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 the review action that is necessary for the authorization.

Context of Use

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

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

Usage info

Usages:

• Use this Extension: PAS Claim Response Base and PAS Claim Response Base
• Examples for this Extension: Bundle/PASClaimInquiryResponseBundleExample, Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample, Bundle/ReferralPendingAuthorizationResponseBundleExample... Show 7 more, Bundle/RejectionResponseBundleExample, 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
• 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:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/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		Extension
url		1..1	uri	"number"
value[x]		0..1	string	Value of extension
extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
extension		0..0		Extension
url		1..1	uri	"reasonCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.0-snapshot) (required)
extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
extension		0..0		Extension
url		1..1	uri	"secondSurgicalOpinionFlag"
value[x]		0..1	boolean	Value of extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍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:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"number"
value[x]		0..1	string	Value of extension
extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"reasonCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.0-snapshot) (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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"secondSurgicalOpinionFlag"
value[x]		0..1	boolean	Value of extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍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 the review action that is necessary for the authorization.

• number: string: An Extension
• reasonCode: CodeableConcept: An Extension
• secondSurgicalOpinionFlag: boolean: 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:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/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		Extension
url		1..1	uri	"number"
value[x]		0..1	string	Value of extension
extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
extension		0..0		Extension
url		1..1	uri	"reasonCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.0-snapshot) (required)
extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
extension		0..0		Extension
url		1..1	uri	"secondSurgicalOpinionFlag"
value[x]		0..1	boolean	Value of extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍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:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"number"
value[x]		0..1	string	Value of extension
extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"reasonCode"
value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.0-snapshot) (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		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"secondSurgicalOpinionFlag"
value[x]		0..1	boolean	Value of extension
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍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 the review action that is necessary for the authorization.

• number: string: An Extension
• reasonCode: CodeableConcept: An Extension
• secondSurgicalOpinionFlag: boolean: An Extension

Maturity: 4

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