# input/resources-yaml/structuredefinition-cdex-task-attachment-request.yml

resourceType: StructureDefinition
id: cdex-task-attachment-request
url: 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request'
name: CDexTaskAttachmentRequest
title: CDex Task Attachment Request Profile
date: '2025-05-22'
status: active
description: |
  Payers use this [Task](http://hl7.org/StructureDefinition/Task) based profile to request additional documentation ("attachments") for claims or prior authorizations. It constrains the Task resource to minimal necessary data elements needed to request attachments and respond in a way that is compatible with existing X12 277 RFAI and 278 response transactions to allow for association and requests for (typically PDF and CCDA) documents using LOINC and X12 standard codes. It also supports requests for more detailed missing data using Questionnaire, CQL, and QuestionnaireResponse, as supported by [Da Vinci Documentation Templates and Rules (DTR)](http://hl7.org/fhir/us/davinci-dtr/index.html).
fhirVersion: 4.0.1
kind: resource
abstract: false
type: Task
baseDefinition: 'http://hl7.org/fhir/StructureDefinition/Task'
derivation: constraint
differential:
  element:
    - id: Task
      path: Task
      definition: >-
        This Task profile is used to request additional documentation ("attachments") for claims or prior authorizations.
      constraint:
        - key: cdex-1
          severity: error
          human: >-
            The "ServiceDate" input SHALL be present if the attachment is for a claim.
          expression: >-
            Task.reasonCode.coding.code.where($this='claim').exists() implies Task.input.type.coding.code.where($this='service-date').exists()
        - key: cdex-4
          severity: error
          human: If code = "attachment-request-code", must have one or more "AttachmentsNeeded" inputs.
          expression: >-
            Task.code.coding.code.where($this='attachment-request-code').exists() implies Task.input.type.coding.code.where($this='attachments-needed').exists()
        - key: cdex-5
          severity: error
          human: If code = "attachment-request-questionnaire", must have one or more "QuestionnaireContext" inputs.
          expression: >-
            Task.code.coding.code.where($this='attachment-request-questionnaire').exists() implies Task.input.type.coding.code.where($this='questionnaire-context').exists()
        - key: cdex-6
          severity: error
          human: Must have only "AttachmentsNeeded" or "QuestionnaireContext" inputs not both.
          expression: >-
            Task.input.type.coding.code.where($this='attachments-needed').exists() implies Task.input.type.coding.code.where($this='questionnaire-context').empty()
        - key: cdex-10
          severity: warning
          human: If code = "attachment-request-questionnaire" and status = "completed", should have one or more "questionnaire-context" outputs referencing the QuestionnaireResponse.
          expression: >-
            (Task.code.coding.code.where($this='attachment-request-questionnaire').exists() and Task.status.where($this='completed').exists()) implies Task.output.type.coding.code.where($this='questionnaire-context').exists()
        - key: tdr-2
          severity: error
          human: >-
            Task statusReason SHALL be populated if status is 'rejected' or
            'failed'
          expression: >-
            (status = 'rejected' or status = 'failed') implies
            statusReason.exists()
    # - id: Task.meta
    #   path: Task.meta
    #   min: 1
    #   mustSupport: true
      
    # - id: 'Task.meta.profile'
    #   path: 'Task.meta.profile'
    #   slicing:
    #     discriminator:
    #       - type: value
    #         path: $this
    #     rules: open
    #   comment: >-
    #     meta.profile is required as a matter of convenience of receiving
    #     systems. The meta.profile should be used by the Server to
    #     hint/assert/declare that this instance conforms to one (or more) stated
    #     profiles (with business versions). meta.profile does not capture any
    #     business logic, processing directives, or semantics (for example,
    #     inpatient or outpatient). Clients should not assume that the Server will
    #     exhaustively indicate all profiles with all versions that this instance
    #     conforms to. Clients can (and should) perform their validation of
    #     conformance to the indicated profile(s) and to any other profiles of
    #     interest.
    #   min: 1
    #   mustSupport: true

    # - id: 'Task.meta.profile:cdex'
    #   path: 'Task.meta.profile'
    #   sliceName: cdex
    #   short: CDex Attachment Request Profile
    #   definition: Profile declaration asserting that this resource instance contains all the data elements required for CDex attachment requests.
    #   min: 1
    #   max: '1'
    #   # type:
    #   #   - code: canonical
    #   fixedCanonical: http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request
    #   mustSupport: true 

