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

: Provenance of AI drafted Prior Authorization Determination

Raw ttl | Download

@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/Provenance/AI-PriorAuth-Provenance> a fhir:Provenance ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "AI-PriorAuth-Provenance"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/uv/aitransparency/StructureDefinition/AI-Provenance" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/uv/aitransparency/StructureDefinition/AI-Provenance>
     ]
  ] ;
  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: 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>"
  ] ;
  fhir:Provenance.target [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/ClaimResponse/AI-PriorAuth-Determination> ;
     fhir:Reference.reference [ fhir:value "ClaimResponse/AI-PriorAuth-Determination" ]
  ] ;
  fhir:Provenance.occurredDateTime [ fhir:value "2026-02-10T09:15:00Z"^^xsd:dateTime] ;
  fhir:Provenance.recorded [ fhir:value "2026-02-10T09:20:00Z"^^xsd:dateTime] ;
  fhir:Provenance.reason [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ObservationValue" ] ;
       fhir:Coding.code [ fhir:value "AIAST" ]
     ]
  ] ;
  fhir:Provenance.activity [
     fhir:CodeableConcept.text [ fhir:value "AI drafted prior-authorization determination, verified by a utilization reviewer" ]
  ] ;
  fhir:Provenance.agent [
     fhir:index -1 ;
     fhir:Provenance.agent.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/provenance-participant-type" ] ;
         fhir:Coding.code [ fhir:value "verifier" ] ;
         fhir:Coding.display [ fhir:value "Verifier" ]
       ]
     ] ;
     fhir:Provenance.agent.who [
       fhir:link <http://server.example.org/fhir/Practitioner/utilization-reviewer> ;
       fhir:Reference.reference [ fhir:value "http://server.example.org/fhir/Practitioner/utilization-reviewer" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Provenance.agent.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/provenance-participant-type" ] ;
         fhir:Coding.code [ fhir:value "author" ] ;
         fhir:Coding.display [ fhir:value "Author" ]
       ]
     ] ;
     fhir:Provenance.agent.who [
       fhir:link <http://hl7.org/fhir/Device/TheAI> ;
       fhir:Reference.reference [ fhir:value "Device/TheAI" ]
     ]
  ] ;
  fhir:Provenance.entity [
     fhir:index -1 ;
     fhir:Provenance.entity.role [ fhir:value "source" ] ;
     fhir:Provenance.entity.what [
       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" ]
     ]
  ] .

<http://hl7.org/fhir/ClaimResponse/AI-PriorAuth-Determination> a fhir:ClaimResponse .

<http://hl7.org/fhir/Device/TheAI> a fhir:Device .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Provenance/AI-PriorAuth-Provenance.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Provenance/AI-PriorAuth-Provenance.ttl> .