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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<Provenance xmlns="http://hl7.org/fhir">
  <id value="AI-PriorAuth-Provenance"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/aitransparency/StructureDefinition/AI-Provenance"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <target>🔗 
    <reference value="ClaimResponse/AI-PriorAuth-Determination"/>
  </target>
  <occurredDateTime value="2026-02-10T09:15:00Z"/>
  <recorded value="2026-02-10T09:20:00Z"/>
  <reason>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ObservationValue"/>
      <code value="AIAST"/>
    </coding>
  </reason>
  <activity>
    <text
          value="AI drafted prior-authorization determination, verified by a utilization reviewer"/>
  </activity>
  <agent>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
        <code value="verifier"/>
        <display value="Verifier"/>
      </coding>
    </type>
    <who>
      <reference
                 value="http://server.example.org/fhir/Practitioner/utilization-reviewer"/>
    </who>
  </agent>
  <agent>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
        <code value="author"/>
        <display value="Author"/>
      </coding>
    </type>
    <who>🔗 
      <reference value="Device/TheAI"/>
    </who>
  </agent>
  <entity>
    <role value="source"/>
    <what>
      <reference
                 value="http://server.example.org/fhir/Claim/priorauth-mri-request"/>
    </what>
  </entity>
</Provenance>