Da Vinci Payer Data Exchange
2.1.0 - STU2 United States of America flag

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

Extension: ReviewAction

Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction Version: 2.1.0
Active as of 2024-02-23 Computable Name: ReviewAction

The details of the review action that is necessary for the authorization.

Context of Use

This extension may be used on the following element(s):

  • Element ID ExplanationOfBenefit.item.adjudication

Usage info

Usage:

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

  • number: string: An Extension
  • reasonCode: CodeableConcept: An Extension
  • secondSurgicalOpinionFlag: boolean: An Extension

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... code 0..1CodeableConceptHealthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... extension:number 0..1ExtensionItem Level Review Number
.... extension 0..0
.... url 1..1uri"number"
.... value[x] 0..1stringValue of extension
... extension:reasonCode 0..*ExtensionExplanation of the review denial or partial approval
.... extension 0..0
.... url 1..1uri"reasonCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension 0..0
.... url 1..1uri"secondSurgicalOpinionFlag"
.... value[x] 0..1booleanValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... code 0..1CodeableConceptHealthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"number"
.... value[x] 0..1stringValue of extension
... extension:reasonCode 0..*ExtensionExplanation of the review denial or partial approval
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"reasonCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Review Decision Reason Codes (required)
... extension:secondSurgicalOpinionFlag 0..1ExtensionWhether a second surgical opinion is need for approval
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"secondSurgicalOpinionFlag"
.... value[x] 0..1booleanValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

  • number: string: An Extension
  • reasonCode: CodeableConcept: An Extension
  • secondSurgicalOpinionFlag: boolean: An Extension

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... code 0..1CodeableConceptHealthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

... extension:number 0..1ExtensionItem Level Review Number
.... extension 0..0
.... url 1..1uri"number"
.... value[x] 0..1stringValue of extension
... extension:reasonCode 0..*ExtensionExplanation of the review denial or partial approval
.... extension 0..0
.... url 1..1uri"reasonCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Review Decision Reason Codes (required)
.... extension 0..0
.... url 1..1uri"secondSurgicalOpinionFlag"
.... value[x] 0..1booleanValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionExtension
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... code 0..1CodeableConceptHealthcare Services Outcome
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewActionCode
Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"number"
.... value[x] 0..1stringValue of extension
... extension:reasonCode 0..*ExtensionExplanation of the review denial or partial approval
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"reasonCode"
.... value[x] 0..1CodeableConceptValue of extension
Binding: X12 278 Review Decision Reason Codes (required)
... extension:secondSurgicalOpinionFlag 0..1ExtensionWhether a second surgical opinion is need for approval
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"secondSurgicalOpinionFlag"
.... value[x] 0..1booleanValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSetURI
Extension.extension:reasonCode.value[x]requiredX12278ReviewDecisionReasonCode (a valid code from https://codesystem.x12.org/external/886)
http://hl7.org/fhir/us/davinci-pdex/ValueSet/X12278ReviewDecisionReasonCode
from this IG