Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

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Extension:

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: ExplanationOfBenefit.item
• Element ID: ClaimResponse.item

Usage info

Usages:

• Use this Extension: PAS Claim Response Base and PAS Claim Response Base
• Examples for this Extension: Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample, ClaimResponse/PractitionerRequestorAdditionalContentResponseExample and ClaimResponse/PractitionerRequestorResponseExample

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
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:productOrServiceCode		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:modifier		0..*	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
extension:unitPrice		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"unitPrice"
value[x]		0..1	Money	Value of extension
extension:quantity		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"quantity"
value[x]		0..1	PASQuantity(2.2.0-snapshot)	Value of extension
extension:epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension: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.
extension:revenue		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
extension:revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService		0..1	Reference(PAS Medication Request(2.2.0-snapshot) | PAS Service Request(2.2.0-snapshot) | PAS Device Request(2.2.0-snapshot) | PAS Nutrition Order(2.2.0-snapshot))	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		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:productOrServiceCode.​value[x]	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Extension.extension:modifier.​value[x]	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:modifier		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
extension:unitPrice		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"quantity"
value[x]		0..1	PASQuantity(2.2.0-snapshot)	Value of extension
extension:epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension: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.
extension:revenue		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
extension:revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService		0..1	Reference(PAS Medication Request(2.2.0-snapshot) | PAS Service Request(2.2.0-snapshot) | PAS Device Request(2.2.0-snapshot) | PAS Nutrition Order(2.2.0-snapshot))	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"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:productOrServiceCode.​value[x]	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Extension.extension:modifier.​value[x]	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG

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

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: 4

Differential ViewDifferential View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:productOrServiceCode		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:modifier		0..*	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
extension:unitPrice		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"unitPrice"
value[x]		0..1	Money	Value of extension
extension:quantity		0..1	Extension	Extension
extension		0..0		Extension
url		1..1	uri	"quantity"
value[x]		0..1	PASQuantity(2.2.0-snapshot)	Value of extension
extension:epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension: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.
extension:revenue		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
extension:revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService		0..1	Reference(PAS Medication Request(2.2.0-snapshot) | PAS Service Request(2.2.0-snapshot) | PAS Device Request(2.2.0-snapshot) | PAS Nutrition Order(2.2.0-snapshot))	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		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:productOrServiceCode.​value[x]	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Extension.extension:modifier.​value[x]	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"productOrServiceCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:productOrServiceCodeEnd		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
extension:modifier		0..*	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"modifier"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
extension:unitPrice		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"quantity"
value[x]		0..1	PASQuantity(2.2.0-snapshot)	Value of extension
extension:epsdtIndicator		0..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension: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.
extension:revenue		0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
extension:revenueUnitRateLimit		0..1	decimal	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService		0..1	Reference(PAS Medication Request(2.2.0-snapshot) | PAS Service Request(2.2.0-snapshot) | PAS Device Request(2.2.0-snapshot) | PAS Nutrition Order(2.2.0-snapshot))	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"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:productOrServiceCode.​value[x]	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Extension.extension:modifier.​value[x]	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG

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

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: 4

Other representations of profile: CSV, Excel, Schematron