This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.2.1: 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

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Extension: Review Action Code

The code describing the result of the review.

Context of Use

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

• Element ID: ClaimResponse.addItem.adjudication.extension
• Element ID: ClaimResponse.item.adjudication.extension
• Element ID: Claim.item

Usage info

Usages:

• Use this Extension: Review Action, PAS Claim Inquiry, ReviewAction and PAS Claim Inquiry
• Examples for this Extension: Bundle/PASClaimInquiryBundleExample, Bundle/PASClaimInquiryResponseBundleExample, Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample... Show 9 more, Bundle/ReferralPendingAuthorizationResponseBundleExample, Bundle/RejectionResponseBundleExample, Claim/PASClaimInquiryExample, ClaimResponse/PASClaimInquiryResponseExample, ClaimResponse/PractitionerRequestorAdditionalContentResponseExample, ClaimResponse/PractitionerRequestorPendingResponseExample, ClaimResponse/PractitionerRequestorResponseExample, ClaimResponse/RejectionResponseExample and Parameters/PASClaimInquiryOperationResponseExample

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

• Differential Table
• Snapshot Table
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action Code
extension		0..0		Extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"
value[x]		0..1	CodeableConcept	Value of extension 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.
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.value[x]	Base	required	https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306	Not State	Unknown

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action Code
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"
value[x]		0..1	CodeableConcept	Value of extension 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.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.value[x]	Base	required	https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306	Not State	Unknown

Constraints

Id	Grade	Path(s)	Description	Expression
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()

Summary

Simple Extension with the type CodeableConcept: The code describing the result of the review.

Maturity: 4

Differential ViewDifferential View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action Code
extension		0..0		Extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"
value[x]		0..1	CodeableConcept	Value of extension 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.
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.value[x]	Base	required	https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306	Not State	Unknown

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action Code
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"
value[x]		0..1	CodeableConcept	Value of extension 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.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.value[x]	Base	required	https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306	Not State	Unknown

Constraints

Id	Grade	Path(s)	Description	Expression
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()

Summary

Simple Extension with the type CodeableConcept: The code describing the result of the review.

Maturity: 4

Other representations of profile: CSV, Excel, Schematron