    - id: Task.contained
      path: Task.contained
      min: 2
      slicing:
        discriminator:
          - type: type
            path: $this
        rules: open
      mustSupport: true

    - id: Task.contained:practitionerrole
      path: Task.contained
      sliceName: practitionerrole
      definition: >-
        The contained practitionerrole profile communicates the provider ID as either a unique organization/location identifier (e.g., Type 2 NPI) or unique provider identifier (e.g., Type 1 NPI) or both.
      short: Contained PractitionerRole resource
      min: 1
      max: '1'
      type:
        - code: PractitionerRole
          profile:
            - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole'
      mustSupport: true

    - id: Task.contained:patient
      path: Task.contained
      sliceName: patient
      definition: >-
        The contained patient profile represents the patient data elements used to verify patient identity.
      short: Contained Patient resource
      min: 1
      max: '1'
      type:
        - code: Patient
          profile:
            - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics'
      mustSupport: true

    # - id: Task.contained:claim
    #   path: Task.contained
    #   sliceName: claim
    #   definition: >-
    #     The contained claim profile representing the required claim or pre-authorization data needed for attachments requests
    #   short: Contained Claim resource
    #   min: 1
    #   max: '1'
    #   type:
    #     - code: Claim
    #       profile:
    #         - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-claim'
    #   mustSupport: true

    - id: Task.identifier
      path: Task.identifier
      min: 1
      slicing:
        discriminator:
          - type: value
            path: $this
        rules: open
      mustSupport: true

    - id: 'Task.identifier:TrackingId'
      path: Task.identifier
      sliceName: TrackingId
      short: Re-association tracking control number
      definition: A Payer-assigned business identifier that ties the attachment(s) back to the claim or prior authorization. This value referred to as the “re-association tracking control numbers” or "attachment control number (ACN)".
      min: 1
      max: '1'
      patternIdentifier:
        type:         
          coding:
            - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
              code: tracking-id
      mustSupport: true

    - id: 'Task.identifier:TrackingId.system'
      path: Task.identifier.system
      mustSupport: true


    - id: 'Task.identifier:TrackingId.value'
      path: Task.identifier.value
      min: 1
      mustSupport: true


    - id: 'Task.identifier:AdminRefNumber'
      path: Task.identifier
      sliceName: AdminRefNumber
      short: Administrative reference number
      definition: A secondary Payer-assigned business identifier that ties the attachment(s) back to the claim or prior authorization. This value is referred to as the "administrative reference number".
      min: 0
      max: '1'
      patternIdentifier:
        type:
          coding:
            - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
              code: admin-ref-number
      mustSupport: true

    - id: 'Task.identifier:AdminRefNumber.system'
      path: Task.identifier.system
      mustSupport: true


    - id: 'Task.identifier:AdminRefNumber.value'
      path: Task.identifier.value
      min: 1
      mustSupport: true


    - id: Task.status
      path: Task.status
      condition:
        - cdex-10
        - tdr-2
      mustSupport: true
      binding:
        strength: required
        valueSet: 'http://hl7.org/fhir/us/davinci-hrex/ValueSet/hrex-task-status'

    - id: Task.statusReason
      path: Task.statusReason
      requirements: Indicates why task failed or was rejected.
      condition:
        - tdr-2
      mustSupport: true

    - id: Task.statusReason.text
      path: Task.statusReason.text
      min: 1
      mustSupport: true
  
    - id: Task.intent
      path: Task.intent
      fixedCode: order
      mustSupport: true

    - id: Task.code
      path: Task.code
      short: 'attachment-request-code | attachment-request-questionnaire'
      definition: >-
        The code element is used to indicate the type of attachment request. The code element is a required element and must be populated with one of the following values: "attachment-request-code" or "attachment-request-questionnaire".
      min: 1
      condition:
        - cdex-4
        - cdex-5
        - cdex-10
      mustSupport: true
      binding:
        strength: required
        valueSet: http://hl7.org/fhir/us/davinci-pas/ValueSet/PASTaskCodes

    - id: Task.code.coding
      path: Task.code.coding
      min: 1
      mustSupport: true

    - id: Task.code.coding.system
      path: Task.code.coding.system
      fixedUri: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
      mustSupport: true

    - id: Task.code.coding.code
      path: Task.code.coding.code
      min: 1
      mustSupport: true

