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

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: Provenance of AI drafted Prior Authorization Determination

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{
  "resourceType" : "Provenance",
  "id" : "AI-PriorAuth-Provenance",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/uv/aitransparency/StructureDefinition/AI-Provenance"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Provenance AI-PriorAuth-Provenance</b></p><a name=\"AI-PriorAuth-Provenance\"> </a><a name=\"hcAI-PriorAuth-Provenance\"> </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\">Profile: <a href=\"StructureDefinition-AI-Provenance.html\">AI Provenance</a></p></div><p>Provenance for <a href=\"ClaimResponse-AI-PriorAuth-Determination.html\">ClaimResponse: status = active; type = Professional; use = preauthorization; created = 2026-02-10 09:15:00+0000; 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</a></p><p>Summary</p><table class=\"grid\"><tr><td>Occurrence</td><td>2026-02-10 09:15:00+0000</td></tr><tr><td>Recorded</td><td>2026-02-10 09:20:00+0000</td></tr><tr><td>Activity</td><td><span title=\"Codes:\">AI drafted prior-authorization determination, verified by a utilization reviewer</span></td></tr></table><p><b>Agents</b></p><table class=\"grid\"><tr><td><b>Type</b></td><td><b>who</b></td></tr><tr><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/provenance-participant-type verifier}\">Verifier</span></td><td><a href=\"http://server.example.org/fhir/Practitioner/utilization-reviewer\">http://server.example.org/fhir/Practitioner/utilization-reviewer</a></td></tr><tr><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/provenance-participant-type author}\">Author</span></td><td><a href=\"Device-TheAI.html\">Device: extension = Large Language Models; identifier = http://example.org/ehr/client-ids#goodhealth; manufacturer = Acme Devices, Inc; type = All kinds of Artificial Intelligence; contact = http://example.org</a></td></tr></table></div>"
  },
  "target" : [
    {
      🔗 "reference" : "ClaimResponse/AI-PriorAuth-Determination"
    }
  ],
  "occurredDateTime" : "2026-02-10T09:15:00Z",
  "recorded" : "2026-02-10T09:20:00Z",
  "reason" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
          "code" : "AIAST"
        }
      ]
    }
  ],
  "activity" : {
    "text" : "AI drafted prior-authorization determination, verified by a utilization reviewer"
  },
  "agent" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code" : "verifier",
            "display" : "Verifier"
          }
        ]
      },
      "who" : {
        "reference" : "http://server.example.org/fhir/Practitioner/utilization-reviewer"
      }
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code" : "author",
            "display" : "Author"
          }
        ]
      },
      "who" : {
        🔗 "reference" : "Device/TheAI"
      }
    }
  ],
  "entity" : [
    {
      "role" : "source",
      "what" : {
        "reference" : "http://server.example.org/fhir/Claim/priorauth-mri-request"
      }
    }
  ]
}