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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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="AI-PriorAuth-Determination"/>
  <meta>
    <security>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ObservationValue"/>
      <code value="AIAST"/>
      <display value="Artificial Intelligence asserted"/>
    </security>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
      <display value="Professional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>
    <reference value="http://server.example.org/fhir/Patient/pat"/>
  </patient>
  <created value="2026-02-10T09:15:00Z"/>
  <insurer>
    <reference value="http://server.example.org/fhir/Organization/payer"/>
  </insurer>
  <request>
    <reference
               value="http://server.example.org/fhir/Claim/priorauth-mri-request"/>
  </request>
  <outcome value="complete"/>
  <disposition
               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."/>
  <preAuthRef value="PA-2026-0099"/>
</ClaimResponse>