*BackboneElementMessage payload
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... content[x] S1..1stringMessage part content
... occurrence[x] Σ0..1When scheduled
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeWhen request transitioned to being actionable
... requester SΣ0..1Reference(PAS Insurer Organization)Who/what is requesting service
... recipient S0..*Reference(PAS Practitioner | US Core Organization Profile)Message recipient
... sender SΣ0..1Reference(PAS Requestor Organization)Message sender
... reasonCode Σ0..*CodeableConceptWhy is communication needed?
Binding: v3 Code System ActReason (example): Codes for describing reasons for the occurrence of a communication.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why is communication needed?
... note 0..*AnnotationComments made about communication request

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. CommunicationRequest 0..*CommunicationRequestA request for information to be sent to a receiver
... extension-communicatedDiagnosis 0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis
Binding: X12 278 Diagnosis Code Value Set (required)
... extension-contentModifier 0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier
Binding: X12 278 Diagnosis Information Type (required)
... identifier Σ0..*IdentifierUnique identifier
... medium 0..*CodeableConceptA channel of communication
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756 (required): Codes defining timing, transmission method or format by which reports are to be sent. 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.


... payload 0..*BackboneElementMessage payload
.... content[x] 1..1stringMessage part content
... requester Σ0..1Reference(PAS Insurer Organization)Who/what is requesting service
... recipient 0..*Reference(PAS Practitioner | US Core Organization Profile)Message recipient
... sender Σ0..1Reference(PAS Requestor Organization)Message sender

doco Documentation for this format

Differential View

This structure is derived from CommunicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. CommunicationRequest 0..*CommunicationRequestA request for information to be sent to a receiver
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-communicatedDiagnosis S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis
Binding: X12 278 Diagnosis Code Value Set (required)
... extension-contentModifier S0..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier
Binding: X12 278 Diagnosis Information Type (required)
... status 1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Fixed Value: active
... category S0..*CodeableConceptMessage category
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755 (required): Codes indicating the title or contents of a document, report or supporting item. 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.

... medium S0..*CodeableConceptA channel of communication
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756 (required): Codes defining timing, transmission method or format by which reports are to be sent. 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.

... payload S0..*BackboneElementMessage payload
.... content[x] S1..1stringMessage part content
... requester S0..1Reference(PAS Insurer Organization)Who/what is requesting service
... recipient S0..*Reference(PAS Practitioner | US Core Organization Profile)Message recipient
... sender S0..1Reference(PAS Requestor Organization)Message sender

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CommunicationRequest 0..*CommunicationRequestA request for information to be sent to a receiver
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension-communicatedDiagnosis S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis
Binding: X12 278 Diagnosis Code Value Set (required)
... extension-contentModifier S0..1CodeableConceptOptional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier
Binding: X12 278 Diagnosis Information Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierUnique identifier
... basedOn Σ0..*Reference(Resource)Fulfills plan or proposal
... replaces Σ0..*Reference(CommunicationRequest)Request(s) replaced by this request
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of the communication request.


Fixed Value: active
... statusReason 0..1CodeableConceptReason for current status
Binding: (unbound) (example): Codes identifying the reason for the current state of a request.

... category S0..*CodeableConceptMessage category
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755 (required): Codes indicating the title or contents of a document, report or supporting item. 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.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Codes indicating the relative importance of a communication request.

... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... medium S0..*CodeableConceptA channel of communication
Binding: https://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756 (required): Codes defining timing, transmission method or format by which reports are to be sent. 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.


... subject 0..1Reference(Patient | Group)Focus of message
... about 0..*Reference(Resource)Resources that pertain to this communication request
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... payload S0..*BackboneElementMessage payload
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... content[x] S1..1stringMessage part content
... occurrence[x] Σ0..1When scheduled
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... authoredOn Σ0..1dateTimeWhen request transitioned to being actionable
... requester SΣ0..1Reference(PAS Insurer Organization)Who/what is requesting service
... recipient S0..*Reference(PAS Practitioner | US Core Organization Profile)Message recipient
... sender SΣ0..1Reference(PAS Requestor Organization)Message sender
... reasonCode Σ0..*CodeableConceptWhy is communication needed?
Binding: v3 Code System ActReason (example): Codes for describing reasons for the occurrence of a communication.


... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why is communication needed?
... note 0..*AnnotationComments made about communication request

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
CommunicationRequest.languagepreferredCommonLanguages
Max Binding: AllLanguages
CommunicationRequest.statusrequiredFixed Value: active
CommunicationRequest.statusReasonexample
CommunicationRequest.categoryrequiredhttps://valueset.x12.org/x217/005010/response/2000D/PWK/1/01/00/755
CommunicationRequest.priorityrequiredRequestPriority
CommunicationRequest.mediumrequiredhttps://valueset.x12.org/x217/005010/response/2000D/PWK/1/02/00/756
CommunicationRequest.reasonCodeexamplev3.ActReason