AI Transparency on FHIR, published by HL7 International / Electronic Health Records. This guide is not an authorized publication; it is the continuous build for version 1.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/aitransparency-ig/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Prior Authorization Determination drafted by AI

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{
  "resourceType" : "ClaimResponse",
  "id" : "AI-PriorAuth-Determination",
  "meta" : {
    "security" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
        "code" : "AIAST",
        "display" : "Artificial Intelligence asserted"
      }
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse AI-PriorAuth-Determination</b></p><a name=\"AI-PriorAuth-Determination\"> </a><a name=\"hcAI-PriorAuth-Determination\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Security Label: <a href=\"http://terminology.hl7.org/7.2.0/CodeSystem-v3-ObservationValue.html\">Artificial Intelligence asserted (Details: ObservationValue code AIAST = 'Artificial Intelligence asserted')</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"http://server.example.org/fhir/Patient/pat\">http://server.example.org/fhir/Patient/pat</a></p><p><b>created</b>: 2026-02-10 09:15:00+0000</p><p><b>insurer</b>: <a href=\"http://server.example.org/fhir/Organization/payer\">http://server.example.org/fhir/Organization/payer</a></p><p><b>request</b>: <a href=\"http://server.example.org/fhir/Claim/priorauth-mri-request\">http://server.example.org/fhir/Claim/priorauth-mri-request</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Prior authorization approved for the requested MRI of the lumbar spine based on the submitted clinical documentation and the plan's medical-necessity criteria.</p><p><b>preAuthRef</b>: PA-2026-0099</p></div>"
  },
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional",
        "display" : "Professional"
      }
    ]
  },
  "use" : "preauthorization",
  "patient" : {
    "reference" : "http://server.example.org/fhir/Patient/pat"
  },
  "created" : "2026-02-10T09:15:00Z",
  "insurer" : {
    "reference" : "http://server.example.org/fhir/Organization/payer"
  },
  "request" : {
    "reference" : "http://server.example.org/fhir/Claim/priorauth-mri-request"
  },
  "outcome" : "complete",
  "disposition" : "Prior authorization approved for the requested MRI of the lumbar spine based on the submitted clinical documentation and the plan's medical-necessity criteria.",
  "preAuthRef" : "PA-2026-0099"
}