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
: Prior Authorization Determination drafted by AI
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/ClaimResponse/AI-PriorAuth-Determination> a fhir:ClaimResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "AI-PriorAuth-Determination"] ;
fhir:Resource.meta [
fhir:Meta.security [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ObservationValue" ] ;
fhir:Coding.code [ fhir:value "AIAST" ] ;
fhir:Coding.display [ fhir:value "Artificial Intelligence asserted" ]
]
] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.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>"
] ;
fhir:ClaimResponse.status [ fhir:value "active"] ;
fhir:ClaimResponse.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
fhir:Coding.code [ fhir:value "professional" ] ;
fhir:Coding.display [ fhir:value "Professional" ]
]
] ;
fhir:ClaimResponse.use [ fhir:value "preauthorization"] ;
fhir:ClaimResponse.patient [
fhir:link <http://server.example.org/fhir/Patient/pat> ;
fhir:Reference.reference [ fhir:value "http://server.example.org/fhir/Patient/pat" ]
] ;
fhir:ClaimResponse.created [ fhir:value "2026-02-10T09:15:00Z"^^xsd:dateTime] ;
fhir:ClaimResponse.insurer [
fhir:link <http://server.example.org/fhir/Organization/payer> ;
fhir:Reference.reference [ fhir:value "http://server.example.org/fhir/Organization/payer" ]
] ;
fhir:ClaimResponse.request [
fhir:link <http://server.example.org/fhir/Claim/priorauth-mri-request> ;
fhir:Reference.reference [ fhir:value "http://server.example.org/fhir/Claim/priorauth-mri-request" ]
] ;
fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
fhir:ClaimResponse.disposition [ fhir:value "Prior authorization approved for the requested MRI of the lumbar spine based on the submitted clinical documentation and the plan's medical-necessity criteria."] ;
fhir:ClaimResponse.preAuthRef [ fhir:value "PA-2026-0099"] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/ClaimResponse/AI-PriorAuth-Determination.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/ClaimResponse/AI-PriorAuth-Determination.ttl> .
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