    - id: Task.for
      path: Task.for
      short: Contained Patient.
      definition: Reference to a contained Patient resource defined by the CDex Patient Demographics Profile. It represents the member who is subject of the claim or preauthorization and demographic data elements that are used by the Provider to verify member identity.
      min: 1
      type:
        - code: Reference
          targetProfile:
            - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics'
          aggregation:
            - contained
      mustSupport: true
  
    - id: Task.for.reference
      path: Task.for.reference
      short: Contained resource reference
      min: 1
      fixedString: '#patient'
      mustSupport: true
      # add invariant  

    # - id: Task.for.identifier     # Currently ms 0..1 in data profile!!
    #   path: Task.for.identifier
    #   # short: Payer ID
    #   # definition: business identifier representing the Patient ID
    #   min: 1
    #   mustSupport: true
    #  identifier on the contained patient
 
    - id: Task.requester
      path: Task.requester
      short: Payer asking for attachments
      min: 1
      type:
        - code: Reference
          targetProfile:
            - 'http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-organization'
      mustSupport: true

    - id: Task.requester.identifier
      path: Task.requester.identifier
      short: Payer ID
      definition: business identifier representing the Payer ID
      min: 1
      mustSupport: true

    - id: Task.owner
      path: Task.owner
      short: Provider who submitted claim or preauthorization
      comment: The term "Provider" means a person or organization that provided the health care services to a patient.
      min: 1
      type:
        # - code: Reference
        #   targetProfile:
        #     - 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner'
        #     - 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization'
        - code: Reference
          targetProfile:
            - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole'
          aggregation: 
            - contained
      mustSupport: true

    - id: Task.owner.reference
      path: Task.owner.reference
      short: Contained resource reference
      min: 1
      fixedString: '#practitionerrole'
      mustSupport: true

    # - id: Task.owner.identifier
    #   path: Task.owner.identifier
    #   short: Provider ID
    #   definition: business identifier representing the Provider
    #   min: 1 
    #   mustSupport: true

    - id: Task.reasonCode
      path: Task.reasonCode
      min: 1
      mustSupport: true

    - id: Task.reasonCode.coding
      path: Task.reasonCode.coding
      min: 1
      slicing:
        discriminator:
          - type: value
            path: $this  #if the element has a terminology binding, a required binding with a Value Set that enumerates the list of possible codes in the value set ("extensional definition")
        rules: open
      condition:
        - cdex-1
      mustSupport: true

    - id: Task.reasonCode.coding:use
      path: Task.reasonCode.coding
      sliceName: use
      min: 1
      max: '*'
      binding:
        strength: required
        valueSet: 'http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-claim-use' 
      mustSupport: true

    - id: Task.reasonCode.coding:use.system
      path: Task.reasonCode.coding.system
      mustSupport: true

    - id: Task.reasonCode.coding:use.code
      path: Task.reasonCode.coding.code
      short: claim | preauthorization
      min: 1
      mustSupport: true

    - id: Task.reasonCode.text
      path: Task.reasonCode.text
      short: claim | preauthorization
      binding:
        strength: required
        valueSet: 'http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-claim-use'
      mustSupport: true

    - id: Task.reasonReference
      path: Task.reasonReference
      min: 1
      mustSupport: true

    - id: Task.reasonReference.identifier
      path: Task.reasonReference.identifier
      short: Claim or prior authorization ID
      definition: The business identifier representing the claim or prior authorization ID
      min: 1
      mustSupport: true    
      # add invariant 

    - id: Task.restriction
      path: Task.restriction
      min: 0
      mustSupport: true
    
    - id: Task.restriction.period
      path: Task.restriction.period
      short: Attachments due date
      definition: due date for the attachments
      # comment: Note that `Task.restriction.period.end` is the due date representing the time by which the task should be completed.
      min: 0
      mustSupport: true

    - id: Task.input
      path: Task.input
      slicing:
        discriminator:
          - type: value
            path: type
        rules: open
      min: 2
      mustSupport: true

    - id: 'Task.input:AttachmentsNeeded'
      path: Task.input
      sliceName: AttachmentsNeeded
      short: Attachment Code
      definition: A code indicating the type of data/document to be returned
      comment: This value set includes LOINC terms that can be sent by a payer as part of an HL7 attachment request for additional documentation. It has been curated by the HL7 Payer/Provider Information Exchange (PIE) Work Group.  More information about using LOINC in HIPAA attachments and the source of this value set can be found at https://loinc.org/attachments.  For prior authorization, [X12](https://x12.org/) PWK01 Report Type Codes may also be used.
      # min: 1
      # max: '*'
      binding:

