Da Vinci Payer Data Exchange
2.1.1 - STU 2.1

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 2.1.1 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 (Experimental)

Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction | Version: 2.1.1
Standards status: Informative | Computable Name: ReviewAction
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

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`
- Element ID: `ExplanationOfBenefit.adjudication`
- Element ID: `ExplanationOfBenefit.addItem.adjudication`

Usage info

Usages:

- Use this Extension: PDex Prior Authorization
- Examples for this Extension: ExplanationOfBenefit/PDexPriorAuth1

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

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

- Differential Table
- Snapshot Table
- Statistics/References
- All

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:code |  | 0..1 | CodeableConcept | Healthcare 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..1 | Extension | Item Level Review Number
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "number"
value[x] |  | 0..1 | string | Value of extension
extension:reasonCode |  | 0..* | Extension | Explanation of the pending, review denial or partial approval
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "reasonCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Review Decision Reason Codes (required)
extension:secondSurgicalOpinionFlag |  | 0..1 | Extension | Whether a second surgical opinion is need for approval
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "secondSurgicalOpinionFlag"
value[x] |  | 0..1 | boolean | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:code |  | 0..1 | CodeableConcept | Healthcare 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..1 | Extension | Item Level Review Number
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "number"
value[x] |  | 0..1 | string | Value of extension
extension:reasonCode |  | 0..* | Extension | Explanation of the pending, review denial or partial approval
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "reasonCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Review Decision Reason Codes (required)
extension:secondSurgicalOpinionFlag |  | 0..1 | Extension | Whether a second surgical opinion is need for approval
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "secondSurgicalOpinionFlag"
value[x] |  | 0..1 | boolean | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:code |  | 0..1 | CodeableConcept | Healthcare 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..1 | Extension | Item Level Review Number
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "number"
value[x] |  | 0..1 | string | Value of extension
extension:reasonCode |  | 0..* | Extension | Explanation of the pending, review denial or partial approval
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "reasonCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Review Decision Reason Codes (required)
extension:secondSurgicalOpinionFlag |  | 0..1 | Extension | Whether a second surgical opinion is need for approval
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "secondSurgicalOpinionFlag"
value[x] |  | 0..1 | boolean | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:code |  | 0..1 | CodeableConcept | Healthcare 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..1 | Extension | Item Level Review Number
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "number"
value[x] |  | 0..1 | string | Value of extension
extension:reasonCode |  | 0..* | Extension | Explanation of the pending, review denial or partial approval
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "reasonCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Review Decision Reason Codes (required)
extension:secondSurgicalOpinionFlag |  | 0..1 | Extension | Whether a second surgical opinion is need for approval
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "secondSurgicalOpinionFlag"
value[x] |  | 0..1 | boolean | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/extension-reviewAction"
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

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:reasonCode.​value[x] | Base | required | X12 278 Review Decision Reason Codes | 📦2.1.1 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`