  # ====== New R5 additional Binding Element Here ====
        extension:
        - url: http://hl7.org/fhir/tools/StructureDefinition/additional-binding
          extension:
          - url: purpose
            valueCode: extensible
          - url: valueSet
            valueCanonical: http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-pwk01-attachment-report-type-code
          - url: documentation
            valueMarkdown: In addition to using LOINC attachment codes, a payer may request for additional information from the provider to support a prior authorization request using X12's PWK01 Attachment Report Type Code.  Note that the PWK01 codes will not be published in this guide due to X12's IP restrictions.
          - url: usage
            valueUsageContext:
                code:
                  system: 'http://terminology.hl7.org/ValueSet/usage-context-type'
                  code: workflow
                valueCodeableConcept:
                  coding:
                    - system: http://hl7.org/fhir/claim-use
                      code: preauthorization
                      display: Preauthorization
                  text: A payer request for additional information from the provider to support a prior authorization request
          - url: any
            valueBoolean: true


  # ====== New R5 additional Binding Element Here ====


        strength: extensible
        valueSet: 'http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-loinc-attachment-codes' 
        # valueSet: 'http://loinc.org/vs/valid-hl7-attachment-requests'
      condition:
        - cdex-4
        - cdex-6
      mustSupport: true


    - id: 'Task.input:AttachmentsNeeded.extension'
      path: Task.input.extension
      min: 0
      mustSupport: true

    - id: 'Task.input:AttachmentsNeeded.extension.url'
      path: Task.input.extension.url
      fixedUri: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber'
      mustSupport: true

    - id: 'Task.input:AttachmentsNeeded.extension.value[x]'
      path: Task.input.extension.value[x]
      min: 1
      type:
        - code: integer
      mustSupport: true
 

    - id: 'Task.input:AttachmentsNeeded.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
            code: attachments-needed
      mustSupport: true

    - id: 'Task.input:AttachmentsNeeded.value[x]'
      path: 'Task.input.value[x]'
      short: Attachment code value
      type:
        - code: CodeableConcept
      mustSupport: true
      
    - id: 'Task.input:QuestionnaireContext' # struct copied from SDC except using DTR Q/AQ profiles
      path: Task.input
      sliceName: QuestionnaireContext
      short: Data Request questionnaire
      definition: Indicates the questionnaire to be completed.
      # max: '1'
      condition:
        - cdex-5
        - cdex-6
      # mustSupport: true


    - id: 'Task.input:QuestionnaireContext.extension'
      path: Task.input.extension
      min: 0
      mustSupport: true

    - id: 'Task.input:QuestionnaireContext.extension.url'
      path: Task.input.extension.url
      fixedUri: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber'
      mustSupport: true

    - id: 'Task.input:QuestionnaireContext.extension.value[x]'
      path: Task.input.extension.value[x]
      min: 1
      type:
        - code: integer
      mustSupport: true

    - id: 'Task.input:QuestionnaireContext.type'
      path: Task.input.type
      min: 1
      max: '1'
      type:
        - code: CodeableConcept
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'
            code: questionnaire-context
      # mustSupport: true
    - id: 'Task.input:QuestionnaireContext.value[x]'
      path: 'Task.input.value[x]'
      short: URL
      min: 1
      max: '1'
      type:
        - code: canonical
          targetProfile:
            - 'http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-std-questionnaire'
            - 'http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaire-adapt'
      # mustSupport: true

    - id: 'Task.input:QuestionnaireContext.value[x].extension:questionnaireDisplay'
      path: Task.input.value[x].extension
      sliceName: questionnaireDisplay
      comment: >-
        This can be handy for commonly used questionnaires with a recognizable name.
      min: 0
      max: '1'
      type:
        - code: Extension
          profile:
            - 'http://hl7.org/fhir/StructureDefinition/display'
      # mustSupport: true

    - id: 'Task.input:PayerUrl'
      path: Task.input
      sliceName: PayerUrl
      short: Payer Url
      definition: The Payer Endpoint URL for submitting attachments using the $submit-attachment operation.
      min: 1
      max: '1'
      mustSupport: true     

    - id: 'Task.input:PayerUrl.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'
            code: payer-url
      mustSupport: true

    - id: 'Task.input:PayerUrl.value[x]'
      path: 'Task.input.value[x]'
      short: Payer url value
      type:
        - code: url
      mustSupport: true

    - id: 'Task.input:ServiceDate'
      path: Task.input
      sliceName: ServiceDate
      short: Service Date
      definition: Date of service or starting date of the service for the claim or prior authorization. This element SHALL be present and precise to the day if the attachment is for a claim. It is optional if the attachment is for prior authorization.
      max: '1'
      condition: 
        - cdex-1
      mustSupport: true

    - id: 'Task.input:ServiceDate.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
            code: service-date
      mustSupport: true

    - id: 'Task.input:ServiceDate.value[x]'
      path: 'Task.input.value[x]'
      short: Service Date value
      type:
        - code: date
      condition: 
        - cdex-2
      constraint:
        - key: cdex-2
          severity: error
          human: Date must be to day.
          expression: $this.toString().length() = 10
      mustSupport: true

    - id: 'Task.input:Signature'
      path: Task.input
      sliceName: Signature
      short: Signature flag
      definition: Flag to indicate whether the requested data requires a signature.
      max: '1'
      mustSupport: true

    - id: 'Task.input:Signature.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
            code: signature-flag
      mustSupport: true

    - id: 'Task.input:Signature.value[x]'
      path: 'Task.input.value[x]'
      short: Signature flag value
      type:
        - code: boolean
      mustSupport: true

    - id: 'Task.input:POU'
      path: Task.input
      sliceName: POU
      short: Purpose of use code'
      definition: Represent the purpose of use for the requested data.
      max: '1'
      # mustSupport: true

    - id: 'Task.input:POU.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
            code: purpose-of-use
      # mustSupport: true

    - id: 'Task.input:POU.value[x]'
      path: 'Task.input.value[x]'
      short: Purpose of use value
      type:
        - code: CodeableConcept
      binding:
        strength: extensible
        valueSet: 'http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-POU'
      # mustSupport: true

    - id: 'Task.input:MultipleSubmits'
      path: Task.input
      sliceName: MultipleSubmits
      short: Multiple submits flag
      definition: |-
        Flag to indicate whether the requested data can be submitted in multiple submissions. The default meaning when this input is omitted is multiple-submits = "false" -  all the requested data should be submitted in a single transaction.
      max: '1'
      # mustSupport: true

    - id: 'Task.input:MultipleSubmits.type'
      path: Task.input.type
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp'
            code: multiple-submits-flag
      # mustSupport: true


    - id: 'Task.input:MultipleSubmits.value[x]'
      path: 'Task.input.value[x]'
      short: Multiple submits flag value
      type:
        - code: boolean
      # mustSupport: true

    - id: Task.output # struct copied from HRex and SDC
      path: Task.output
      slicing:
        discriminator:
          - type: value
            path: type
        rules: open
      # mustSupport: true
    - id: 'Task.output:AttachmentsNeeded'
      path: Task.output
      sliceName: AttachmentsNeeded
      short: Requested attachments
      definition: >-
        FHIR resource(s) representing the result(s) of the attachments request.
      comment: >-
        Note that all returned attachments SHOULD comply with appropriate US-Core
        and/or Da Vinci profiles. The "questionnaire-response" output type is for a QuestionnaireResponse resulting from the request.
      # mustSupport: true
    - id: 'Task.output:AttachmentsNeeded.type'
      path: Task.output.type
      patternCodeableConcept:
        coding:
          - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
            code: attachments-needed
      # mustSupport: true
    - id: 'Task.output:AttachmentsNeeded.value[x]'
      path: 'Task.output.value[x]'
      short: AttachmentsNeeded reference
      type:
        - code: Reference
      # mustSupport: true
    - id: 'Task.output:QuestionnaireContext'

      path: Task.output
      sliceName: QuestionnaireContext
      definition: Indicates the questionnaire QuestionnaireContext resulting from the request.
      max: '1'
      condition:
        - cdex-10
      # mustSupport: true
    - id: 'Task.output:QuestionnaireContext.type'
      path: Task.output.type
      type:
        - code: CodeableConcept
      patternCodeableConcept:
        coding:
          - system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'
            code: questionnaire-context
      # mustSupport: true
    - id: 'Task.output:QuestionnaireContext.value[x]'
      path: 'Task.output.value[x]'
      short: Reference to the QuestionnaireResponse
      min: 1
      max: '1'
      type:
        - code: Reference
          targetProfile:
            - 'http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-sdc-questionnaireresponse'
            - 'http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse-adapt'
      # mustSupport: true